Understanding vaccination hesitation among health professionals: a systematic review of qualitative studies.

OBJECTIVES: In terms of vaccination, people trust healthcare professionals (HCPs) more than any other source of information. They are the cornerstone of vaccination as they can move undecided populations not only towards vaccination but also towards non-vaccination. The aim of this systematic review was to explore the knowledge, beliefs, attitudes, and barriers associated with own vaccination and patient recommendation in HCPs. STUDY DESIGN: This study incorporated a systematic review. METHODS: A systematic review of studies published from January 1, 2000, to June 1, 2020, was conducted by searching PubMed and EMBASE electronic databases. Qualitative studies reporting outcomes related to knowledge, attitudes, or barriers related to vaccination/recommendation by healthcare personnel were included. The guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. RESULTS: From a total of 2916 studies identified, 36 articles met the inclusion criteria. Some of the factors cited by the HCP that may contribute to vaccine hesitancy were (a) concerns regarding safety or efficacy of vaccines (23 articles); (b) time constraints (21 articles); (c) lack of knowledge about the vaccination/vaccine (19 articles); (d) costs (13 articles); (e) distrust of pharmaceutical industry (8 articles); and (f) considering oneself insusceptible (7 articles), stock shortage (7 articles), lack of personnel (5 articles), and feelings of unnecessary vaccination (5 articles). CONCLUSIONS: Our review suggests that interventions to combat vaccine hesitancy should increase HCP education on vaccine efficacy and safety, as well as intervene on health system factors such as cost and time per visit. In this way, we could tackle the problem of vaccine hesitancy, which seriously threatens global public health.

Wildfire and smoke association with COVID-19 cases in the Pantanal wetland, Brazil.

OBJECTIVES: In 2020, Brazil experienced two concurrent public health challenges related to respiratory disease: wildfires and increased mortality due to the coronavirus (COVID-19) pandemic. Smoke from these wildfires contributed to a variety of air pollutants, including fine particulate matter (PM2.5). The present study aims to investigate the effects of environmental and socio-economic factors on COVID-19 hospitalisation in the Pantanal. STUDY DESIGN: Ecological retrospective study. METHODS: We applied a multilevel negative binomial model to relate monthly hospitalisation data with environmental variables. RESULTS: We showed that monthly PM2.5 concentration levels had the greatest influence on the increase in hospitalisations by COVID-19 in the elderly (23 % increase). The Gini index, a coefficient that reflects income inequalities, also had a positive association with COVID-19 hospitalisations (18 % increase). Higher temperatures and humidity were protective factors, showing a 15 % and 14 % decrease in hospitalisations, respectively. The results of the present study suggest that high PM2.5 exposure contributed to the increase in COVID-19 hospitalisations, as did the social inequalities of each municipality. CONCLUSIONS: The present study highlights the importance of gathering evidence supported by multiple information sources to guide decision-making and identify populations needing better public health systems.

Experimental determination of nanocomposite grating structures by light- and neutron-diffraction in the multi-wave-coupling regime.

We experimentally demonstrate how to accurately retrieve the refractive index profile of photonic structures by standard diffraction experiments and use of the rigorous coupled-wave analysis in the multi-wave coupling regime, without the need for taking any auxiliary data. In particular, we show how the phases of the Fourier components of a periodic structure can be fully recovered by deliberately choosing a probe wavelength of the diffracting radiation much smaller than the lattice constant of the structure. In the course of our demonstration, we accurately determine the slight asymmetry of the structure of nanocomposite phase gratings by light and neutron diffraction measurements.

The serial millisecond crystallography instrument at the Australian Synchrotron incorporating the "Lipidico" injector.

A serial millisecond crystallography (SMX) facility has recently been implemented at the macromolecular crystallography beamline, MX2 at the Australian Synchrotron. The setup utilizes a combination of an EIGER X 16M detector system and an in-house developed high-viscosity injector, "Lipidico." Lipidico uses a syringe needle to extrude the microcrystal-containing viscous media and it is compatible with commercially available syringes. The combination of sample delivery via protein crystals suspended in a viscous mixture and a millisecond frame rate detector enables high-throughput serial crystallography at the Australian Synchrotron. A hit-finding algorithm, based on the principles of "robust-statistics," is employed to rapidly process the data. Here we present the first SMX experimental results with a detector frame rate of 100 Hz (10 ms exposures) and the Lipidico injector using a mixture of lysozyme microcrystals embedded in high vacuum silicon grease. Details of the experimental setup, sample injector, and data analysis pipeline are designed and developed as part of the Australian Synchrotron SMX instrument and are reviewed here.

