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To develop and internally validate a deep-learning algorithm from fetal ultrasound images for the diagnosis of cystic hygromas in the first trimester. All first trimester ultrasound scans with a diagnosis of a cystic hygroma between 11 and 14 weeks gestation at our tertiary care centre in Ontario, Canada were studied. Ultrasound scans with normal nuchal translucency were used as controls. The dataset was partitioned with 75% of images used for model training and 25% used for model validation. Images were analyzed using a DenseNet model and the accuracy of the trained model to correctly identify cases of cystic hygroma was assessed by calculating sensitivity, specificity, and the area under the receiver-operating characteristic (ROC) curve. Gradient class activation heat maps (Grad-CAM) were generated to assess model interpretability. The dataset included 289 sagittal fetal ultrasound images;129 cystic hygroma cases and 160 normal NT controls. Overall model accuracy was 93% (95% CI: 88-98%), sensitivity 92% (95% CI: 79-100%), specificity 94% (95% CI: 91-96%), and the area under the ROC curve 0.94 (95% CI: 0.89-1.0). Grad-CAM heat maps demonstrated that the model predictions were driven primarily by the fetal posterior cervical area. Our findings demonstrate that deep-learning algorithms can achieve high accuracy in diagnostic interpretation of cystic hygroma in the first trimester, validated against expert clinical assessment.

Background. Discordant birth weight in twins is linked to poor outcomes and predicting this discrepancy may lead to enhanced screening and surveillance. Our purpose was to quantify the relationship between intertwin nuchal translucency (NT) and crown-rump length (CRL) discordance with birth weight discrepancies ≥ 20%. Methods. We conducted a retrospective cohort study of 887 live twin births delivering at a Canadian tertiary care center over a 7-year period who opted for integrated prenatal screening. Categorical data are presented as numbers and percentages, and continuous data are expressed as means and standard deviations. Chi-square tests, Fisher’s Exact tests, or T-test were performed as appropriate. We then used published data and receiver operating curves to determine the optimal thresholds for predicting birth weight discordance based on first trimester intertwin NT differences. These values were used in multivariate logistic regression models accounting for known confounders. Results. Roughly 16% of twin pairs exhibited ≥ 20% difference in birth weight. Twin pairs with a CRL discordance greater than 10% have nearly a 4 times greater likelihood of having a birth weight discordance greater than 20% (OR 3.71, CI 2.24-6.14) while controlling for chorionicity, maternal age, gestational age at delivery, maternal body mass index (BMI), and parity. In these models, intertwin NT discordance ≥ 20% (OR 1.16, CI 0.77-1.77) and NT discordance ≥ 14% (OR 1.08, CI 0.73-1.60) were not statistically significant predictors of twin birth weight differences. However, when evaluating the effect of the larger intertwin NT value corresponding to the 95th percentile, an NT difference ≥ 0.9 mm was predictive of birth weight discordance ≥ 20% (OR 2.53, CI 1.21-5.29). Conclusion. Although intertwin CRL and NT discordance measured via ultrasound between 11-14 weeks gestation are related to birth weight discordance, there is uncertainty as to whether twin birth weight differences are related to adverse pregnancy outcomes in this population.

Digital mental health interventions (DMHIs) have surged in popularity over the last few years. However, adherence to self-guided interventions remains a major hurdle to overcome. The current study utilized a phased implementation design, incorporating diverse samples and contexts to delve into the engagement challenges faced by a recently launched online mental health platform in Brazil with self-evaluation forms. Employing an iterative mixed-methods approach, including focus groups, online surveys, and think-aloud protocols, the research aims to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions. Engagement in the platform was evaluated by descriptive statistics of the number of instruments completed, and qualitative interviews that were interpreted thematically. In the fully self-guided mode, 2,145 individuals registered, but a substantial majority (88.9%) engaged with the platform for only 1 day, and merely 3.3% completed all activities. In another sample of 50 participants were given a choice between online-only or a hybrid experience with face-to-face meetings. 40% of individuals from the hybrid group completed all activities, compared to 8% in the online-only format. Time constraints emerged as a significant barrier to engagement, with suggested improvements including app development, periodic reminders, and meetings with healthcare professionals. While the study identified weaknesses in the number and length of instruments, personalized results stood out as a major strength. Overall, the findings indicate high satisfaction with the mental health platform but underscore the need for improvements, emphasizing the promise of personalized mental health information and acknowledging persistent barriers in a digital-only setting.

