Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing.

Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.

Genomic prediction of strawberry resistance to postharvest fruit decay caused by the fungal pathogen Botrytis cinerea.

Gray mold, a disease of strawberry (Fragaria × ananassa) caused by the ubiquitous necrotroph Botrytis cinerea, renders fruit unmarketable and causes economic losses in the postharvest supply chain. To explore the feasibility of selecting for increased resistance to gray mold, we undertook genetic and genomic prediction studies in strawberry populations segregating for fruit quality and shelf life traits hypothesized to pleiotropically affect susceptibility. As predicted, resistance to gray mold was heritable but quantitative and genetically complex. While every individual was susceptible, the speed of symptom progression and severity differed. Narrow-sense heritability ranged from 0.38 to 0.71 for lesion diameter (LD) and 0.39 to 0.44 for speed of emergence of external mycelium (EM). Even though significant additive genetic variation was observed for LD and EM, the phenotypic ranges were comparatively narrow and genome-wide analyses did not identify any large-effect loci. Genomic selection (GS) accuracy ranged from 0.28 to 0.59 for LD and 0.37 to 0.47 for EM. Additive genetic correlations between fruit quality and gray mold resistance traits were consistent with prevailing hypotheses: LD decreased as titratable acidity increased, whereas EM increased as soluble solid content decreased and firmness increased. We concluded that phenotypic and GS could be effective for reducing LD and increasing EM, especially in long shelf life populations, but that a significant fraction of the genetic variation for resistance to gray mold was caused by the pleiotropic effects of fruit quality traits that differ among market and shelf life classes.

Estrategias de afrontamiento en familiares de pacientes críticos / Coping strategies for relatives of critically ill patients

Introducción: la estadía en la unidad de cuidados intensivos genera cambios en la dinámica familiar causados por las alteraciones en las actividades diarias que obligan a utilizar estrategias que los mitiguen. Objetivo: describir las estrategias de afrontamiento de los familiares de pacientes críticos. Materiales y métodos: revisión integradora de literatura en las bases de datos y metabuscadores PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY, obteniendo 13 artículos: 7 estudios cuantitativos observacionales, 4 cualitativos fenomenológicos y 2 revisiones sistemáticas. Resultados: se determinó que las estrategias más utilizadas por los familiares de pacientes críticos son respuesta emocional, apoyo social, valores y creencias y crisis familiar. La más recurrente en los estudios revisados es la respuesta emocional debido a la implicación afectiva que tiene en los familiares la hospitalización de su ser querido. Conclusión: la respuesta emocional usada por los familiares como estrategia evidencia la necesidad de que los enfermeros garanticen espacios de acercamiento y expresión de sentimientos. Los servicios de salud deben priorizar el trato humanizado y una comunicación acorde con las necesidades de los familiares.

Introduction: the stay in the intensive care unit generates changes in the family dynamics caused by alterations in its daily activities that force the use of strategies that mitigate them. Objective: to describe the coping strategies for the relatives of critically ill patients. Materials and methods: integrative review of the literature in the PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY databases, obtaining 13 articles: 7 quantitative observational studies, 4 qualitative phenomenological studies and 2 systematic reviews. Results: it was determined that the most used strategies by relatives of critically ill patients are emotional response, social support, values and beliefs and family crisis. The most recurrent in the studies reviewed is the emotional response due to the emotional involvement of the family members in the hospitalization of their loved ones. Conclusion: the emotional response used by relatives as a strategy shows the need for nurses to guarantee spaces for approaching and expressing feelings. Health services should prioritize humanized treatment and communication according to the need of family members.

Multi-dimensional machine learning approaches for fruit shape phenotyping in strawberry.

BACKGROUND: Shape is a critical element of the visual appeal of strawberry fruit and is influenced by both genetic and non-genetic determinants. Current fruit phenotyping approaches for external characteristics in strawberry often rely on the human eye to make categorical assessments. However, fruit shape is an inherently multi-dimensional, continuously variable trait and not adequately described by a single categorical or quantitative feature. Morphometric approaches enable the study of complex, multi-dimensional forms but are often abstract and difficult to interpret. In this study, we developed a mathematical approach for transforming fruit shape classifications from digital images onto an ordinal scale called the Principal Progression of k Clusters (PPKC). We use these human-recognizable shape categories to select quantitative features extracted from multiple morphometric analyses that are best fit for genetic dissection and analysis. RESULTS: We transformed images of strawberry fruit into human-recognizable categories using unsupervised machine learning, discovered 4 principal shape categories, and inferred progression using PPKC. We extracted 68 quantitative features from digital images of strawberries using a suite of morphometric analyses and multivariate statistical approaches. These analyses defined informative feature sets that effectively captured quantitative differences between shape classes. Classification accuracy ranged from 68% to 99% for the newly created phenotypic variables for describing a shape. CONCLUSIONS: Our results demonstrated that strawberry fruit shapes could be robustly quantified, accurately classified, and empirically ordered using image analyses, machine learning, and PPKC. We generated a dictionary of quantitative traits for studying and predicting shape classes and identifying genetic factors underlying phenotypic variability for fruit shape in strawberry. The methods and approaches that we applied in strawberry should apply to other fruits, vegetables, and specialty crops.

