Prediction of emergency department revisits among child and youth mental health outpatients using deep learning techniques.

BACKGROUND: The proportion of Canadian youth seeking mental health support from an emergency department (ED) has risen in recent years. As EDs typically address urgent mental health crises, revisiting an ED may represent unmet mental health needs. Accurate ED revisit prediction could aid early intervention and ensure efficient healthcare resource allocation. We examine the potential increased accuracy and performance of graph neural network (GNN) machine learning models compared to recurrent neural network (RNN), and baseline conventional machine learning and regression models for predicting ED revisit in electronic health record (EHR) data. METHODS: This study used EHR data for children and youth aged 4-17 seeking services at McMaster Children's Hospital's Child and Youth Mental Health Program outpatient service to develop and evaluate GNN and RNN models to predict whether a child/youth with an ED visit had an ED revisit within 30 days. GNN and RNN models were developed and compared against conventional baseline models. Model performance for GNN, RNN, XGBoost, decision tree and logistic regression models was evaluated using F1 scores. RESULTS: The GNN model outperformed the RNN model by an F1-score increase of 0.0511 and the best performing conventional machine learning model by an F1-score increase of 0.0470. Precision, recall, receiver operating characteristic (ROC) curves, and positive and negative predictive values showed that the GNN model performed the best, and the RNN model performed similarly to the XGBoost model. Performance increases were most noticeable for recall and negative predictive value than for precision and positive predictive value. CONCLUSIONS: This study demonstrates the improved accuracy and potential utility of GNN models in predicting ED revisits among children and youth, although model performance may not be sufficient for clinical implementation. Given the improvements in recall and negative predictive value, GNN models should be further explored to develop algorithms that can inform clinical decision-making in ways that facilitate targeted interventions, optimize resource allocation, and improve outcomes for children and youth.

Parasitosis in Pet Dogs from Rondônia, Amazon Biome, and Human Perception of Zoonoses.

Zoonotic parasitic diseases in dogs are particularly concerning in regions with low human development indices due to inadequate sanitary services and insufficient environmental and health education. This study aimed to assess the parasitological status of dogs living in households and evaluate their owners' knowledge about zoonoses. A total of 183 dogs from Rolim de Moura, Rondônia State, were screened for the presence of ectoparasites, and 163 fecal samples were collected for analysis. The results showed that 74.23% (112/163) of the animals had at least one species of endoparasite. The most identified pathogens were Ancylostoma spp. (68.71%, 112/163), Trichuris vulpis (11.66%, 19/163), Toxocara canis (6.75%, 11/163), Cystoisospora canis (4.91%, 8/163), Dipylidium caninum (1.23%, 2/163), and Hammondia/Neospora (0.61%, 1/163). Ectoparasites were observed in 43.17% (79/183) of the evaluated animals, with Rhipicephalus sanguineus found in 31.15% (57/183) and Ctenocephalides felis felis in 20.77% (38/183). Only 11.48% (7/61) of the owners were familiar with the term "Zoonoses." However, a significant majority (83.61%, 51/61) believed that dogs can transmit diseases to humans. Our findings highlight the prevalence of parasites in the studied area and associated risk factors, underscoring the urgent need for educational interventions to raise awareness about these diseases and their risks to human health.

Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis.

Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.

Endothelial KIR2 channel dysfunction in aged cerebral parenchymal arterioles.