Different dietary trace mineral sources for broiler breeders and their progenies.

The objective of this study was to evaluate the effect of different trace mineral supplementation sources in the diet of broiler breeders on their performance and on their progenies. In total, 128 Cobb 500 broiler breeders were distributed according to a completely randomized experimental design in 2 experimental treatments. The control group was fed a diet supplemented with inorganic trace minerals (ITM), while the other group was fed a diet supplemented with reduced levels of trace minerals in the organic form. Eggs were collected when breeders were 35, 47, and 53 wk old. Their progeny (450 hatchlings) were divided according to trace mineral supplementation source from the maternal diet, creating 2 treatments with 16 replicates of 15 birds each. Organic trace mineral (OTM) supplementation improved broiler breeder performance, as shown by higher egg production and better eggshell quality of OTM-fed hens compared with those fed ITM. Egg fertility and hatchability were not influenced by the treatments. As to progeny performance, higher weight gain, and consequently, better feed conversion ratio, were obtained in the 41-day-old progenies of OTM-fed breeders, independently of hen age. Maternal diet trace mineral source did not affect broiler carcass, breast meat, or leg yields. The results of the present study show that supplementing broiler breeder diets with organic trace mineral sources enhances the performance of breeders and their progenies.

Effects of Wood Density on Aquatic Insect Communities in a Cuban Montane Rainforest Stream.

We tested whether hardness or different wood carbon densities, considered as the concentration of carbon structural compounds, influence functional feeding groups and species richness of aquatic insects in a tropical stream. We expected that harder woods would harbor aquatic insect communities with species richness and functional food group profile different from softwoods. We also expected that collector-gatherers and collector-filterers will be more abundant in softwood because harder woods are less substrate suitable for biofilm production. Aquatic insects associated with the following plants were analyzed: Gomidesia lindeniana with high-density, Psychotria grandis with medium-density, and Meriania leucantha with low-density wood. Diptera and Ephemeroptera were the most abundant groups sampled in the woods. Psychotria grandis shows higher concentrations of lignin, cellulose, and hemicellulose, followed by G. lindeniana and M. leucantha. Breakdown rates are different among plant species with M. leucantha having four times highest breakdown rates and on average three more species in the species richness value. We did not find significant differences in the composition of insect species associated with the plants. We found evidence that the richness and functional organization of aquatic insect communities were mostly related to the breakdown rates and lignin amount of the woods. Plants that decompose faster on average have three more species and two more insect functional groups. Our findings suggest that the loss of high carbon density trees in tropical forests can affect aquatic biodiversity.

Results of surgical treatment for juvenile myasthenia gravis. / Resultados del tratamiento quirúrgico en la miastenia gravis juvenil.

INTRODUCTION: Radical or extended thymectomy is an effective treatment for myasthenia gravis in the adult population. There are few reports to demonstrate the effectiveness of this treatment in patients with juvenile myasthenia gravis. OBJECTIVE: The main objective of this study was to show that extended transsternal thymectomy is a valid option for treating this disease in paediatric patients. RESULTS: Twenty-three patients with juvenile myasthenia gravis underwent this surgical treatment in the period between April 2003 and April 2014; mean age was 12.13 years and the sample was predominantly female. The main indication for surgery, in 22 patients, was the generalised form of the disease (Osserman stage II) together with no response to 6 months of medical treatment. The histological diagnosis was thymic hyperplasia in 22 patients and thymoma in one patient. There were no deaths and no major complications in the postoperative period. After a mean follow-up period of 58.87 months, 22 patients are taking no medication or need less medication to manage myasthenic symptoms. CONCLUSIONS: Extended (radical) transsternal thymectomy is a safe and effective surgical treatment for juvenile myasthenia gravis.

Potential Effects of Climate Change on Ecological Interaction Outcomes Between Two Disease-Vector Mosquitoes: A Mesocosm Experimental Study.

