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The PHQ-9 questionnaire is a screening test worldwide used to measure depression. But it cannot be used in Costa Rica, due to the fact that it has not previously been validated for its population. The present study aims to show the validation of the PHQ-9 questionnaire and its variants (PHQ-2, PHQ-4, PHQ-8) in a population sample of adults residing in Costa Rica. A sample was collected (n = 1162) using a self-administered questionnaire. Confirmatory Factor Analysis (CFA), Receiver Operating Characteristic (ROC) curve, and Multiple Group Confirmatory Factor Analysis (MGCFA) were tested. One factor was found that explained 73.33% of the variance with excellent internal consistency (α = 0.928). Goodness-of-fit measures were adequate (RMSEA = 0.107; CFI = 0.948), as was diagnostic power at a cut-off of 10 (78.60 for Sensitivity and 27.95 for 1-Specificity). External validation indices were good (r = 0.843 with GAD-7, r = − 0.647 with RS14, and r = 0.301 with FCV19S), and the model showed invariance by sex (∆χ2 = 27.90; df = 27; p < 0.001). Additionally, new cut-off points were proposed for PHQ-9 and its variants for Costa Rican male, female, and general populations. The PHQ-9 and its variants (PHQ-2, 4, and 8) are valid tools for detecting depression (and anxiety for PHQ-4) in Costa Rican population. In addition, new cut-off points differentiated by sex are proposed. [ABSTRACT FROM AUTHOR]

The PHQ-9 questionnaire is a screening test worldwide used to measure depression. But it cannot be used in Costa Rica, due to the fact that it has not previously been validated for its population. The present study aims to show the validation of the PHQ-9 questionnaire and its variants (PHQ-2, PHQ-4, PHQ-8) in a population sample of adults residing in Costa Rica. A sample was collected (n = 1162) using a self-administered questionnaire. Confirmatory Factor Analysis (CFA), Receiver Operating Characteristic (ROC) curve, and Multiple Group Confirmatory Factor Analysis (MGCFA) were tested. One factor was found that explained 73.33% of the variance with excellent internal consistency (α = 0.928). Goodness-of-fit measures were adequate (RMSEA = 0.107; CFI = 0.948), as was diagnostic power at a cut-off of 10 (78.60 for Sensitivity and 27.95 for 1-Specificity). External validation indices were good (r = 0.843 with GAD-7, r = − 0.647 with RS14, and r = 0.301 with FCV19S), and the model showed invariance by sex (∆χ2 = 27.90; df = 27; p < 0.001). Additionally, new cut-off points were proposed for PHQ-9 and its variants for Costa Rican male, female, and general populations. The PHQ-9 and its variants (PHQ-2, 4, and 8) are valid tools for detecting depression (and anxiety for PHQ-4) in Costa Rican population. In addition, new cut-off points differentiated by sex are proposed. [ABSTRACT FROM AUTHOR]

