Operationalizing shared decision making in clinical practice.

Shared decision-making (SDM) requires a clear-eyed view of evidence certainty, context, and equipoise in clinical care. This paradigm of care builds on the foundational ethical principle of patient autonomy, further leveraging beneficence, nonmaleficence, and justice to provide bespoke care in the appropriate clinical setting. When evidence is carefully evaluated together with acceptability and feasibility, equity, cost-effectiveness, resources, and patient preferences, an individualized assessment of the trade-off between possible benefits and harms can optimize patient management.

Floristic survey of vascular plants of the Parque Estadual da Pedra Selada, Rio de Janeiro, Brazil.

Background: The Atlantic Forest is one of the most diverse and threatened phytogeographical domains in the world. Despite that, it includes regions with poor floristic knowledge, even in protected areas. Although the importance of protected areas in conserving the Atlantic Forest hotspot is undisputed, it is necessary to recognise the floristic richness of these areas to propose effective conservation actions.

A comprehensive floristic knowledge of a fragment of Semideciduous Seasonal Forest [Parque Estadual da Serra da Concórdia], Rio de Janeiro, Brazil.

Background: The "Serra da Concórdia" is part of the Atlantic Forest phytogeographical domain in the Brazilian state of Rio de Janeiro and it has a predominant phytophysiognomy of Semideciduous Seasonal Forest. This region underwent intense habitat loss and fragmentation during the 19 century, due to coffee plantations and later pastures. With the decline of these activities, the areas were abandoned, triggering secondary succession.

Teamwork in Clinical Medicine.

Clinical teams are at the heart of healthcare value. Teamwork requires an appreciation of the unique geniuses of each team member as well as an understanding of team dynamics and larger organizational challenges. Effective teams leverage each member's unique talents within a culture of shared humility, service, and dedication.

Interprofessional education in traditional and complementary medicine: a scoping review.

Interprofessional education (IPE) is a teaching method that improves collaboration and communication across health professions. There are consistent reports of poor interprofessional collaboration and communication between conventional health professionals and traditional and complementary medicine (TCM) professions. The application of IPE within courses that provide training in TCM requires close examination.

A Media Advocacy Toolkit for the Allergist-Immunologist.

For clinicians involved in improving healthcare for patients with allergic and immunologic conditions, advocacy on a broader level through public outreach is key to advancing value-based care. In this article, we provide a toolkit of strategies and resources that can be used to raise public awareness of important issues through various mediums, including podcasts and social media, newspapers, testimonies, presentations, and interviews. A simple approach to effective media interactions is described using the acronym "RATIO," which stands for Research, Audience, Targeted topic, Interview rephrasing, and Optimism.

Beyond Confirmed Mast Cell Activation Syndrome: Approaching Patients With Dysautonomia and Related Conditions.

Allergist-immunologists face significant challenges as experts in an ever-evolving field of neuroimmunology. Among these challenges is the increasingly frequent need to counsel patients with suspected mast cell activation disorders about perceived comorbidities, which may include hypermobile Ehlers-Danlos syndrome, amplified pain syndrome, fibromyalgia, burning sensation syndromes, migraines, irritable bowel syndrome, and postural orthostatic tachycardia syndrome. Patients may experience comorbid anxiety, panic disorder, and depression associated with disturbed sleep, fatigue, and cognitive impairment that often worsen when their physical symptoms increase in severity.

Leveraging learning systems to improve quality and patient safety in allergen immunotherapy.

Adverse events occur in all fields of medicine, including allergy-immunology, in which allergen immunotherapy medical errors can cause significant harm. Although difficult to experience, such errors constitute opportunities for improvement. Identifying system vulnerabilities can allow resolution of latent errors before they become active problems.

Growing up with allergies: Transitioning from adolescence to adulthood.

Allergic disease management for adolescents and young adults requires consideration of unique psychosocial challenges and opportunities. Erik Erikson's model for the Stages of Psychosocial Development is a useful lens through which we can understand adolescent and young adult experiences with allergic and immunologic disease, particularly with regard to identity and relationship development. It is important to provide anticipatory guidance for patients who are transitioning environments (eg, home to college), with attention to the anxiety-provoking demands for increased responsibility on top of new stressors such as academic and vocational demands.