CIRCADA: Shiny Apps for Exploration of Experimental and Synthetic Circadian Time Series with an Educational Emphasis.

Circadian rhythms are daily oscillations in physiology and behavior that can be assessed by recording body temperature, locomotor activity, or bioluminescent reporters, among other measures. These different types of data can vary greatly in waveform, noise characteristics, typical sampling rate, and length of recording. We developed 2 Shiny apps for exploration of these data, enabling visualization and analysis of circadian parameters such as period and phase. Methods include the discrete wavelet transform, sine fitting, the Lomb-Scargle periodogram, autocorrelation, and maximum entropy spectral analysis, giving a sense of how well each method works on each type of data. The apps also provide educational overviews and guidance for these methods, supporting the training of those new to this type of analysis. CIRCADA-E (Circadian App for Data Analysis-Experimental Time Series) allows users to explore a large curated experimental data set with mouse body temperature, locomotor activity, and PER2::LUC rhythms recorded from multiple tissues. CIRCADA-S (Circadian App for Data Analysis-Synthetic Time Series) generates and analyzes time series with user-specified parameters, thereby demonstrating how the accuracy of period and phase estimation depends on the type and level of noise, sampling rate, length of recording, and method. We demonstrate the potential uses of the apps through 2 in silico case studies.

Estándares de protección del Derecho Humano a la salud en la Corte Interamericana de Derechos Humanos / Standards of Protection of the Human Right to Health in the Inter-American Court of Human Rights

Resumen El derecho a la salud ha sido objeto de análisis por parte de la Corte Interamericana de Derechos Humanos, a través de los casos contenciosos donde ha interpretado su contenido y alcance, emitiendo diferentes estándares de protección por medio de una conexión e interrelación entre los derechos humanos a la vida en condiciones de dignidad e integridad personal contenidos en la Convención Americana sobre Derechos Humanos, así mismo ha identificado diferentes espacios convencionales derivados de las obligaciones internacionales de los Estados Partes, como la posición de garante del Estado ante los grupos vulnerables, los derechos sexuales y reproductivos y la salud mental.

Abstract The right to health has been the subject of analysis by the Inter-American Court of Human rights, through the contentious cases where it has interpreted its content and scope, by emitting different standards of protection, by means of a connection and interrelation of human rights to life in conditions of dignity, and personal integrity, which are contained in the American Convention on Human Rights. Similarly, it has also identified different conventional spaces derived from international obligations from States parties, as the guarantor of the State before the vulnerable groups, sexual and reproductive rights, and mental health.

Una nueva visión metodológica para la formación básica especializada en el campo de la Imagenología / New methodological point of view about the elemental and specialized formation on the Imagenology field

La formación posgraduada de carácter emergente del Médico General Integral (MGI) en el campo de la imagenología y en particular en el Pesquisaje de Malformaciones Congénitas por Ultrasonido es una realidad que reclama la necesidad de incrementar los esfuerzos para enfrentar esta tarea a nivel de la Comunidad, la cual cuenta ya con el equipamiento necesario y su ejecución se encuentra a la espera del personal capacitado en la atención de la gestante de 20 a 22 semanas que requiere del mismo, lo que redundará en beneficio de la embarazada, del Programa de Atención Materno Infantil de nuestro país, así como de otros países que necesitan de este servicio. La formación básica especializada en Imagenología requiere de una Estrategia Metodológica que favorezca la comprensión de todas respuestas de cambio en la cual se conciba un aprendizaje potencialmente significativo a partir de relacionar gradualmente los conocimientos desde el desarrollo embriológico, anatómico, aspectos géticos, reconocimiento sonográfico de estructuras normales hasta la identificación de las modificaciones de dichas estructuras mediante el Ultrasonido Obstétrico, apoyándonos en las nuevas técnicas de la información y la comunicación (NTIC) en función de fortalecer la pedagogía de la imagen, contribuyendo a lograr que la formación posgraduada del Médico General Integral (MGI) pueda responder de manera coherente a las aspiraciones del programa Materno Infantil y en particular al Medicina preventiva en la Comunidad(AU)