The city governments of Costa Rica have a significant role in the National Risk Management System (SNGR in Spanish) to face the multiple threats and risks that affect the country from their territories. The different frameworks and policies that work with the Disaster Risk Management approach, among which are international (e. g., Sendai Framework for Action), regional (e. g., Central American Policy for Comprehensive Disaster Risk Management), and national instruments (e. g., National Risk Management Policy), promote risk analysis as a process that contributes to their reduction and mitigation, which, together with specific policies focused on gender (e. g., Convention on the Elimination of All Forms of Discrimination Against Women [CEDAW]), highlight the gender approach as a principle or axis, making the need to carry out reviews and actions differentiated by gender visible. The growth of inequalities in events such as disasters emphasizes the fact that there are gender differences in the perception of risks, the levels of vulnerability that exist and the capacities to cope. This article collects the research carried out that answers the question: "What are the psychosocial elements that influence the implementation of mainstreaming the gender approach in DRM processes in municipal offices?" from Community Social Psychology and Feminist Social Psychology. A study with a qualitative approach and phenomenological design was carried out, in which interviews were applied to institutional representatives in DRM and gender. The first seeks to promote processes of social transformation, considering the psychosocial processes that permeate community dynamics, which, in turn, are influenced by specific contexts. As for Feminist Psychology, it promotes the identification of inequalities and the creation of options for change. The relationship between feminist political perspectives and psychological practices and sexual and gender differences were considered as causes of inequalities, generating certain psychosocial analyzes not widely developed so far. A subjective perspective to the lived experience of the people participating in the research was considered in order to emphasize the meanings and knowledge as a process, based on interviews with institutional representatives of municipal offices and national institutions both focused on DRM or gender. Twelve psychosocial elements that influence the mainstreaming of the gender approach in municipal DRM were identified: the need for training and awareness, the requirement of political will, the naturalization of gender roles and stereotypes, the recognition of gender differences, resistance to mainstreaming gender, subjectivity, the presence or absence of inter and intra-institutional articulations, the social participation of women, the recognition of gender violence, the recognition of vulnerable populations, the cultural context and social inequalities. Moreover, gender inequalities are recognized as an element that affects and emphasizes the vulnerabilities of specific populations, such as women of different ages, transgender people, people with disabilities, among others. The research allowed an approach to ten different territorial contexts where DRM is put into practice from an office or as a process, and how the experience of the people who lead them understands the gender approach, contrasting with the institutional perspective applied at the national level. It is concluded that these should be made visible and can be worked on to address the risks of two historically discriminated populations: women and LGTBIQ+ population. Considering gender inequalities as an underlying cause of risk is a priority for Disaster Risk Management. [ABSTRACT FROM AUTHOR]

Image segmentation is an important issue in many industrial processes, with high potential to enhance the manufacturing process derived from raw material imaging. For example, metal phases contained in microstructures yield information on the physical properties of the steel. Existing prior literature has been devoted to develop specific computer vision techniques able to tackle a single problem involving a particular type of metallographic image. However, the field lacks a comprehensive tutorial on the different types of techniques, methodologies, their generalizations and the algorithms that can be applied in each scenario. This paper aims to fill this gap. First, the typologies of computer vision techniques to perform the segmentation of metallographic images are reviewed and categorized in a taxonomy. Second, the potential utilization of pixel similarity is discussed by introducing novel deep learning-based ensemble techniques that exploit this information. Third, a thorough comparison of the reviewed techniques is carried out in two openly available real-world datasets, one of them being a newly published dataset directly provided by ArcelorMittal, which opens up the discussion on the strengths and weaknesses of each technique and the appropriate application framework for each one. Finally, the open challenges in the topic are discussed, aiming to provide guidance in future research to cover the existing gaps. [Display omitted] • We create a metallography dataset from additive manufacturing of steels (MetalDAM). • We provide an updated taxonomy of segmentation methods. • We propose a new DL-based ensemble specialized in the semantic segmentation task. • We compare state-of-the-art models and the new ensembles with UHCS and MetalDAM. • We present a thorough analysis of the current difficulties and challenges. [ABSTRACT FROM AUTHOR]

This article examines Count Lucanor's exemplum 38, in which a man dies crossing a river after deciding not to let go of his treasure. This exemplum has barely received attention from critics. After proposing two potential Dominican sources (the origin of the story is unknown) and studying the socio-economic context, I maintain that, beyond an abstract condemnation of greed, Juan Manuel condemns the accumulation of wealth by members of the Third Estate. The example also reads as a variant of the scholastic debate of voluntary and involuntary acts (choice), developed by theologians such as Thomas Aquinas. This double reading confirms, in addition to certain features pointed out by traditional critics for Count Lucanor (cultural relevance of Sancho IV's reign, Dominican influence, the need to read the exempla in conjunction with the other parts...), the greater semantic complexity that critics like Laurence de Looze or Jonathan Burgoyne suggested for the book. [ABSTRACT FROM AUTHOR]

Background: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. Objectives: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. Methods: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. Results: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. Conclusion: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes. [ABSTRACT FROM AUTHOR]

Source Citation: Thiele H, Zeymer U, Akin I, et al; ECLS-SHOCK Investigators. Extracorporeal life support in infarct-related cardiogenic shock. N Engl J Med. 2023;389:1286-1297. 37634145 Clinical Impact Ratings: GIM/FP/GP: Cardiology: Critical Care: [ABSTRACT FROM AUTHOR]