Aging is associated with cognitive decline via incompletely understood mechanisms. Cerebral microvascular dysfunction occurs in aging, particularly impaired endothelium-mediated dilation. Parenchymal arterioles are bottlenecks of the cerebral microcirculation, and dysfunction causes a mismatch in nutrient demand and delivery, leaving neurons at risk. Extracellular nucleotides elicit parenchymal arteriole dilation by activating endothelial purinergic receptors (P2Y), leading to opening of K+ channels, including inwardly-rectifying K+ channels (KIR2). These channels amplify hyperpolarizing signals, resulting in dilation. However, it remains unknown if endothelial P2Y and KIR2 signaling are altered in brain parenchymal arterioles during aging. We hypothesized that aging impairs endothelial P2Y and KIR2 function in parenchymal arterioles. We observed reduced dilation to the purinergic agonist 2-methyl-S-ADP (1 µM) in arterioles from Aged (>24-month-old) mice when compared to Young (4-6 months of age) despite similar hyperpolarization in endothelial cells tubes. No differences were observed in vasodilation or endothelial cell hyperpolarization to activation of small- and intermediate-conductance Ca2+-activated K+ channels (KCa2.3 / KCa3.1) by NS309. Hyperpolarization to 15 mM [K+]E was smaller in Aged than Young mice, despite a paradoxical increased dilation in Aged arterioles to 15 mM [K+]E that was unchanged by endothelium removal. KIR2 Inhibition attenuated vasodilatory responses to 15 mM [K+]E and 1 µM 2-me-S-ADP in both Young and Aged arterioles. Further, we observed a significant increase in myogenic tone in Aged parenchymal arterioles, which was not enhanced by endothelium removal. We conclude that aging impairs endothelial KIR2 channel function in the cerebral microcirculation with possible compensation by smooth muscle cells.

PNA5, A Novel Mas Receptor Agonist, Improves Neurovascular and Blood-Brain-Barrier Function in a Mouse Model of Vascular Cognitive Impairment and Dementia.

It is well established that decreased brain blood flow, increased reactive oxygen species production (ROS), and pro-inflammatory mechanisms accelerate neurodegenerative disease progressions, including vascular cognitive impairment and dementia (VCID). Previous studies in our laboratory have shown that our novel glycosylated Angiotensin-(1-7) Mas receptor agonist PNA5 reverses cognitive deficits, decreases ROS production, and inhibits inflammatory cytokine production in our preclinical mouse model of VCID that is induced by chronic heart failure (VCID-HF). In the present study, the effects of VCID-HF and treatment with PNA5 on microglia activation, blood-brain-barrier (BBB) integrity, and neurovascular coupling were assessed in our mouse model of VCID-HF. Three-month-old male C57BL/6J mice were subjected to myocardial infarction (MI) to induce heart failure for four weeks and then treated with subcutaneous injections of extended-release PNA5. Microglia activation, BBB permeability, cerebral perfusion, and neurovascular coupling were assessed. Results show that in our VCID-HF model, there was an increase in microglial activation and recruitment within the CA1 and CA3 regions of the hippocampus, a disruption in BBB integrity, and a decrease in neurovascular coupling. Treatment with PNA5 reversed these neuropathological effects of VCID-HF, suggesting that PNA5 may be an effective disease-modifying therapy to treat and prevent VCID. This study identifies potential mechanisms by which heart failure may induce VCID and highlights the possible mechanisms by which treatment with our novel glycosylated Angiotensin-(1-7) Mas receptor agonist, PNA5, may protect cognitive function in our model of VCID.

Vascular Dysfunction in Polycystic Kidney Disease: A Mini-Review.

Polycystic kidney disease (PKD) is one of the most common hereditary kidney diseases, which is characterized by progressive cyst growth and secondary hypertension. In addition to cystogenesis and renal abnormalities, patients with PKD can develop vascular abnormalities and cardiovascular complications. Progressive cyst growth substantially alters renal structure and culminates into end-stage renal disease. There remains no cure beyond renal transplantation, and treatment options remain largely limited to chronic renal replacement therapy. In addition to end-stage renal disease, patients with PKD also present with hypertension and cardiovascular disease, yet the timing and interactions between the cardiovascular and renal effects of PKD progression are understudied. Here, we review the vascular dysfunction found in clinical and preclinical models of PKD, including the clinical manifestations and relationship to hypertension, stroke, and related cardiovascular diseases. Finally, our discussion also highlights the critical questions and emerging areas in vascular research in PKD.