The objective of this study was to experimentally assess the effects of different climate change scenarios on the outcomes of interactions between Aedes aegypti (L.) and Culex quinquefasciatus (Say) (Diptera: Culicidae) larvae. The experimental design maintained a constant density of specimens while the proportion of the species in different experimental climate change scenarios varied. Our results indicate that survival of the two species was not affected, but larval development and pupation times decreased under elevated atmospheric CO(2) concentration and high air temperature. In climate change scenarios with both species together, the survival of Ae. aegypti increased and its larval development time decreased with increasing density of Cx. quinquefasciatus. This may be attributed to the effects of intraspecific competition being more significant than interspecific competition in Ae. aegypti. Our study also reveals that climatic changes may affect the patterns of interactions between Cx. quinquefasciatus and Ae. aegypti. Alterations in climatic conditions changed the response of context-dependent competition, indicating the importance of studies on how ecological interactions will be affected by projected future climatic change.

Responses of Aquatic Saproxylic Macroinvertebrates to Reduced-Impact Logging in Central Amazonia.

Reduced-impact logging (RIL) is an alternative land use because it reduces damage to forest cover in comparison with clear-cut practices. However, management practices adopted in RIL can affect wood availability and, consequently, fauna associated with dead wood during part of their life cycle (saproxylic). In this study, we evaluated whether aquatic saproxylic macroinvertebrates are affected by reduced-impact logging in Central Amazonia. We selected six streams in areas under reduced-impacted logging and six in primary forest areas and collected submerged woody debris. We did not find any differences in water pH, conductivity, and wood availability between reduced-impacted forest and primary forest streams. We found 248 saproxylic aquatic macroinvertebrates belonging to 37 taxa. We found five wood specialist (Dryops, Lutrochus, Stenochironomus, Oukuriella, and Endotribelos) and 32 generalists, totalling 98 and 150 individuals, respectively. In general, our results show that reduced-impact logging does not affect richness, abundance, and composition of saproxylic macroinvertebrates. The main explanation for this pattern is that management practices do not change important macroinvertebrate niche dimensions, including wood availability and the water's chemical and physical variables. Thus, controlled logging, such as applied in the area of the Central Amazonian streams studied, opens a new prospect for insect conservation and commercial exploitation of wood, which is not possible when clear-cut practices are adopted.

Assessment of the abiotic and biotic effects of sodium metabisulphite pulses discharged from desalination plant chemical treatments on seagrass (Cymodocea nodosa) habitats in the Canary Islands.

Reverse osmosis membranes at many desalination plants are disinfected by periodic shock treatments with sodium metabisulphite, which have potentially toxic effects to the environment for marine life, although no empirical and experimental evidence for this is yet available. The aim of this study was to characterise for the first time, the physico-chemical modification of the marine environment and its biological effects, caused by hypersaline plumes during these membrane cleaning treatments. The case study was the Maspalomas II desalination plant, located in the south of Gran Canaria (Canary Islands, Spain). Toxicity bioassays were performed on marine species characteristic for the infralittoral soft bottoms influenced by the brine plume (Synodus synodus and Cymodocea nodosa), and revealed a high sensitivity to short-term exposure to low sodium metabisulphite concentrations. The corrective measure of incorporating a diffusion system with Venturi Eductors reduced nearly all the areas of influence, virtually eliminating the impact of the disinfectant.

The taxonomic distinctness of macroinvertebrate communities of Atlantic Forest streams cannot be predicted by landscape and climate variables, but traditional biodiversity indices can.

Predicting how anthropogenic activities may influence the various components of biodiversity is essential for finding ways to reduce diversity loss. This challenge involves: a) understanding how environmental factors influence diversity across different spatial scales, and b) developing ways to measure these relationships in a way that is fast, economical, and easy to communicate. In this study, we investigate whether landscape and bioclimatic variables could explain variation in biodiversity indices in macroinvertebrate communities from 39 Atlantic Forest streams. In addition to traditional diversity measures, i.e., species richness, abundance and Shannon index, we used a taxonomic distinctness index that measures the degree of phylogenetic relationship among taxa. The amount of variation in the diversity measures that was explained by environmental and spatial variables was estimated using variation partitioning based on multiple regression. Our study demonstrates that taxonomic distinctness does not respond in the same way as the traditional used in biodiversity studies. We found no evidence that taxonomic distinctness responds predictably to variation in landscape metrics, indicating the need for the incorporation of predictors at multiple scales in this type of study. The lack of congruence between taxonomic distinctness and other indices and its low predictability may be related to the fact that this measure expresses long-term evolutionary adaptation to ecosystem conditions, while the other traditional biodiversity metrics respond to short-term environmental changes.