Climate classifications based on temperature and precipitation measurements are increasingly being used for environmental and climate change studies. Using three classification methods (Köppen, Extended Köppen, and Holdridge) and one observational dataset for present climate (CRU, Climate Research Unit), we show that GCMs have bridged the gap that led to the emergence of RCMs thirty years ago, as GCMs can now provide global climate classifications whose accuracy and precision are comparable to those of regional outputs of the RCMs. Projections of high-resolution GCMs for future climates under the assumptions of three Representative Concentration Pathways (RCP26, RCP45 and RCP85) can therefore be used as a primary source for climate change and global warming studies at high resolution. This paper provides comprehensive, model-derived climate classifications for the entire planet, using RCMs and two GCMs for present and future climate-change scenarios, and discusses how well the models actually represent the climates of the world when compared with reference, ground validation data. It turns out that both GCMs and RCMs appear still limited to provide practical estimates of the world climates even for present climate conditions. The modeling of precipitation remains the Achilles' heel of models and thus of multidimensional indices, which are very sensitive to this variable. The conclusion is that model outputs at regional scale need to be taken with extreme caution without venturing into informing policies presenting potentially large societal impacts. Nonetheless, the role of models as privileged tools to advance our scientific knowledge of the Earth's system remains undisputed. • A systematic analysis of climate classifications with RCMs and two high resolution GCMs is presented. • Three classification methods are used to illustrate the differences between models and observations. • Current high-resolution GCMs can provide climate classifications with the same accuracy as those from RCMs. • Uncertainties in modeling precipitation persist for large parts of the world. [ABSTRACT FROM AUTHOR]

Abstract Climate classifications of climate models' outputs have been used to assess environmental changes but systematic analyses of the differences between models, scenarios and classification methods are scarce. Here, the results of applying the most commonly used climate classifications to the outputs of 47 Global Climate Models (GCM) of different physical parameterizations and varied grid size are presented. The extent and intensity of changes for present climate, three different Representative Pathways Scenarios (RCP26, RCP45 and RCP85) and three increasingly-fine classification methods show that there is a consensus between models, and that climate classifications are indeed useful tools to translate physical climatology variables into environmental changes. The main conclusions are that climate classifications can indeed be used to gauge model performance at several grid sizes and that the classification method does not decisively affects the potential global changes in future climates under increasing greenhouse gas emissions. The analyses also reveal that there are several uncertainties that are not attributable to model grid size or to limitations in the reference datasets but more likely to deficiencies in the physics of the models. Highlights • This paper provides a systematic analysis of climate classifications for present and future climates. • Several classifications methods are used to illustrate the consensus between models and observations. • Overall, global models show consistent changes but uncertainties persist with large differences in individual model skill. [ABSTRACT FROM AUTHOR]

ESMs (Earth system models) are important tools that help scientists understand the complexities of the Earth's climate. Advances in computing power have permitted the development of increasingly complex ESMs and the introduction of better, more accurate parameterizations of processes that are too complex to be described in detail. One of the least well-controlled parameterizations involves human activities and their direct impact at local and regional scales. In order to improve the direct representation of human activities and climate, we have developed a simple, scalable approach that we have named the POPEM module (POpulation Parameterization for Earth Models). This module computes monthly fossil fuel emissions at grid-point scale using the modeled population projections. This paper shows how integrating POPEM parameterization into the CESM (Community Earth System Model) enhances the realism of global climate modeling, improving this beyond simpler approaches. The results show that it is indeed advantageous to model CO2 emissions and pollutants directly at model grid points rather than using the same mean value globally. A major bonus of this approach is the increased capacity to understand the potential effects of localized pollutant emissions on long-term global climate statistics, thus assisting adaptation and mitigation policies. [ABSTRACT FROM AUTHOR]

