Validation of the LATCH breastfeeding assessment instrument for the Portuguese language

Objective: To translate into Portuguese and validate the LATCH breastfeeding assessment scale. Methods: This was a methodological study through translation and validation of the instrument. The following steps were followed: translation, back-translation, committee of judges, pre-test and validation. The validation process includes the analysis of 160 women in breastfeeding in the first postpartum days during hospitalization. Results: The results indicate that the LATCH instrument translated into Portuguese can be used by nurses for breastfeeding assessment, enabling the early detection of possible problems presented by the mother-baby binomial during breastfeeding. Conclusion: The study fulfilled the objective of adapting the LATCH breastfeeding assessment instrument to the Portuguese language and verifying its psychometric properties. The LATCH instrument validity measures what it was designed to do and is applicable in clinical practice.Objetivo: Traduzir para a língua portuguesa e validar a escala de avaliação da amamentação LATCH. Métodos: Tratou-se de um estudo do tipo metodológico, por meio da tradução e validação de instrumento. Seguiu-se as etapas estabelecidas: tradução, back-translation, comitê de juízes, pré-teste e validação. O processo de validação inclui a análise de 160 mamadas de mulheres nos primeiros dias pós-parto, durante a internação hospitalar. Resultados: Os resultados obtidos indicam que o instrumento LATCH traduzido para o português pode ser utilizado na avaliação do aleitamento materno pelo profissional enfermeiro, possibilitando a detecção precoce de possíveis problemas apresentados pelo binômio mãe-bebê durante a amamentação. Conclusão: O estudo cumpriu o objetivo de adaptar para a língua portuguesa e verificar as propriedades psicométricas do instrumento de avaliação de aleitamento materno LATCH. A validade do instrumento LATCH mede o que foi concebido para medir, sendo ele aplicável na prática clínica.Hospital e Faculdade Israelita de Ciencias da Saude Albert EinsteinHosp Israelita Albert Einstein, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Enfermagem, Sao Paulo, SP, BrazilHosp Municipal Vila Santa Catarina, Sao Paulo, SP, BrazilFac Israelita Ciencias Saude Albert Einstein, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Enfermagem, Sao Paulo, SP, BrazilWeb of Scienc

Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients

Chronic Cough and Eosinophilic Esophagitis: An Uncommon Association

An increasing number of children, usually with gastrointestinal symptoms, is diagnosed with eosinophilic esophagitis (EE), and a particular subset of these patients complains of airway manifestations. We present the case of a 2-year-old child with chronic dry cough in whom EE was found after a first diagnosis of gastroesophageal reflux disease (GERD) due to pathological 24-hour esophageal pH monitoring. Traditional allergologic tests were negative, while patch tests were diagnostic for cow's milk allergy. We discuss the intriguing relationship between GERD and EE and the use of patch test for the allergologic screening of patients

Supporting international medical graduates’ transition to their host-country: realist synthesis

Context Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs’ transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective. Methods The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement. Results Sixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment. Conclusions Organisational, training and individual contexts all play a role in IMGs’ adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given

An Explanation for the Nitrous Oxide Layer Observed in the Mesopause Region

Recent satellite measurements of a layer of enhanced nitrous oxide (N₂O) in the mesosphere-lower thermosphere (MLT) from the Atmospheric Chemistry Experiment-Fourier Transform Spectrometer have suggested an unexpected, minor high-altitude production source. Here we report the development of a mechanism and the first model simulations, which can explain the formation of this MLT N₂O layer. N₂O production occurs primarily via a reaction route involving the excitation of N₂ from secondary electrons. Simulations using the Whole Atmosphere Community Climate Model, with external forcing from the Global Airglow model, quantitatively reproduce the observed vertical, latitudinal, and seasonal N₂O variations. Sensitivity results indicate that photoelectrons are far more important than previously predicted, causing approximately two thirds of global N₂O production in the MLT. Energetic electron precipitation over high latitudes provides the remaining contribution. Solar cycle analysis reveals N₂O enhancements of up to ×2 at solar maximum compared to solar minimum

Addressing the climate challenge

In 2021, colleagues from across the University of Birmingham community were invited to write articles about topics relevant to the COP26 climate change summit. In this series of articles, experts from across many different disciplines provide new insight and evidence on how we might all understand and tackle climate change

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Elucidation of the Roles of TNFRSF Receptors in Cutaneous T Cell Responses