The association between mental health stigma and face emotion recognition in individuals at risk for psychosis.

Self-stigma has been associated with reduced accuracy of face emotion recognition in individuals at clinical high risk for psychosis (CHR). Stigma may also relate to slowing of performance during cognitive tasks for which a negative stereotype is relevant. This study aimed to investigate the association of mental illness stigma with face emotion recognition among CHR individuals.

Mixed 3D-2D Perovskite Flexible Films for the Direct Detection of 5 MeV Protons.

This study reports on a novel, flexible, proton beam detector based on mixed 3D-2D perovskite films deposited by solution onto thin plastic foils. The 3D-2D mixture allows to obtain micrometer-thick and highly uniform films that constitute the detector's active layer. The devices demonstrate excellent flexibility with stable electric transport properties down to a bending radius of 3.

[Evaluability study of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD)].

With the implementation of home care in the Brazilian Unified National Health System (SUS), the need to train administrators and health workers led to the creation of the Multicenter Program for Professional Qualification in Distance Home Care (PMQPAD) in a partnership between the SUS Open University and the General Coordinating Division for Home Care, of the Brazilian Ministry of Health. Through courses in specialization, improvement, and self-instruction, the program achieved wide capillarity and scope in the country, with nearly 300,000 enrollments across all states of Brazil. The current study aimed to structure a model to assess the PMQPAD through an evaluability study with participation by the program's administrators.

Emotional and stigma-related experiences relative to being told one is at risk for psychosis.

Objective: Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information.

Methods: Participants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR.

Management of the health workforce in facing COVID-19: disinformation and absences in Brazil's Public Policies.

The objective of this research was to analyse federal government interventions in crisis management and the consequences for health professionals. This is a documentary-type qualitative research. Brazilian Federal regulations referring to work and health education produced during the pandemic emergency of COVID-19, published from January 28 to June 2, 2020, were identified.

Designing Ultraflexible Perovskite X-Ray Detectors through Interface Engineering.

X-ray detectors play a pivotal role in development and advancement of humankind, from far-reaching impact in medicine to furthering the ability to observe distant objects in outer space. While other electronics show the ability to adapt to flexible and lightweight formats, state-of-the-art X-ray detectors rely on materials requiring bulky and fragile configurations, severely limiting their applications. Lead halide perovskites is one of the most rapidly advancing novel materials with success in the field of semiconductor devices.

Educational strategies for human resources in home health care: 8 years' experience from Brazil.

Objective: To analyze characteristics, enrollments and completion rates of healthcare professionals enrolled in Self-Instructional Online Courses of the Home Health Care Multicentre Qualification Program, developed by the Ministry of Health and the Universidade Aberta do SUS (UNASUS), and its relationship with Home Health Care Teams implementation.

Methods: Data were extracted from the Self-Instructional Online Courses' UNASUS enrollment platform database (2012-2018), cross-referenced with the Health Facilities' National Database and compared to Home Care General Coordination team's database. Main outcomes were completion rates and number of courses enrollments, analyzed by sex, age, region, location, profession, workplace, health teams and course type.

Effects of hybrid, kernel maturity, and storage period on the bacterial community in high-moisture and rehydrated corn grain silages.

This study evaluated changes in the bacterial community in high-moisture and rehydrated corn grain silage, and their correlation with fermentation quality attributes in distinct corn hybrids, the storage period, and kernel maturity at plant harvest. Most silages achieved good fermentation (pH<4.2).

Modes of care production and universal access - an analysis of federal guidance on the work of Primary Healthcare teams in Brazil.

This article analyzes federal guidance on the organization of primary healthcare work processes and the modes of production of care aimed at promoting universal access to services. A qualitative document analysis was undertaken of documents related to the National Health Policy, National Program for Improving Primary Care Access and Quality, More Doctors Program, and National Tele health Networks Brazil Program. Five thematic categories were defined for content analysis: staff training, valuing staff and work, organization of health actions for/with people and communities, complexity of healthcare and multiprofessional work, and collective construction of health as a right.