ESMs (Earth System Models) are important tools that help scientists understand the complexities of the Earth's climate. Advances in computing power have permitted the development of increasingly complex ESMs and the introduction of better, more accurate parameterizations of processes that are too complex to be described in detail. One of the least well-controlled parameterizations involves human activities and their direct impact at local and regional scales. In order to improve the direct representation of human activities and climate, we have developed a simple, scalable approach that we have named the POPEM module (POpulation Parameterization for Earth Models). This module computes monthly fossil fuel emissions at grid point scale using the modeled population projections. This paper shows how integrating POPEM parameterization into the CESM (Community Earth System Model) enhances the realism of global climate modeling, improving this beyond simpler approaches. The results show that it is indeed advantageous to model CO2 emissions and pollutants directly at model grid points rather than using the forcing approach. A major bonus of this approach is the increased capacity to understand the potential effects of localized pollutant emissions on long-term global climate statistics, thus assisting adaptation and mitigation policies. [ABSTRACT FROM AUTHOR]

The influence of the 'Little Ice Age' (LIA) on the glaciers of Svalbard has been well documented for a long time. This paper presents new data on the LIA maximum glacier extent and retreat by aerial photo interpretation and Geographic Information Systems (GIS) tools. We also make cartography where all results are shown in greater detail. During the LIA maximum, we find that the glacier area of Svalbard was 38,871 km2, and since then, the total glacier area loss in the archipelago has been 5096 km2 (13.1%). The total current glaciated area from the late 2000s is 33,775 km2. Since the LIA, the glaciers in the main islands of the archipelago have retreated by 12.8% in Spitsbergen, 13.4% in Nordaustlandet, and 16.7% in Barentsøya and Edgeøya. The analysis of the LIA maximum glacier extent in the different major drainage basins shows important differences; about 100 years ago, some glacier basins were more than 19% larger in the western and central regions of Spitsbergen, or even more than 23% larger in southern Nordaustlandet, while other small basins found in the northeast of this island were barely 1% larger. The greatest retreats are found in the tidewater glaciers, more variable and responsive to the water temperature changes, water dynamics, and bathymetry. In addition, the advances at some of these glaciers may correspond with surges, which means that the rapid retreats are caused by the post-surging phases as well as climate. The conclusions of this research point out an important ice loss in all of Svalbard since the LIA and the high vulnerability of this Arctic archipelago to global warming. [ABSTRACT FROM AUTHOR]

Entamoeba histolytica trophozoites dwell in the human intestine as comensals although under still unclear circumstances become invasive and destroy the host tissues. For these activities, trophozoites relay on remarkable motility provided by the cytoskeleton organization. Amebic actin and some of its actin-associated proteins are well known, while components of the myosin II molecule, although predicted from the E. histolytica genome, need biochemical and functional characterization. Recently, an amebic essential light myosin II chain, named Eh MLCI, was identified and reported to be phosphorylated in tyrosines. The phosphorylated form of the protein was associated with the soluble assembly incompetent conformation of the heavy myosin chains, while the non-phosphorylated protein was identified with filamentous heavy chains, organized in an assembly competent conformation. It was postulated that Eh MLCI tyrosine phosphorylation could act as a negative regulator of myosin II activity by its phosphorylation/dephosphorylation cycles. To test this hypothesis, we constructed an expression vector containing an Eh MLCI DNA sequence where two tyrosine residues, with strong probability of phosphorylation and fall within the single EF-hand domain that interacts with the N-terminus of myosin II heavy chains, were replaced by phenylalanines. Transfected trophozoites, expressing the mutant MutEh MLCI protein cannot process it, thereby not incorporated into the phosphorylation/dephosphorylation cycles required for myosin II activity, results in motility defective trophozoites. [ABSTRACT FROM AUTHOR]

Introduction and aims: Living habits, several nutritional aspects and the relationship between them were studied at Hospital de Mérida health professionals in the Extremadura Health Service. Methods: Forty-three employed workers voluntary participated in this project by submitting a questionnaire about personal details and life style, and a seven-day food intake diary. Finally, their anthropometric data were also measured. Results: Men tended to do more physical activities than women. They also were more sedentary. They used to smoke less than women, but they drank more alcohol. Normoweight subjects tried to practice sport during more time than overweight and obese ones. However, they also remained sitting for longer periods on a weekly basis. The average daily intakes of kilocalories were higher in men, but protein intakes were higher in women. Fat intake was increased in both sexes. The average daily intake of kilocalories was lower in obese subjects than overweight and normoweight ones. An increase in the body mass index was accompanied by a bigger waist perimeter, waist to hip ratio, fat mass and body fat percentage. Conclusion: The majority of people interviewed in the survey have healthy living and dietary habits. Protein and fat daily intake is slightly higher than the values recommended by the WHO. Carbohydrate intake, by contrast, is lower. [ABSTRACT FROM AUTHOR]

This article discusses the nationalistic qualities of Spanish literature during the Spanish Civil War and under the regime of Francisco Franco. The author comments on the testimonial aspects of this literature, especially those accounts written by prisoners during the war. He also considers the relationship between political atmosphere in Spain at the time and the literature being produced.