An Exploratory Study on Spoilage Bacteria and Listeria monocytogenes in Fresh Salmon: Extending Shelf-Life Using Vacuum and Seasonings as Natural Preservatives.

A growing population increases the demand for food, but short shelf-lives and microbial hazards reduce supply and increase food waste. Fresh fish is highly perishable and may be consumed raw, such as salmon in sushi. This work aims to identify strategies to improve the shelf-life and safety of fresh salmon, using available methods (i.e., vacuum) and exploring the use of natural preservatives (i.e., seasonings). Vacuum packaging and good hygiene practices (which reduce initial flora) extended shelf-life up to 20 days. Carnobacterium maltaromaticum was dominant in vacuum packaging conditions and showed potential for inhibiting Listeria monocytogenes. For natural preservatives, L. monocytogenes required higher inhibitory concentrations in vitro when compared to the 10 spoilage bacteria isolated from fresh salmon fillets, presenting a minimum inhibitory concentration (MIC) of 0.13% for oregano essential oil (OEO), 10% for lemon juice, 50 mg mL-1 for garlic powder, and >10% for NaCl. A good bacteriostatic and bactericidal effect was observed for a mixture containing 5% NaCl, 0.002% OEO, 2.5% lemon juice, and 0.08 mg mL-1 garlic powder. Finally, using the salmon medium showed an adequate correlation with the commercial culture medium.

BK Ca nitrosylation is associated with cerebral microvascular dysfunction in female 5x-FAD mice.

Cerebral microvascular dysfunction and nitro-oxidative stress are present in patients with Alzheimer's disease (AD) and may contribute to disease progression and severity. Large conductance Ca 2+ -activated K + channels (BK Ca ) play an essential role in vasodilatory responses and maintenance of myogenic tone in resistance arteries. BK Ca can be modified in a pro-nitro-oxidative environment, resulting in decreased activity and vascular hyper-contractility, which can compromise cerebral blood flow regulation. We hypothesized that reductions in BK Ca function in cerebral arteries, as a consequence of nitro-oxidative stress, are associated with blunted neurovascular responses in the 5x-FAD model of AD. Using pressure myography, we observed that posterior communicating arteries (PComA) from 5 months-old female 5x-FAD mice showed higher spontaneous myogenic tone than wild-type (WT) littermates. Constriction to the BK Ca blocker iberiotoxin (30 nM) was smaller in 5x-FAD than WT, suggesting lower basal BK Ca activity, which was independent of alterations in intracellular Ca 2+ transients or BK Ca mRNA expression. These vascular changes were associated with higher levels of oxidative stress in female 5x-FAD and a higher level of S-nitrosylation in the BK Ca α-subunit. In females, pre-incubation of PComA from 5x-FAD with the reducing agent DTT (10 µM) rescued iberiotoxin-induced contraction. Female 5x-FAD mice showed increased expression of iNOS mRNA, lower resting cortical perfusion atop the frontal cortex, and impaired neurovascular coupling responses. No significant differences between male 5x-FAD and WT were observed for all parameters above. These data suggest that the exacerbation in BK Ca S-nitrosylation contributes to cerebrovascular and neurovascular impairments in female 5x-FAD mice. Significance Statement: Cerebral vascular dysfunction is increasingly recognized as a hallmark of Alzheimer's disease and other dementias. Impaired microvascular regulation can lead to deficits in blood flow to the brain. An intrinsic property of the resistance vasculature is to constrict when pressurized (myogenic tone), generating a vasodilatory reserve. Detrimental over-constriction is prevented by vascular feedback mechanisms, including the opening of large-conductance Ca 2+ -activated K + channels (BK Ca ). Here, using a combination of molecular biology tools with ex vivo and in vivo vascular assessments, we show a novel mechanism associated with BK Ca dysfunction in the cerebral microvasculature of female 5x-FAD mice. We report increased BK Ca S-nitrosylation linked to reduced activity and, consequently, higher basal myogenic tone. These changes were associated with lower perfusion of the frontal cortex and impaired neurovascular reactivity, suggesting that nitro-oxidative stress is an important mechanism of vascular dysfunction in Alzheimer's disease.

