Foundation for Professional Development

It was established that women with endometriosis undergoing preparation for in vitro fertilization demonstrate distinct immunological features of the follicular microenvironment. It was found that the levels of interleukins, as well as the expression of CD16, CD25, and CD95 in follicular fluid, are closely associated with oocyte quality and embryological outcomes. Immune imbalance was shown to correlate with reduced fertilization and implantation rates. The findings support the importance of individualized pregravid preparation in women with endometriosis. The results highlight the clinical relevance of follicular fluid immunological markers for improving IVF outcomes.

Timeously completing tuberculosis (TB) treatment is key to optimal health outcomes. Suboptimal treatment refill patterns, even among those categorized as "treatment success," may portend unfavorable outcomes. Using patient-level medication refill data, latent-class mixed modelling was used to identify longitudinal trajectories of care engagement among TB patients achieving programmatic treatment success. Logistic regression was conducted to investigate participant-level characteristics associated with trajectory class membership. Among 548 participants, we identified three trajectories: Class 1 (consistent engagement; 84.1%), Class 2 (suboptimal engagement after 2 months; 7.7%) and Class 3 (suboptimal engagement from initiation; 8.2%). At treatment completion, Classes 1-3 accumulated 9.7 (95% CI: 7.4-11.8), 68.4 (60.4-76.9) and 55.5 (48.1-62.7) missed refill days, respectively. In gender-stratified models, men exhibited all three trajectories (83.1%, 7.4%, and 9.5%, respectively), and accumulated 10.6 [7.8-13.3], 61.0 [50.2-71.3], 62.31 [53.14-71.72] missed refill days, respectively. Women exhibited only Classes 1 and 3 (89.5% and 10.5%, respectively) and accumulated 12.1 [7.8-16.5] and 46.9 [33.3-61.6] missed refill days, respectively. Among men, prior TB (Class 2: aOR 7.44, 2.79-19.8; Class 3: aOR 2.78, 1.07-7.25) and HIV-negative status (Class 3: aOR 2.72, 1.13-6.54) were associated with suboptimal trajectories. Among women, prior TB was associated with suboptimal engagement (aOR 5.22, 1.11-24.44). Programmatic "treatment success" obscured heterogeneity in treatment refill patterns. Patient-centered counseling and gender-responsive interventions are needed to address treatment refill behaviors. Shorter regimens alone may not resolve suboptimal engagement, highlighting the need for flexible treatment strategies.

Background:Adherence to tuberculosis (TB) treatment is key to optimal health outcomes. Programmatic definitions of treatment success may mask heterogeneity in care engagement patterns that increase risk of unfavorable outcomes.Methods:Using patient-level medication refill data, latent-class growth modelling was used to identify longitudinal trajectories of care engagement among participants who programmatically achieved treatment success. Logistic regression was conducted to investigate participant-level characteristics associated with trajectory class membership.Results:Among 548 participants, we identified three trajectories: Class 1 (consistent engagement; 84.1%), Class 2 (suboptimal engagement after 2 months; 7.7%) and Class 3 (suboptimal engagement from initiation; 8.2%). At treatment completion, Classes 1–3 accumulated 9.7 (95% CI: 7.4–11.8), 68.4 (60.4–76.9) and 55.5 (48.1–62.7) missed refill days, respectively. In gender-stratified models, men exhibited all three trajectories (83.1%, 7.4%, and 9.5%, respectively), and accumulated 10.6 [7.8–13.3], 61.0 [50.2–71.3], 53.3 [53.3–71.4] missed refill days, respectively. Women exhibited only Classes 1 and 3 (89.5% and 10.5%, respectively) and accumulated 12.1 [7.8–16.5] and 46.9 [33.3–61.6] missed refill days, respectively. Among men, prior TB (Class 2: aOR 7.44, 2.79–19.8; Class 3: aOR 2.78, 1.07–7.25) and HIV-negative status (Class 3: aOR 2.72, 1.13–6.54) were associated with suboptimal trajectories. Among women, prior TB was associated with suboptimal engagement (aOR 5.22, 1.11–24.44).Conclusion:Programmatic Treatment Success obscured suboptimal engagement trajectories. Patient-centered counseling and gender-responsive interventions are needed to address suboptimal engagement across treatment stages. Shorter treatment regimens will unlikely resolve suboptimal engagement, underscoring the importance of regimen forgiveness.

Neste artigo tenho como escopo a romaria do Morro de Santana em São Paulo do Potengi. Situada em um dos menores municípios do Rio Grande do Norte, o Monte Santana realiza duas importantes romarias ao longo do ano: no dia primeiro de janeiro e na primeira segunda-feira de agosto, no chamado “Dias e Águas”. Aciono essa celebração religiosa com o fulcro de analisar os impasses no processo de construção do espaço devocional a partir dos registros publicados na imprensa norte-rio-grandense e da legislação atinente ao controle do espaço da ermida. Trata-se, em certa medida, de uma documentação que busca elucidar a romaria como evidência da visibilidade do município e da permanência das práticas populares.