Regulatory T cells (Tregs) are closely related to Th17 cells and utilize aspects of the Th17-differentiation program for optimal immune regulation. In several chronic inflammatory human diseases, Tregs express IL-17A, suggesting that dysregulation of Th17-associated pathways in Tregs may result in either loss of suppressive function and/or conversion into pathogenic cells. The pathways that regulate the Th17 program in Tregs are poorly understood. We have identified two TNFRSF members, CD27 and OX40, to be preferentially expressed by skin-resident Tregs. Both CD27 and OX40 signaling suppressed the expression of Th17-associated genes from Tregs in a cell intrinsic manner in vitro and in vivo. However, only OX40 played a non-redundant role in promoting Treg survival. Tregs that lacked both CD27 and OX40 were defective in controlling inflammation, had reduced accumulation in both skin and SDLNs, and expressed high levels of IL-17A, as well as the master Th17 transcription factor, RORt. Finally, we found that CD27 expression was inversely correlated with Treg IL-17 production in skin of psoriasis and hidradenitis suppurativa patients. Taken together, our results suggest that TNFRSF members play both redundant and unique roles in regulating Treg plasticity.We further explored how CD27 influences CD4+ effector (Teff) cells in inflamed tissues. Utilizing a murine model of inducible self-antigen expression in the epidermis, we elucidated the functional role of CD27 on auto-reactive Teff cells. Expression of CD27 on antigen-specific Teff cells resulted in markedly enhanced skin inflammation when compared to CD27-deficient Teff cells. CD27 signaling promoted the accumulation of cytokine-producing T cells in a cell-intrinsic fashion. Surprisingly, this costimulatory pathway had minimal effect on early T cell activation and proliferation. Instead, signaling through CD27 resulted in the progressive survival of Teff cells during the autoimmune response. CD27 did not appear to affect the intrinsic (mitochondrial) apoptosis pathway. Instead, CD27-deficient Teff cells expressed higher levels of active-caspase 8. Taken together, these results suggest that CD27 does not promote Teff cell survival by increasing expression of anti-apoptotic BCL2 family members but instead acts by preferentially suppressing the cell-extrinsic apoptosis pathway, highlighting a previously un-identified role for CD27 in augmenting autoreactive Teff cell responses

Elucidation of the Roles of TNFRSF Receptors in Cutaneous T Cell Responses

Regulatory T cells (Tregs) are closely related to Th17 cells and utilize aspects of the Th17-differentiation program for optimal immune regulation. In several chronic inflammatory human diseases, Tregs express IL-17A, suggesting that dysregulation of Th17-associated pathways in Tregs may result in either loss of suppressive function and/or conversion into pathogenic cells. The pathways that regulate the Th17 program in Tregs are poorly understood. We have identified two TNFRSF members, CD27 and OX40, to be preferentially expressed by skin-resident Tregs. Both CD27 and OX40 signaling suppressed the expression of Th17-associated genes from Tregs in a cell intrinsic manner in vitro and in vivo. However, only OX40 played a non-redundant role in promoting Treg survival. Tregs that lacked both CD27 and OX40 were defective in controlling inflammation, had reduced accumulation in both skin and SDLNs, and expressed high levels of IL-17A, as well as the master Th17 transcription factor, RORt. Finally, we found that CD27 expression was inversely correlated with Treg IL-17 production in skin of psoriasis and hidradenitis suppurativa patients. Taken together, our results suggest that TNFRSF members play both redundant and unique roles in regulating Treg plasticity.We further explored how CD27 influences CD4+ effector (Teff) cells in inflamed tissues. Utilizing a murine model of inducible self-antigen expression in the epidermis, we elucidated the functional role of CD27 on auto-reactive Teff cells. Expression of CD27 on antigen-specific Teff cells resulted in markedly enhanced skin inflammation when compared to CD27-deficient Teff cells. CD27 signaling promoted the accumulation of cytokine-producing T cells in a cell-intrinsic fashion. Surprisingly, this costimulatory pathway had minimal effect on early T cell activation and proliferation. Instead, signaling through CD27 resulted in the progressive survival of Teff cells during the autoimmune response. CD27 did not appear to affect the intrinsic (mitochondrial) apoptosis pathway. Instead, CD27-deficient Teff cells expressed higher levels of active-caspase 8. Taken together, these results suggest that CD27 does not promote Teff cell survival by increasing expression of anti-apoptotic BCL2 family members but instead acts by preferentially suppressing the cell-extrinsic apoptosis pathway, highlighting a previously un-identified role for CD27 in augmenting autoreactive Teff cell responses