Ultrasound, photoacoustic, and magnetic resonance imaging to study hyperacute pathophysiology of traumatic and vascular brain injury.

BACKGROUND AND PURPOSE: Cerebrovascular dynamics and pathomechanisms that evolve in the minutes and hours following traumatic vascular injury in the brain remain largely unknown. We investigated the pathophysiology evolution in mice within the first 3 hours after closed-head traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), two significant traumatic vascular injuries. METHODS: We took a multimodal imaging approach using photoacoustic imaging, color Doppler ultrasound, and MRI to track injury outcomes using a variety of metrics. RESULTS: Brain oxygenation and velocity-weighted volume of blood flow (VVF) values significantly decreased from baseline to 15 minutes after both TBI and SAH. TBI resulted in 19.2% and 41.0% ipsilateral oxygenation and VVF reductions 15 minutes postinjury, while SAH resulted in 43.9% and 85.0% ipsilateral oxygenation and VVF reduction (p < .001). We found partial recovery of oxygenation from 15 minutes to 3 hours after injury for TBI but not SAH. Hemorrhage, edema, reduced perfusion, and altered diffusivity were evident from MRI scans acquired 90-150 minutes after injury in both injury models, although the spatial distribution was mostly focal for TBI and diffuse for SAH. CONCLUSIONS: The results reveal that the cerebral oxygenation deficits immediately following injuries are reversible for TBI and irreversible for SAH. Our findings can inform future studies on mitigating these early responses to improve long-term recovery.

Drivers of child marriage in specific settings of Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia - findings from the Yes I Do! baseline study.

BACKGROUND: Child marriage persists in many countries and has severe impacts on health, education, economic and social status of girls. Child marriage has many interlinked causes. This study aimed to explore the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia. METHODS: The study combined a household survey among youth (15-24 years) with focus group discussions and interviews conducted with youth (15-24 years) and parents. A variety of community stakeholders were interviewed as well. Logistic regression was done to explore associations between individual and family-level characteristics of young women and the occurrence of child marriage. Transcripts were analysed using an inductive approach. Narratives on the main drivers of child marriage across study contexts were written and inspired by the theory of normative spectrum. RESULTS: A lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambia. In all countries, teenage pregnancy was associated with child marriage. In Ethiopia, Kenya and Mozambique, fathers' education seemed a protective factor for child marriage. Narratives of study participants showed that in Ethiopia, Indonesia and (to a lesser extent) Kenya, child marriage was perceived as an 'appropriate practice' to avoid premarital sex or pregnancy, whether it involved sex with or without consent. In all countries, child marriage was driven by difficult economic circumstances, which were often intertwined with disapproved social circumstances, in particular teenage pregnancy, in case of Kenya, Malawi, Mozambique and Zambia. These circumstances made child marriage an 'acceptable practice'. Some youth, particularly in Indonesia, made their own choices to marry early, making child marriage a 'possible practice'. CONCLUSIONS: Multiple intersecting drivers, which were present in different degrees in each country setting, influenced the occurrence of child marriage. We found that child marriage is a manifestation of social norms, particularly related to girls' sexuality, which are intersecting with other factors at individual, social, material, and institutional level - most prominently poverty or economic constraints. Child marriage was, in some cases, a result of girls' agentic choices. Efforts to prevent child marriage need to take these realities of girls and their families into account.

Combined Effects of Temperature and Dietary Lipid Level on Body Composition, Growth, and Freshness Profile in European Seabass, Dicentrarchus labrax.