This review exposes the results of a first approximation to the analysis of the moderator effect of the geographical, social, and cultural context on subjective indicators of healthy aging in the Costa Rican context. Costa Rica is a middle-income democratic country that is in an advanced demographic changing process; this phenomenon makes it one of the aged countries in the Latin American region. Therefore, studying healthy aging becomes relevant in the context of population demographic change in the present and future aging societies. The study compared several subjective indicators of healthy aging among people older than 46 who resided in three different geographical areas in the country. Participants were 305 healthy people from three locations: one urban (Heredia Central City), one semi-urban (Santa Ana Central City), and one mainly rural (Nicoya). Participants completed standardized assessment scales to evaluate social participation, social support, perceived health, spirituality, self-efficacy, self-care behaviors, and subjective well-being (life satisfaction and psychological well-being). All variables were conditioned by geographical zone (urban, semi-urban, and mainly rural), age, and gender. Either Analysis of Covariance (ANCOVA) or Multivariate Analysis of Covariance (MANCOVA) were estimated depending on the number of dependent variables analyzed to test the effect of the zone of residence, gender, and age, over the subjective indicator of healthy aging studied. In general, participants evidenced high scores on subjective indicators such as self-care, social support, spirituality, life satis- faction, and psychological well-being, which have been associated with health and well- being during the aging process. Participants reported high levels of social participation and perceived that they received adequate support for their daily life needs. Likewise, participants evidenced a general state of well- being, a positive state of health, high levels of self-efficacy, and positive moods. Differences were found among the groups by comparing age. However, no significant differences were found in the variables studied related to geographical areas of residence and sex, suggesting invariant comparison evidence by zone of residence and sex. Nevertheless, the results indicate that the subjective indicators of healthy aging studied are key to promoting healthy aging at the national level. It is considered necessary to improve opportunities for social participation aimed at older adults, to strengthen community and family social networks, to promote socio-economic support such as financial and instrumental support for activities of daily living, and finally emotional support such as listening, empathy and advice. Although the differences among geographical areas of residence of the people studied were not statistically significant in this study, the evidence suggested a trend of high well-being indicators mainly in the rural areas studied, and particularly more in males than in females. As this study only reached preliminary data, further research must obtain conclusive evidence, as previous research had suggested older people living in rural areas with high longevity indicators in Costa Rica might enjoy unusual environmental characteristics and personal protective factors that could be absent in most of the urban areas in the country. On the other hand, it will be necessary to include the historical and socio-cultural determinants focusing on context-specific review analyses in the mainstream research on healthy aging, even more in aged countries like Costa Rica. The findings are discussed within the inter-cultural emphasis and healthy aging models in order to contribute to a better understanding of how the context (physical-constructed and social/cultural) influences the differences, although subtle, in the study´s variables and participants, and how the process of aging might be different according to the multiple contextual conditions in which people live and adapt their capacities and abilities for coping with daily life demands. [ABSTRACT FROM AUTHOR]

Grid computing technologies are emerging as the latest generation of distributed computing, as they allow the aggregation of resources that are geographically distributed over different locations. Since researchers need to conduct repeatable and controlled experiments, it is easier to use simulation as a means of studying complex scenarios. In this area, the GridSim simulation toolkit is a widely accepted option. We have designed and implemented a simulator of systems that integrates sensors and a grid. In particular, an extension of GridSim has been created in order to enable the execution of simulations in a way the users can perform queries on sensor networks. In this paper, we present the features of the system to be simulated, the modeling proposed, and the high-level user interfaces of the simulator. We also describe an experiment that demonstrates how our proposal works, which may well be helpful for the research community. [ABSTRACT FROM AUTHOR]

