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This research describes a mechanism wherein a bacterium prompts the metamorphic development of an animal from larva to juvenile form by injecting a protein that disrupts membranes in the larval cilia. Specifically, results show that a bacterial contractile injection system and the protein effector it injects form pores in larval cilia, influencing critical signaling pathways like mitogen-activated protein kinase and calcium flux, ultimately driving animal metamorphosis. This discovery sheds light on how a bacterial protein effector exerts its activity through membrane disruption, a phenomenon observed in various bacterial toxins affecting cellular functions, and elicits a developmental response. This work reveals a potential strategy used by marine organisms to respond to microbial cues, which could inform efforts in coral reef restoration and biofouling prevention. The study’s insights into metamorphosis-associated contractile structures’ delivery of protein effectors to specific anatomical locations highlight prospects for future biomedical and environmental applications.

Background Rare diseases (RDs) are a heterogeneous group of complex and low-prevalence conditions in which the time to establish a definitive diagnosis is often too long. In addition, for most RDs, few to no treatments are available and it is often difficult to find a specialized care team. Objectives The project “acERca las enfermedades raras” (in English: “bringing RDs closer”) is an initiative primary designed to generate a consensus by a multidisciplinary group of experts to detect the strengths and weaknesses in the public healthcare system concerning the comprehensive care of persons living with a RD (PLWRD) in the region of Catalonia, Spain, where a Network of Clinical Expert Units (Xarxa d’Unitats de Expertesa Clínica or XUEC) was created and is being implemented since 2015. The additional primary aim was to propose recommendations to solve or improve the limitations found. Methods A task force of 13 participants with multidisciplinary expertise on RDs completed a questionnaire and participated in two focus groups. A document was drafted with an item series of strengths and weaknesses of the healthcare system regarding the care of PLWRD, and a set of proposals or recommendations to overcome the problems identified. Results The Catalan Government healthcare model of XUECs for the comprehensive care for RDs is currently valid and adapted to the needs of PLWRD and their families since its strategic optimal and operational framework, and it is aligned with the European Reference Networks (ERNs) thematic areas. The problems found in the current healthcare model were grouped into ten main areas: (1) the healthcare model for RDs; (2) coordination with primary healthcare providers and other tertiary and secondary hospitals; (3) access to and coordination with non-medical services; (4) the role of case manager in the XUEC; (5) genetic diagnosis; (6) undiagnosed patients; (7) treatments; (8) referring process, continuous follow-up, and transition from pediatric to adult centers; (9) research and education for professionals; and (10) associations of PLWRD and their families (patients’ advocacy). The need for more resources was currently detected as the common factor for most of them. Ten key recommendations to improve the healthcare system regarding RDs were postulated. Conclusions Catalonia has established a unique healthcare model for RDs in Spain, with clear strengths and advantages. However, after analyzing them, the experts suggested that new governmental political and administrative decisions are needed to ensure the efficient implementation of a healthcare plan for PLWRD in Catalonia, which could be applied to other regions and nations worldwide.

Objetivo: Analizar la calidad de vida relacionada con la salud de los pacientes en tratamiento con hemodiálisis y su relación con su adherencia al tratamiento, comorbilidad y aspectos prácticos de autocuidado.Material y Método: Se ha llevado a cabo un estudio descriptivo, transversal, realizado en el Complexo Hospitalario de Ourense (España). Se incluyeron 51 pacientes en programa de hemodiálisis, con una edad media 64,96±13,03 años, y un tiempo en diálisis fue de 4,32±5,32 años. El 62,75% fueron hombres. Se analizó calidad de vida relacionada con la salud, comorbilidad, adherencia al tratamiento, nivel de conocimientos prácticos, además de variables sociodemográficas. Como instrumentos de medida: Índice comorbilidad de Charlson modificado, Test de Hermes, Kidney Disease Quality of Life-Short Form (KDQOL-SFTM). Se evaluaron conocimientos de autocuidado sobre cuidados generales, acceso vascular y dietéticos.Resultados: El índice de Comorbilidad medio fue de 4,42±2,83 puntos, y la adherencia al tratamiento, mediante el Test de Hermes de 2,78±0,84 puntos. En el análisis de regresión lineal, según modelo del componente físico, los valores del coeficiente Beta (β) asociado al sexo fueron β=0,304 (p=0,031) y a la comorbilidad de β=-0,436 (p=0,003). En el componente mental, coeficiente Beta (β) asociado al sexo β=0,330 (p=0,035) y la adherencia al tratamiento de β=0,311 (p=0,048) respectivamente.Conclusiones: El bajo nivel de conocimientos no se asocia a menor calidad de vida en la muestra estudiada. Los pacientes cumplidores obtienen mejores resultados en el componente mental estandarizado. A mayor comorbilidad menor calidad de vida.