The status of taxonomic knowledge varies across the Globe. Quantifying and mapping the geographic patterns of taxonomic status is essential to prioritise regions that require greater attention from the taxonomic community. Here, we compiled all valid orthopteran species names and their synonyms, extracted from the Catalogue of Life (CoL) and allocated them geographically, based on data from the Global Biodiversity Information Facility (GBIF) and the Orthoptera Species File (OSF). This allowed us to create measures of taxonomic effort, based on the date of species descriptions and the number of associated synonyms and combine them across space. Our analyses show that the descriptions of currently valid species increased exponentially since the 19 th century, with a temporary decline following World War II, while synonyms outpaced the number of valid species until the 1980s. The number of taxonomists also increased over time, with declines after World Wars, followed by a significant rise from the 1950s onwards, continuing through the 21 st century (with > 100 taxonomists currently active). Per-taxonomist description rates transitioned from highly variable before the 20 th century to consistent rates of 5–10 species annually with collaborative efforts. Tropical regions and the Southern Hemisphere hold the majority of recently described species names with fewer associated synonyms, indicating a predominance of alpha taxonomy and highlighting the need for greater taxonomic efforts. In contrast, temperate regions, particularly in Europe and south-western Asia, contain the majority of older names and synonyms, indicating a predominance of beta taxonomy and regions that have been more thoroughly studied. Our findings are discussed in the context of sociopolitical factors, scientific investments and the history of taxonomy. Finally, we propose a framework that makes the links between taxonomy and macroecology accessible for biodiversity in the era of Big Data. Alpha taxonomy (i.e. the description of new species) and Beta taxonomy (i.e. the revision of the taxonomic status and relationships of already described taxa) vary across space and time. We present a framework that connects taxonomy and macroecology, allowing us to assess taxonomic trends to provide information for biodiversity studies in the era of Big Data. We mapped alpha taxonomy rates using the date of species descriptions across space and beta taxonomy rates using the number of synonyms associated with each species. We combined alpha and beta taxonomy rates to understand the global taxonomic status of Orthoptera (Arthropoda, Insecta), the sixth most species-rich insect order, which includes grasshoppers, crickets, katydids and relatives. In tropical regions, orthopteran taxonomy is recent and has few revisions, while in temperate regions, it is older and more consolidated.

Background Depression in older adults is a challenge for health systems in most low- and middle-income countries (LMICs). Digital strategies for the management of this condition have been emerging worldwide, but the effectiveness of most of them is still unclear, especially among older adults. Thus, we aim to assess the effectiveness and cost-effectiveness of a digital psychosocial intervention to treat depression among older adults living in socioeconomically deprived areas in Guarulhos, Brazil. Methods We will conduct a two-arm individually randomised controlled trial with 1:1 allocation ratio. Five hundred older adults aged 60 years or over with depressive symptomatology (9-item Patient Health Questionnaire score, PHQ-9 ≥ 10) and registered with one of the primary care clinics will be recruited to participate in this study. A 6-week digital psychosocial programme, named Viva Vida, will be delivered via WhatsApp to participants allocated to the intervention arm. The Viva Vida will send psychoeducational and behavioural activation audio and visual messages 4 days a week for 6 weeks. The control arm will only receive a single message with general information about depression. The primary outcome will be the proportion of depression recovery (PHQ-9 < 10) assessed at 3 months. The cost-effectiveness of the intervention will be assessed at 5 months. A detailed process evaluation will be used to explore context and important implementation outcomes. Discussion This programme was based on the PROACTIVE intervention and designed to be delivered without face-to-face contact. If effective, it could be a simple treatment option, appropriate not only when social distancing is required, but it could also be included as a regular public health programme to initiate depression treatment, particularly in LMICs where resources allocated to mental health are scarce. Trial registration Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-4c94dtn. Registered on 22 October 2021 (submitted on 03 August 2021).