Abstract: Under environmental stress conditions, mesquite trees can excrete a proteinaceous arabinogalactan gum that is similar to gum arabic. Given the application potential of this type of gums a classification procedure for the mesquite gum is proposed. The main physicochemical properties of the best-quality mesquite gum were determined and compared with those of gum arabic. Additionally, the composition and molecular changes induced by purification processes were recorded. One batch (157kg) of mesquite gum was categorized by subjective assessment into three classes (MGA, MGB and MGC) from high- to low-quality. Approximately 17.5% was classified as top-quality gum. It was found that this class of mesquite gum has lower humidity, inorganic and tannins content than the other classes, or even than the gum arabic sample used as a reference. All of the mesquite gum classes have higher protein content and lower intrinsic viscosity than gum arabic. The purification processes were shown to reduce the content of lower molecular weight compounds that modify the interface properties of the gum. The results indicate that the proposed classification method can be used to select mesquite gum with physicochemical properties comparable to those of commercial gum arabic. [Copyright &y& Elsevier]

Abstract: Different platforms based on carbon pastes and composite materials, such as epoxy resin, are used to construct chromium (VI) potentiometric sensors. The materials are modified with diphenylcarbazide as selective agent for chromium (VI) ions. Matrix compositions of each sensor are optimized on the basis of graphite and ionophore amounts. The performance characteristics of all the designed solid-state potentiometric sensors are described. The same linear response range from 1.00×10−6 to 1.00×10−2 molL−1 and similar detection limits, 6.3×10−7 molL−1 for graphite-epoxy sensor and 9×10−7 molL−1 for carbon paste sensor, are obtained. However, the sensor based on graphite-epoxy materials shows better selective responses and lifetime. Both sensors exhibit high selectivity to hexavalent chromium even in presence of trivalent chromium. The sensors are successfully used in direct potentiometric determinations of hexavalent chromium and are also employed as indicator electrodes in potentiometric titrations with successful results. [Copyright &y& Elsevier]

Abstract: A new and easy device for direct detection of chromium(III) in batch and flow analysis without previous oxidation/reduction or preconcentration steps of samples is designed and evaluated. For this purpose a potentiometric sensor with solid state membrane based on carbon paste matrix is developed. The sensor is modified with di(2-hydroxyphenylimino)ethane and the principal analytical parameters of the potentiometric response in batch and flow analysis are optimized and calculated. Optimal detection limits (1.4×10−7 M in static mode and 5.4×10−7 M in on-line analysis) and selectivity to trivalent chromium are obtained in both analysis modes. The use of this device to direct detection of chromium(III) in real samples is tested using a sediment Certified Reference Material. Chromium(III) determination is also carried out with successful results in environmental samples such as extracts from soils used as barriers in landfills and industrial samples such as waste waters from electroplating industries. [Copyright &y& Elsevier]

Objectives. To characterize the health system stakeholder's perspective on the basics of the political, economic, and sanitary context, as well as the ways in which control activities are being realized in four of Colombia's health departments. Methods. This was a qualitative study of four Colombian health departments chosen for their differing cervical cancer mortality rates and their planned disease control efforts (Boyacá, Caldas, Magdalena, and Tolima). Semistructured interviews were conducted of health care managers, insurance coordinators, and public and private health institutions at the departmental and municipals levels. Focus groups comprised of professionals from health insurance companies and health care services providers were convened. Data analysis was based on the grounded theory with open codes related to the roles of health care managers, insurance companies, and heath care services provided. The technical reports were compared to the testimonies of interviewees. Results. Thirty-eight interviews and 14 focus groups (70.9% response rate) were conducted and 12 technical reports reviewed. Cervical cancer is not perceived to be a public health priority. Interest centers on the flow of financial resources within the health system. Findings indicated unsatisfactory communication among the stakeholders and no consensus on the subject. Planning is limited to meeting the status quo. Staffing is inadequate. Cases with positive outcomes are lost to follow-up due to the fragmentation that results from affiliation with different health care systems. Conclusions. The financial situation, normative planning, and the challenges of decentralization affect the skill-building, at-risk coverage, and the control activities needed for effective screening programs. What is needed is an integrated, more efficiently organized program in which all the health system stakeholders participate. [ABSTRACT FROM AUTHOR]