Kawasaki disease is an acute self-limited systemic vasculitis common in childhood. Intravenous immunoglobulin (IVIG) is an effective treatment, and it reduces the incidence of cardiac complications. Egami score has been validated to identify IVIG non-responder patients in Japanese population, and it has shown high sensitivity and specificity to identify these non-responder patients. Although its effectiveness in Japan, Egami score has shown to be ineffective in non-Japanese populations. The aim of this study was to apply the Egami score in a Western Mediterranean population in Catalonia (Spain). Observational population-based study that includes patients from all Pediatric Units in 33 Catalan hospitals, both public and private management, between January 2004 and March 2014. Sensitivity and specificity for the Egami score was calculated, and a logistic regression analysis of predictors of overall response to IVIG was also developed. Predicting IVIG resistance with a cutoff for Egami score ≥3 obtained 26 % sensitivity and 82 % specificity. Negative predictive value was 85 % and positive predictive value 22 %. This low sensitivity implies that three out of four non-responders will not be identified by the Egami score. Besides, logistic regression models did not found significance for the use of the Egami score to predict IVIG resistance in Catalan population although having an area under the ROC curve of 0.618 (IC 95 % 0.538–0.698, p  < 0.001). Although regression models found an area under the ROC curve >0.5 to predict IVIG resistance, the low sensitivity excludes the Egami score as a useful tool to predict IVIG resistance in Catalan population.

Bacteroides are present in a large percentage of healthy adult microbiomes. However, the mechanisms that Bacteroides interact with their human hosts remain poorly understood. The genome of Bacteroides spp. encode a contractile injection system (CIS) that we suspect is involved in bacteria-host interactions. Although this gene system, named Bacteroidales injection system (BIS), is homologous to CIS found in other bacterial species that interact with eukaryotic partners, the structure and function of BIS has yet to be determined. CIS are classified into two types; type 6 secretion systems are cytoplasmic/inner membrane bound and extracellular CIS which are released into the environment. However, the BIS structure has yet to be detected and observed in the laboratory. To this end, the following aims were carried out; (1) Determine whether BIS are intracellular Type 6 secretion systems or extracellular contractile injection systems in B. cellulosilyticus WH2, (2) Create a BIS overexpression strain by targeting potential negative regulators of the BIS cluster, and (3) Observe BIS expression of B. cellulosilyticus WH2 strains with negative regulator deletions. Our data from western blots of B. cellulosilyticus cell pellet and supernatant shows that the localization of the BIS tube/sheath structure to be membrane-bound rather than excreted. Genomic library screening identified potential regulators of the BIS gene cluster, including potential transcription factors that downregulate the BIS promoter-driven molecular system. β-galactosidase activity assays confirmed the suppression of BIS promoter-driven transcription by several genes of interest. Overexpression of the BIS will aid visualizing it for the first time. Western blot from B. cellulosilyticus negative regulator deletion strain shows differences in sheath expression, and we have observed evidence of BIS-like localization and structures through microscopy.

The purpose of this study was to investigate the effects of state-level testing on the instructional practices and beliefs of middle school science teachers. The study addressed four questions: (a) What are the beliefs of middle school science teachers regarding the pressure to improve their students' test scores? (b) What are the beliefs of middle school science teachers about how standardized tests influence their class time? (c) What are the attitudes of middle school science teachers toward state testing? and (d) What commonalities emerge from teachers' responses about the state tests? The sample was composed of 86 middle school science teachers from states that have state mandated testing programs in the area of science. Descriptive statistics and an inductive analysis were performed to answer the research questions. Teachers reported that they and their students were under a great amount of pressure to increase test scores from central office administrators and from the school principal. Teachers reported spending considerable time on certain test preparation activities throughout the school year. Teachers reported that the three strongest influences in instructional planning were reviewing the content and skills covered on the state tests prior to the test administration, having to prepare students for state tests, and adjusting the curriculum sequence based on the content tested by the state tests. Multiple-choice items were reported to be the most often used assessment strategy. Teachers reported that state-mandated tests were not very helpful because the test results presented an inaccurate picture of student learning. The categories formed from the teachers' written comments reflected the findings of the survey questions. Comments concentrated on the negative effects of the tests in the areas of pressure, overemphasis on the test, accountability, reduction of instructional time due to test preparation, and negative uses of state-mandated tests. Recommendations for further research include collecting samples of teachers' lesson plans, classroom observations, and teacher interviews. Other variables that should be further explored with science teachers include school SES, achievement level of students, and teaching experience. Students' and principals' perceptions on the effects of state-mandated tests should also be investigated.

The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.

This study evaluated the independent and combined environmental impacts of the consumption of beef and ultra-processed foods in Brazil. Cross-sectional study. Brazil. We used food purchases data from a national household budget survey conducted between July 2017 and July 2018, representing all Brazilian households. Food purchases were converted into energy, carbon footprints and water footprints. Multiple linear regression models were used to assess the association between quintiles of beef and ultra-processed foods in total energy purchases and the environmental footprints, controlling for sociodemographic variables. Both beef and ultra-processed foods had a significant linear association with carbon and water footprints ( < 0·01) in crude and adjusted models. In the crude upper quintile of beef purchases, carbon and water footprints were 47·7 % and 30·8 % higher, respectively, compared to the lower quintile. The upper quintile of ultra-processed food purchases showed carbon and water footprints 14·4 % and 22·8 % higher, respectively, than the lower quintile. The greatest reduction in environmental footprints would occur when both beef and ultra-processed food purchases are decreased, resulting in a 21·1 % reduction in carbon footprint and a 20·0 % reduction in water footprint. Although the environmental footprints associated with beef consumption are higher, dietary patterns with lower consumption of beef and ultra-processed foods combined showed the greatest reduction in carbon and water footprints in Brazil. The high consumption of beef and ultra-processed foods is harmful to human health, as well as to the environment; thus, their reduction is beneficial to both.