Posible tratamiento con lípidos intravenosos de carnívoros domésticos intoxicados con lactonas macrocíclicas / Possible treatment of macrocyclic lactone poisoning in pets with intravenous lipids

Las emulsiones lipídicas, utilizadas inicialmente en la alimentación parenteral, están siendo propuestas, desde hace algunos años, en el tratamiento de las intoxicaciones humanas por anestésicos locales. Poco a poco, se van citando algunos casos aislados en la literatura científica. El Centro de Fármaco-vigilancia Veterinaria de Lyon (Francia) ha propuesto esta terapéutica en varias tomas y ha analizado la evolución de 6 casos de intoxicación de perros tratados con la administración intravenosa de emulsión lipídica. Los resultados parecen suficientemente esperanzadores para que esta terapéutica sea sistemáticamente propuesta en el futuro tras una ingestión o tratamiento accidental con ivermectina o moxidectina. Sería aconsejable realizar en el futuro nuevas evaluaciones sobre un mayor número de casos (AU)

Intravenous lipid emulsions (ILE), intended for parenteral nutrition, have been advocated for several years as therapy of humans poisoning by local anesthetics. Their use have been progressively extended to the therapy of other toxicoses, including poisoning of dogs by macrocyclics lactones, with anectodal reports cited in the literature. The Veterinary Pharmacovigilance Centre of Lyon advocated ILE on several occasions. ILE was used in 6 dogs intoxicated by macrocyclic lactones. Results seem sufficiently promising to encourage the systematic use in case of ivermectin or moxidectin toxicosis (accidental ingestion of oral paste or tablets for horses, or inadvertent overdose). It would be advisable in the future further evaluation on a large number of cases (AU)

Multifunctional hybrid materials for combined photo and chemotherapy of cancer.

Combined chemo and photothermal therapy in in vitro testing has been achieved by means of multifunctional nanoparticles formed by plasmonic gold nanoclusters with a protecting shell of porous silica that contains an antitumor drug. We propose a therapeutic nanoplatform that associates the optical activity of small gold nanoparticles aggregates with the cytotoxic activity of 20(S)-camptothecin simultaneously released for the efficient destruction of cancer cells. For this purpose, a method was used for the controlled assembly of gold nanoparticles into stable clusters with a tailored absorption cross-section in the vis/NIR spectrum, which involves aggregation in alkaline medium of 15 nm diameter gold colloids protected with a thin silica layer. Clusters were further encapsulated in an ordered homogeneous mesoporous silica coating that provides biocompatibility and stability in physiological fluids. After internalization in 42-MG-BA human glioma cells, these protected gold nanoclusters were able to produce effective photothermolysis under femtosecond pulse laser irradiation of 790 nm. Cell death occurred by combination of a thermal mechanism and mechanical disruption of the membrane cell due to induced generation of micrometer-scale bubbles by vaporizing the water inside the channels of the mesoporous silica coating. Moreover, the incorporation of 20(S)-camptothecin within the pores of the external shell, which was released during the process, provoked significant cell death increase. This therapeutic model could be of interest for application in the treatment and suppression of non-solid tumors.

Anabolic steroids induce cardiac renin-angiotensin system and impair the beneficial effects of aerobic training in rats.