Abstract: This paper briefly describes the most relevant current approaches to the implementation of scientific models of consciousness. Main aspects of scientific theories of consciousness are characterized in sight of their possible mapping into artificial implementations. These implementations are analyzed both theoretically and functionally. Also, a novel pragmatic functional approach to machine consciousness is proposed and discussed. A set of axioms for the presence of consciousness in agents is applied to evaluate and compare the various models. [Copyright &y& Elsevier]

Abstract: Background: Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), those with multivessel disease have worse prognosis, mainly due to a higher frequency of cardiogenic shock (CS) at admission. The aim of this study was to identify clinical and angiographic characteristics of patients with STEMI, multivessel disease and CS at admission referred to primary PCI. Methods: We studied 630 patients with STEMI treated with primary PCI within 12 h after symptoms onset. Multivessel disease was defined as the presence of ≥50% stenosis in ≥2 major epicardial arteries. Multivessel disease was documented in 276 patients (44%), these patients comprising the study population. Clinical, angiographic and procedural variables were compared between those with and without CS. A logistic regression analysis was performed to identify the independent predictors of CS among patients with multivessel disease. Results: Among patients with multivessel disease, 45 (16%) had CS at admission. The independent predictors of CS in patients with multivessel disease were: STEMI anterior [OR 2.05; 95% CI 1.0 to 4.1; p =0.044], female gender [odds ratio (OR) 2.49; 95% confidence intervals (CI) 1.1 to 5.3; p =0.021], proximal culprit lesion [OR 3.8; 95% CI 1.7 to 8.5; p <0.001], and chronic occlusion of other coronary arteries [OR 4.48; 95% CI 2.1 to 9.1; p <0.001]. Conclusions: Among patients with STEMI and multivessel disease, CS is especially frequent in STEMI anterior, female gender, proximal culprit lesion, and chronic occlusion of other vessels. [Copyright &y& Elsevier]

The only clinical benefit of drug-eluting stents (DESs) over bare metal stents (BMSs) is a significant decrease in the need for new revascularization procedures. We evaluated whether DESs also decrease the incidence of myocardial infarction at midterm. We performed a meta-analysis from 25 randomized trials comparing commercially available DESs with BMSs that included 9,791 patients overall. There was no heterogeneity across the trials included (Q test for heterogeneity, p = 0.68). Of the 9,791 patients included in all the trials, 364 developed an acute myocardial infarction during follow-up (6 to 12 months). The risk of myocardial infarction was significantly lower in patients allocated to DESs (3.3% vs 4.2% in those allocated to BMSs, odds ratio 0.79, 95% confidence interval 0.64 to 0.97, p = 0.03). In conclusion, the significant decrease in angiographic restenosis associated with the use of DESs leads not only to a decreased need for subsequent revascularization procedures but also a decreased incidence of myocardial infarction during the first 12 months after stent implantation. [Copyright &y& Elsevier]

This work was carried out to evaluate the effect of two silvicultural treatments on the composition and structure of forest ecosystems in the "Sierra de la Candela" {Mountain range) near Tepehuanes, Durango. The analysis was done comparing two experimental plots managed under different silvicultural practices, the first with thinning and the second using selective logging. Several neighborhood-based indices were used via the so-called "structural group of five trees" sampling method. The results obtained in the study show that the tree species mixture and diversity is greater in the plot where the selective logging was applied, compared to that treated by thinning. Both plots present a clumped spatial tree distribution. On the other hand, the size differentiation results were not significantly different in relation to the dimensional tree structure of the studied plots. [ABSTRACT FROM AUTHOR]