A fish trial was carried out to evaluate the combined effects of temperature and dietary lipid level on the body composition, growth performance, and freshness profile of the European seabass (Dicentrarchus labrax). Fish were kept for 56 days at 20 °C and 24 °C and fed on two diets, with 16% and 20% lipid. At the end of the trial, fish were euthanized at two temperature conditions (0.6 °C or -0.6 °C) and kept on ice for 10 days at 4 °C to evaluate their freshness condition. Findings demonstrated that fish reared at 24 °C presented a lower lipid level and a higher daily growth index than those at 20 °C. Additionally, sensory analysis (Quality Index Method-QIM) and microbiological analysis revealed that fish reared at 24 °C showed better freshness conditions than those at 20 °C. However, the 16S rRNA metabarcoding analyses revealed a higher proliferation of genera associated with fish-spoiling bacteria in the skin microbiome of fish reared at 24 °C, i.e., Vibrio and Acinetobacter, which was not observed in the skin microbiome of fish reared at 20 °C. Nevertheless, the dietary lipid level did not have any influence on fish freshness. Therefore, our data suggest that the increase in temperature to 24 °C is beneficial for the growth and freshness profile (lower QIM and lower CFUs/cm2) of this particular species. Additionally, the lower euthanasia temperature (-0.6 °C) seems to lead to higher fish freshness than the normal temperature (0.6 °C).

Gulls in Porto Coastline as Reservoirs for Salmonella spp.: Findings from 2008 and 2023.

Gulls act as intermediaries in the exchange of microorganisms between the environment and human settlements, including Salmonella spp. This study assessed the antimicrobial resistance and molecular profiles of Salmonella spp. isolates obtained from fecal samples of gulls in the city of Porto, Portugal, in 2008 and 2023 and from water samples in 2023. Antimicrobial susceptibility profiling revealed an improvement in the prevalence (71% to 17%) and antimicrobial resistance between the two collection dates. Two isolate collections from both 2008 and 2023 underwent serotyping and whole-genome sequencing, revealing genotypic changes, including an increased frequency in the monophasic variant of S. Typhimurium. qacE was identified in 2008 and 2023 in both water and fecal samples, with most isolates exhibiting an MDR profile. The most frequently observed plasmid types were IncF in 2008 (23%), while IncQ1 predominated in 2023 (43%). Findings suggest that Salmonella spp. circulate between humans, animals, and the environment. However, the genetic heterogeneity among the isolates from the gulls' feces and the surface water may indicate a complex ecological and evolutionary dynamic shaped by changing conditions. The observed improvements are likely due to measures to reduce biological contamination and antimicrobial resistance. Nevertheless, additional strategies must be implemented to reduce the public health risk modeled by the dissemination of pathogens by gulls.

The Family-Check-Up® Autism Implementation Research (FAIR) Study: protocol for a study evaluating the effectiveness and implementation of a family-centered intervention within a Canadian autism service setting.

Introduction: Prevalence rates of emotional and behavior problems (EBP) in autistic children and youth are high (40-70%), and often cause severe and chronic impairment. Furthermore, autistic children are also more likely to experience family "social-ecological" adversity compared to neurotypically developing peers, including social isolation, child maltreatment, caregiver mental illness, and socioeconomic risk. These family stressors increase the risk of co-occurring EBP among autistic children and can often impede access to evidence-based care, thus amplifying long-term health inequities for autistic children and their caregivers. In the current autism services landscape, there are few scalable, evidence-based programs that adequately address these needs. The Family Check-Up (FCU®) is a brief, strength-based, and tailored family-centered intervention that supports positive parenting and explicitly assesses the social determinants of child and family mental health within an ecological framework. Studies have demonstrated long-term positive child and caregiver outcomes in other populations, but the FCU® has not been evaluated in families of autistic children and youth. Therefore, we aimed to evaluate FCU® implementation within an established, publicly funded Autism Program in Ontario, Canada, with delivery by autism therapists, to demonstrate sustainable effectiveness within real-world settings. Methods: In this study, we outline the protocol for a hybrid implementation-effectiveness approach with two key components: (1) A parallel-arm randomized controlled trial of N = 80 autistic children/youth (ages 6-17 years) and high levels of EBP and their caregivers. Primary and secondary outcomes include child EBP, and caregiver well-being and parenting. (2) A mixed methods implementation study, to describe facilitators and barriers to implementation of the FCU® within an autism service setting. Discussion: Scalable, ecologically focused family-centered interventions offer promise as key components of a public health framework aimed at reducing mental health inequities among autistic children, youth, and their caregivers. Results of this study will inform further program refinement and scale-up.