Adolescent girls and young women (AGYW) face a high HIV burden, while PrEP persistence often declines post-trial. Understanding access outside research settings is key to improving study-to-clinic transitions. This study explored AGYW's experiences accessing PrEP in public clinics after The Community PrEP Study (CPS) in Eastern Cape, South Africa, a 24-month behavioral intervention. AGYW referred to clinics post-study (June-November 2021) were interviewed on their transition experiences. Interviewers categorized participants as PrEP continuation, discontinuation, or non-presentation. The qualitative team iteratively coded transcripts, used matrix analysis and discussions to examine referral experiences, clinic access, and PrEP motivations. While most accepted the transition, many missed study support. Continuation was linked to clinic adaptation, while discontinuation stemmed from access barriers. Non-presentation resulted from logistical and privacy concerns. Recommendations included youth-friendly provider training, alternative PrEP pick-up options, and service integration. Provider engagement and training remain critical for optimizing PrEP access, even with long-acting modalities.Trial registration number NCT03977181. Date of registration: 6 June 2019 - retrospectively registered.

<p>Background: Funding for educational innovations is increasingly scarce in academic medicine. While there is some funding for medical education research, this is often for discovery or application work, and there are few avenues for those with a heavy innovation focus to fund early work.</p> <p>Objective of the innovation: The objective was to develop an intrapreneurial unit focused on medical education projects and scholarship.</p> <p>Development process and implementation: The GridlockED and TriagED games are educational or serious games that seek to teach health care learners about emergency medicine processes. Both games were cocreated with learners and brought to market in the past 3 years. All of the proceeds from the sales of these games have been accrued over time to create a new innovation fund. This fund seeks to support trainees and early career educators in their medical education projects.</p> <p>Outcomes: Sales for GridlockED began in March 2018 and the TriagED began in November 2019. In the first year, sales for GridlockED yielded a total of $9,534. After 18 months of sales, the fund has accrued a total of $14,530. The fund has helped finance the development of new games. Additionally, the fund awarded two internal $500 Kickstarter grants to assist with evaluating and improving two local education projects. The GridlockED and TriagED games have also spurred multiple academic opportunities for junior educators interested in this domain: five workshops, eight conference abstracts, two peer-reviewed papers, and two research protocols are being developed.</p> <p>Conclusions: The GridlockED and TriagED games represent a new academically oriented, intrapreneurial approach to medical education work.</p>

Background:Accurate HIV point of care testing is the cornerstone of prevention and treatment efforts globally, although false (both negative and positive) results are expected to occur.Setting:We assessed the spectrum of true and false positive HIV results in a large prospective study of HIV incidence in African women using 3 contraceptive methods tested longitudinally in Eswatini, Kenya, South Africa, and Zambia.Methods:HIV serologic testing was conducted quarterly using 2 parallel rapid HIV tests. When one or both tests were positive, additional confirmatory testing was conducted, including HIV enzyme immunoassay (EIA) and RNA.Results:A total of 7730 women contributed 48,234 visits: true positive results occurred at 412 visits (0.9%) and false positives at 96 visits (0.2%). Of 412 women with HIV seroconversion, 10 had discordant (ie, 1 negative and 1 positive) rapid tests and 13 had undetectable HIV RNA levels. Of 62 women with false positive rapid HIV results, most had discordant rapid testing, but 6 (9.7%) had dually positive rapid results, and 4 (6.5%) had false positive or indeterminate EIA results. The positive predictive value of dual positive rapid results was 98.3%.Conclusions:Although most rapid test results were accurate, false positive results were expected and occurred in this population of initially HIV seronegative individuals tested repeatedly and prospectively. When HIV infection occurred, not all cases had textbook laboratory results. Our findings highlight the importance of confirmatory testing, particularly for individuals undergoing repeat testing and in settings where the point prevalence is expected to be low.Trial registration:ClinicalTrials.gov number NCT02550067.

Sexually transmitted infections (STIs) are widespread worldwide and negatively affect sexual and reproductive health. Gaps in evidence and in available tools have long hindered STI programmes and policies, particularly in resource-limited settings. In 2022, WHO initiated a research prioritisation process to identify the most important STI research areas to address the global public health need. Using an adapted Child Health and Nutrition Research Initiative methodology including two global stakeholder surveys, the process identified 40 priority STI research needs. The top priorities centred on developing and implementing affordable, feasible, rapid point-of-care STI diagnostic tests and new treatments, especially for gonorrhoea, chlamydia, and syphilis; designing new multipurpose prevention technologies and vaccines for STIs; and collecting improved STI epidemiologic data on both infection and disease outcomes. The priorities also included innovative programmatic approaches, such as new STI communication and partner management strategies. An additional six research areas related to mpox (formerly known as monkeypox) reflect the need for STI-related research during disease outbreaks where sexual transmission can have a key role. These STI research priorities provide a call to action for focus, investment, and innovation to address existing roadblocks in STI prevention, control, and management to advance sexual and reproductive health and wellbeing for all.