Prolonged periods of leaf wetness, high temperatures, and relative humidity during spring/summer are ideal conditions for the development of apple diseases in Brazil. In 2012, European canker, caused by Neonectria ditissima was officially confirmed in Brazilian apple orchards. The disease has a high potential to adversely affect fruit production as all symptomatic branches and/or all apple trees need to be eliminated to contain the epidemic in the orchards. Knowledge of N. ditissima spore release is required to optimize management practices because it facilitates the prediction of European canker infection risks and improves disease management decisions. Thus, the objective of this study was to investigate the release of N. ditissima spores from apple plants and detached branches over time. In the São Joaquim region of Brazil, both conidia and ascospores of N. ditissima can be released from cankers alive and/or dead in apple tissues year-round. In Brazil, peaks of spore release from N. ditissima were observed in traps when there was rainfall, irrespective of the season. Ascospore peaks were more frequent and higher than those of conidia trapped in both traps and apple tissues. Detached branches of symptomatic apple trees actively released spores of N. ditissima in the three years of evaluation, but in smaller numbers in comparison to traps with live plants. Thus, new and rigorous management measures should be adopted to control European canker dissemination in Brazilian apple orchards.

The objective of this study was to evaluate the different degrees of tolerance to Anthracnose infection in three PIWI varieties (Cabernet Cortis, Regent and Bronner) compared to the Cabenert Sauvignon variety. The experiment was conducted at EPAGRI Experimental Station, located in the city of São Joaquim, Santa Catarina State (28°17′39″ S; 49°55′56″ W, altitude 1,415 m a.s.l.), during 2016/2017 growing season. The evaluation of the disease was performed every 15 days, applying a scale of notes, from the onset of symptoms, and lasted for a period of two months, under the condition of infection Natural. The intensity of the disease was compared by epidemiological measures: time to reach maximum disease severity (TRMDS), maximum disease severity (Smax), and area under the severity disease progress curve (AUDSPC). Maturity indices of the varieties were obtained from juice physical-chemical analysis at the harvest. Although the PIWI varieties were resistant to mildew, they were susceptible to anthracnose. Bronner and Cabernet Cortis showed on average the same intensity of disease in the leaves and branches as the Cabernet Sauvignon variety, the Regent variety showed greater susceptibility to the pathogen, differing statistically from the other varieties evaluated.

Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.” Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD.

Patients with early-onset lysosomal storage diseases are ideal candidates for prenatal therapy because organ damage starts in utero. We report the safety and efficacy results of in utero enzyme-replacement therapy (ERT) in a fetus with CRIM (cross-reactive immunologic material)–negative infantile-onset Pompe’s disease. The family history was positive for infantile-onset Pompe’s disease with cardiomyopathy in two previously affected deceased siblings. After receiving in utero ERT and standard postnatal therapy, the current patient had normal cardiac and age-appropriate motor function postnatally, was meeting developmental milestones, had normal biomarker levels, and was feeding and growing well at 13 months of age. A fetus with infantile-onset Pompe’s disease was treated with a course of intrauterine enzyme replacement starting at approximately 6 months’ gestation.

Scalable solutions to treat depression in older adults in low-resourced settings are urgently needed. The PRODIGITAL-D pragmatic, single-blind, two-arm, individually randomized controlled trial assessed the effectiveness of a mobile messaging psychosocial intervention in improving depressive symptomatology among older adults in socioeconomically deprived areas of Guarulhos, Brazil. Older adults (aged 60+ years) registered with 24 primary care clinics and identified with depressive symptomatology (9-item Patient Health Questionnaire (PHQ-9) scores ≥ 10) received the 6-week Viva Vida intervention based on psychoeducation and behavioral activation ( n  = 298) or a single message ( n  = 305). No health professional support was offered. The primary outcome was improvement from depressive symptomatology (PHQ-9 < 10) at 3 months. Of the 603 participants enrolled (mean age = 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the follow-up assessment. In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive symptomatology, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio = 1.57; 95% confidence interval = 1.07–2.29; P  = 0.019). No severe adverse events related to trial participation were observed. These results demonstrate the usefulness of a digital messaging psychosocial intervention in the short-term improvement from depressive symptomatology that can potentially be integrated into primary care programs for treating older adults with depression. Brazilian Registry of Clinical Trials registration: ReBEC ( RBR-4c94dtn ). The PRODIGITAL-D trial in adults aged 60+ years from socioeconomically deprived areas of Brazil showed that a 6-week self-help mobile messaging psychosocial intervention was effective in improving depression recovery at 3 months compared to a single message control intervention.