Normalization of the electromyographic signals of masticatory muscles during non-habitual chewing activity

There is no consensus on the most appropriate method for normalizing electromyography (EMG) signals from masticatory muscles during isotonic activity. Aim: To analyze the best method for data processing of the EMG signal of the masticatory muscles during isotonic activity (non-habitual chewing), comparing raw data and different types of normalization. Methods: This is a cross-sectional study. Women aged between 18 and 45 years were selected. Anthropometric data were collected (age, height, body mass index ­ BMI, masticatory preference) as well as EMG signal (root mean square ­ RMS) data for the anterior temporal and masseter bilaterally, and for the suprahyoid muscles, during isotonic (non-habitual chewing) and isometric tasks. EMG data were processed offline using Matlab® Software. The normalization of the EMG signal was carried out using the 2nd masticatory cycle, chosen at random, of the 20 cycles collected, the maximum RMS value, and the maximum voluntary contraction (MVC). To analyze the best method of data processing for the isotonic data, the coefficient of variation (CV) was calculated. Descriptive data analysis was adopted, using the mean and standard deviation. ANOVA with repeated measures was used to detect significant differences between the methods of normalization. Statistical significance was set at 5% (α<0.05). Results: The final sample of this research was composed of 86 women. The volunteers presented an average age of 27.83±7.71 years and a mean BMI of 22.85±1.91 Kg/m2. Regarding masticatory preference, 73.25% reported the right side, and 26.75% the left side. Considering the comparison between the methods, the %CV measure of the 2nd cycle showed the lowest variation coefficient during biting for all the muscles from the raw data, RMS Max, and MVC (p=0.001, p=0.003, and p=0.001 respectively). Conclusion: In conclusion, for non-habitual chewing activity, the results of this study recommend data processing using normalization with the second cycle during chewing

Maximum bilateral bite strength and RMS EMG for the diagnosis of myogenic TMD

Aim: The study aimed to evaluate the accuracy of the maximum bilateral molar bite force and the Root Mean Square (RMS) Electromyography (EMG) index of the masticatory muscles in the maximum bilateral molar bite (MMBMax) of women with myogenic Temporomandibular Disorder (TMD) and asymptomatic. Methods: This is a cross-sectional study, composed of 86 women allocated to the TMD Group (n=43) and Control Group (n=43) diagnosis through the Diagnostic Criteria for Temporomandibular Disorders. The maximum bilateral molar bite force was evaluated using a bite dynamometer and the RMS EMG index of the masticatory muscles (anterior temporalis, masseter) during 5 seconds of the MMBMax task. Student t-test was used for data comparison between accuracy of the bite force and RMS EMG of masticatory muscles during the MMBMax. Results: The maximum bilateral molar bite force showed high accuracy (AUC=0.99) for the diagnosis of women with myogenic TMD and asymptomatic women, and the RMS EMG index evaluated during the MMBMax showed a moderate level of accuracy for all masticatory muscles (AUC=0.70 to 0.75). Conclusion: The bilateral bite dynamometer with a surface EMG during bilateral bite can be used to diagnose TMD in young women

Users' perspectives on the quality of family planning services in Mozambique: a case study.