We evaluated the effects of swimming and anabolic steroids (AS) on ventricular function, collagen synthesis, and the local renin-angiotensin system in rats. Male Wistar rats were randomized into control (C), steroid (S; nandrolone decanoate; 5 mg/kg sc, 2x/wk), steroid + losartan (SL; 20 mg.kg(-1).day(-1)), trained (T), trained + steroid (T+S), and trained + steroid + losartan (T+SL; n = 14/group) groups. Swimming was performed 5 times/wk for 10 wk. Serum testosterone increased in S and T+S. Resting heart rate was lower in T and T+S. Percent change in left ventricular (LV) weight-to-body weight ratio increased in S, T, and T+S. LV systolic pressure declined in S and T+S. LV contractility increased in T (P < 0.05). LV relaxation increased in T (P < 0.05). It was significantly lower in T+S compared with C. Collagen volumetric fraction (CVF) and hydroxyproline were higher in S and T+S than in C and T (P < 0.05), and the CVF and LV hypertrophy were prevented by losartan treatment. LV-ANG I-converting enzyme activity increased (28%) in the S group (33%), and type III collagen synthesis increased (56%) in T+S but not in T group. A positive correlation existed between LV-ANG I-converting enzyme activity and collagen type III expression (r(2) = 0.88; P < 0.05, for all groups). The ANG II and angiotensin type 1a receptor expression increased in the S and T+S groups but not in T group. Supraphysiological doses of AS exacerbated the cardiac hypertrophy in exercise-trained rats. Exercise training associated with AS induces maladaptive remodeling and further deterioration in cardiac performance. Exercise training associated with AS causes loss of the beneficial effects in LV function induced by exercising. These results suggest that aerobic exercise plus AS increases cardiac collagen content associated with activation of the local renin-angiotensin system.

[Barrett's esophagus. Update of the endoscopic treatment]. / Esófago de Barrett. Actualización del tratamiento endoscópico.

Actual Barrett's esophagus management includes symptomatic approach for GERD in order to prevent erosive injury and endoscopic & histologycal surveillance to detect dysplasia and early cancer. In high-grade dysplasia and superficial carcinoma, less aggressive procedures has been attempted to avoid extended surgery, such as Argon Plasma Coagulator, Multipolar Coagulation, Heater Probe, Photodynamic Therapy, and recently radiofrequency local treatment, associated or not to antireflux surgery. Ultrasonic therapy and Cryotherapy are new approaches, which are under clinical investigation. Barrett's epithelium resection utilizing endoscopical mucosal resection is a new promising procedure, which comes to the arena, allowing besides the compromised epithelium removal, its complete pathological evaluation and probably a curative intent. The actual revision intents to discuss the results of the different alternatives at the platform of treatment in dysplastic Barrett's or early carcinoma growing in the Barrett's epithelium.

Esófago de Barrett: actualización del tratamiento endoscópico / Barrett's esophagus: update of the endoscopic treatment

El manejo actual del esófago de Barrett incluye el tratamiento de los síntomas de enfermedad por reflujo gastroesofágico, la prevención del daño erosivo y la vigilancia endoscópica para detectar la progresión a displasia de alto grado y adenocarcinoma esofágico. Ante la presencia de displasia de alto grado y cáncer superficial, se han intentado terapias menos invasivas, alternativas a la cirugía resectiva, como el Argon Plasma Coagulator, Electrocoagulación Multipolar, Heater Probe, asociados o no a cirugía antirreflujo, la Terapia Fotodinámica y en los últimos años la ablación endoscópica por radiofrecuencia o BARREx. Se vislumbran además como terapias de destrucción del epitelio de Barrett actualmente en estudio la terapia ultrasónica y la crioterapia. La Resección Mucosa Endoscópica del epitelio de Barrett, procedimiento con potencial curativo, es además la única técnica que permite el análisis histopatológico del tejido. En la presente revisión analizaremos los resultados obtenidos con las diferentes terapias endoscópicas actuales y en desarrollo para el esófago de Barrett.

Actual Barrett’s esophagus management includes symptomatic approach for GERD in order to prevent erosive injury, and endoscopic & histologycal surveillance to detect dysplasia and early cancer. In high-grade dysplasia and superficial carcinoma, less aggressive procedures has been attempted to avoid extended surgery, such as Argon Plasma Coagulator, Multipolar Coagulation, Heater Probe, Photodynamic Therapy, and recently radiofrequency local treatment, associated or not to antireflux surgery. Ultrasonic therapy and Cryotherapy are new approaches, which are under clinical investigation. Barrett’s epithelium resection utilizing endoscopical mucosal resection is a new promising procedure, which comes to the arena, allowing besides the compromised epithelium removal, its complete pathological evaluation and probably a curative intent. The actual revision intents to discuss the results of the different alternatives at the platform of treatment in dysplastic Barrett’s or early carcinoma growing in the Barrett’s epithelium.