Introduction: user satisfaction assessment has been increasingly important in ensuring health care quality and guidance in the health sector. Africa is the region in the world with the lowest prevalence of contraception use. Universal access to family planning has one of the highest rates of benefits for cost among strategic options for development. Family planning can reduce mortality associated with pregnancy, childbirth, and postpartum, and family planning consultations are available in primary health care in Mozambique since 1980, with services delivered at all different levels of the national public health system. In 2017 this country had a high maternal mortality rate and one of the known causes was the low use of family planning. Among other causes for low utilization is the bias introduced by health professionals in the prescription of contraceptives and service deficiencies. We intended to assess the users' opinion about family planning visit quality at the Marrere Health Center, to understand how we might consequently increase the use and quality of these services. This study was designed as a planned intermediary evaluation, as part of a larger implementation research project, aiming to reduce maternal and newborn mortality rates in Natikiri neighbourhood, in Nampula peri-urban area. Methods: we carried out a descriptive cross- sectional quantitative case study, where the target population was users of family planning services at a local health center. A random sample of 137 individuals answered a survey consisting of satisfaction, and we consulted family planning service statistical indicators. Users were considered satisfied if they answered "satisfied" or "very satisfied" on questions. Frequencies were calculated with statistical package for the social sciences (SPSS) 22.0 with a confidence interval of 95% and a 5% margin of error. The study protocol was approved by Lúrio University and the University of Saskatchewan (Canada) Ethics Committees. Results: almost all respondents (93%), were adult women with low levels of education. They stated, in general (88%), they were satisfied with the quality of care in the family planning consultation. There was minor participation of men in family planning. However, health professionals were found to not generally follow a patient-centered service protocol, with weaknesses in communication and information sharing, more commonly with adolescent clients. Conclusion: most family planning visits users were adult women, satisfied with the service provided. Successful changes in family planning practice require broad support from political, religious and community sectors. Additionally, proper technical and professional training of health professionals is necessary to achieve a positive impact on individuals, families, communities, and government. Family planning promotion in primary health care is recommended as an important strategy for achieving universal health coverage, protecting the lives of women, and promoting the country's development.

Cerebral arteriolar and neurovascular dysfunction after chemically induced menopause in mice.

Cognitive decline is linked to decreased cerebral blood flow, particularly in women after menopause. Impaired cerebrovascular function precedes the onset of dementia, possibly because of reduced functional dilation in parenchymal arterioles. These vessels are bottlenecks of the cerebral microcirculation, and dysfunction can limit functional hyperemia in the brain. Large-conductance Ca2+-activated K+ channels (BKCa) are the final effectors of several pathways responsible for functional hyperemia, and their expression is modulated by estrogen. However, it remains unknown whether BKCa function is altered in cerebral parenchymal arterioles after menopause. Using a chemically induced model of menopause, the 4-vinylcyclohexene diepoxide (VCD) model, which depletes follicles while maintaining intact ovaries, we hypothesized that menopause would be associated with reduced functional vasodilatory responses in cerebral parenchymal arterioles of wild-type mice via reduced BKCa function. Using pressure myography of isolated parenchymal arterioles, we observed that menopause (Meno) induced a significant increase in spontaneous myogenic tone. Endothelial function, assessed as nitric oxide production and dilation after cholinergic stimulation or endothelium-dependent hyperpolarization pathways, was unaffected by Meno. BKCa function was significantly impaired in Meno compared with control, without changes in voltage-gated K+ channel activity. Cerebral functional hyperemia, measured by laser-speckle contrast imaging during whisker stimulation, was significantly blunted in Meno mice, without detectable changes in basal perfusion. However, behavioral testing identified no change in cognition. These findings suggest that menopause induces cerebral microvascular and neurovascular deficits.NEW & NOTEWORTHY Cerebral parenchymal arterioles from menopause mice showed increased myogenic tone. We identified an impairment in smooth muscle cell BKCa channel activity, without a reduction in endothelium-dependent dilation or nitric oxide production. Microvascular dysfunction was associated with a reduction in neurovascular responses after somatosensory stimulation. Despite the neurovascular impairment, cognitive abilities were maintained in menopausal mice.

An analysis of the quality of maternity services in Nampula, Mozambique: implementation research.

Introduction: the quality of maternity services is an essential factor in reducing maternal and newborn morbidity and mortality, which remains extremely high in Africa. In Mozambique, maternal mortality rate is 451.6 deaths per 100,000 live births (2017). The reasons for this are complex, but one important factor to reduce this burden is to provide effective and efficient care, to improve institutional deliveries. To reduce maternal and newborn mortality rates in Nampula, researchers from Lúrio University and the University of Saskatchewan, carried out an implementation research program, including various interventions such as training activities for health professionals in maternal and child health care. We planned a mid-project evaluation, to assess the trainings´ impact on the quality of services at Marrere Hospital Maternity. Methods: quantitative pre-post study, carrying out two cross-sectional surveys about maternity service quality, one being conducted after five health professionals´ trainings and the other after six more trainings. The two surveys included samples of post-partum women in the maternity, calculated with a 10% margin error and 90% confidence interval for the first survey, and with a 7% margin error and 95% confidence interval for the second. The surveys were entered into REDCap and analysed to assess frequencies, percentages, mean and standard deviations. This research was approved by the Institutional Committees of Bioethics at Lúrio University and at the University of Saskatchewan. Results: one hundred and sixteen post-partum women were surveyed at the maternity, assessing standards of patient centred care during delivery labour. Most areas showed no improvement. Some positive improvements were delivering women were given the option to have a person of their choice accompany them during labour (75%), notably a traditional birth attendant (34%), and they had continuous support from a health professional (68%). But many shortcomings persisted in areas of privacy (33%) and confidentiality (57%). Conclusion: the quality of patient centred care at Marrere Hospital Maternity did not improve much with health professionals´ trainings. Decreasing the large turnover rate of such staff, reviewing their learning styles, and promoting continuous professional capacity building would be the next steps to improve quality of care.

A Systematic Literature Review on Distributed Machine Learning in Edge Computing.

Distributed edge intelligence is a disruptive research area that enables the execution of machine learning and deep learning (ML/DL) algorithms close to where data are generated. Since edge devices are more limited and heterogeneous than typical cloud devices, many hindrances have to be overcome to fully extract the potential benefits of such an approach (such as data-in-motion analytics). In this paper, we investigate the challenges of running ML/DL on edge devices in a distributed way, paying special attention to how techniques are adapted or designed to execute on these restricted devices. The techniques under discussion pervade the processes of caching, training, inference, and offloading on edge devices. We also explore the benefits and drawbacks of these strategies.

Isolation and Functional Analysis of Arteriolar Endothelium of Mouse Brain Parenchyma.

Cerebral blood flow is conveyed by vascular resistance arteries and downstream parenchymal arterioles. Steady-state vascular resistance to blood flow increases with decreasing diameter from arteries to arterioles that ultimately feed into capillaries. Due to their smaller size and location in the parenchyma, arterioles have been relatively understudied and with less reproducibility in findings than surface pial arteries. Regardless, arteriolar endothelial cell structure and function-integral to the physiology and etiology of chronic degenerative diseases-requires extensive investigation. In particular, emerging evidence demonstrates that compromised endothelial function precedes and exacerbates cognitive impairment and dementia. In the parenchymal microcirculation, endothelial K+ channel function is the most robust stimulus to finely control the spread of vasodilation to promote increases in blood flow to areas of neuronal activity. This paper illustrates a refined method for freshly isolating intact and electrically coupled endothelial "tubes" (diameter, ~25 µm) from mouse brain parenchymal arterioles. Arteriolar endothelial tubes are secured during physiological conditions (37 °C, pH 7.4) to resolve experimental variables that encompass K+ channel function and their regulation, including intracellular Ca2+ dynamics, changes in membrane potential, and membrane lipid regulation. A distinct technical advantage versus arterial endothelium is the enhanced morphological resolution of cell and organelle (e.g., mitochondria) dimensions, which expands the usefulness of this technique. Healthy cerebral perfusion throughout life entails robust endothelial function in parenchymal arterioles, directly linking blood flow to the fueling of neuronal and glial activity throughout precise anatomical regions of the brain. Thus, it is expected that this method will significantly advance the general knowledge of vascular physiology and neuroscience concerning the healthy and diseased brain.