Objectives: We compared the risk of stent thrombosis (ST) after drug-eluting stents (DES) versus bare-metal stents (BMS), and tested the hypothesis that the risk of DES thrombosis is related to stent length. Background: Whether DES increase the risk of ST remains unclear. Given the very low restenosis rate after drug-eluting stenting, longer stents are frequently implanted for the same lesion length in comparison to BMS. Methods: We included in a meta-analysis 10 randomized studies comparing DES and BMS. Overall, 5,030 patients were included (2,602 were allocated to DES and 2,428 to BMS). The risk of thrombosis after DES versus BMS was compared, and the relationship between the rate of DES thrombosis and stent length was evaluated. Results: Incidence of ST was not increased in patients receiving DES (0.58% vs. 0.54% for BMS; odds ratio: 1.05; 95% confidence interval [CI]: 0.51 to 2.15; p = 1.000). The overall rate of ST did not differ significantly between patients receiving sirolimus- or paclitaxel-eluting stents (0.57% vs. 0.58%; p = 1.000). We found a significant relation between the rate of ST and the stented length (Y = −1.455 + 0.121 X; 95% CI for beta: 0.014 to 0.227; R = 0.716; p = 0.031). In patients with DES, mean stented length was longer in those suffering ST (23.4 ± 8.1 mm vs. 21.3 ± 4.1 mm, p = 0.025). Conclusions: Drug-eluting stents do not increase the risk of ST, at least under appropriate anti-platelet therapy. The risk of ST after DES implantation is related to stent length. [Copyright &y& Elsevier]

Abstract: Background: Recently, high-frequency transducers have been introduced in echocardiography laboratories to non-invasively evaluate peripheral arteries. Our aim was to assess the usefulness of these non-invasive vascular ultrasonic techniques in differentiating between ischemic and non-ischemic dilated cardiomyopathy. Methods: Forty patients with dilated cardiomyopathy of uncertain origin who underwent echocardiographic examination were studied. In all patients, carotid, femoral, and brachial arteries were scanned using high-frequency transducers in order to detect atherosclerotic plaques and to measure intima-media wall thickness. Also, flow-mediated vasodilation was measured at the brachial artery. Results: Of the 40 patients studied, 24 (60%) had significant coronary lesions. In patients with ischemic cardiomyopathy, carotid plaques were found more frequently (79% vs. 25%, p=0.001), and intima-media wall thickness was higher in carotid (1.14±0.23 vs. 0.84±0.20 mm, &#60;0.001), femoral (1.21±0.15 vs. 0.90±0.17 mm, p&#60;0.001), and brachial (0.85±0.11 vs. 0.68±0.12, p&#60;0.001) arteries. Carotid intima-media thickness of 1 mm or more was 83% sensitive and 69% specific for the diagnosis of ischemic cardiomyopathy. The highest diagnostic accuracy for any isolated vascular finding was obtained for femoral intima-media thickness greater than 1.1 mm (83% sensitivity, 88% specificity) and for brachial intima-media thickness greater than 0.7 mm (88% sensitivity and 81% specificity). The highest sensitivity (92%) was obtained for the presence of 1 or more vascular findings, and the highest specificity (94%) for 3 or more vascular findings. Conclusion: Non-invasive assessment of peripheral arteries is of help in differentiating between ischemic and non-ischemic dilated cardiomyopathy. These ultrasonic techniques should be considered as complementary examinations in the evaluation of patients with dilated cardiomyopathy in echocardiography laboratories. [Copyright &y& Elsevier]

The National Institute of Statistics, Geography and Informatics (INEGI) have been a processing pilot regional center of SIRGAS. This paper show the advances richen during 2005. [ABSTRACT FROM AUTHOR]

Objectives: A meta-analysis of 11 randomized trials was done to compare stenting versus balloon angioplasty (BA) in small coronary vessels.Background: Randomized studies on coronary stenting (CS) in small vessels have yielded controversial results.Methods: Eleven randomized trials on CS versus BA in small vessels, including angiographic re-evaluation at six months, were analyzed.Results: The BeStent (Medtronic Instent, Minneapolis, Minnesota) was used in four studies, the Multi-Link (Guidant, Advanced Cardiovascular Systems Inc., Santa Clara, California) in three trials, and the NIR (Boston Scientific Corp., Boston, Massachusetts), JoStent (Jomed International AB, Helsingborg, Sweden), Tenax (Biotronik, Berlin, Germany), and BioDivysio (Abbott Vascular Devices, Redwood City, California) in the remaining four trials. Overall, 3,541 patients were included (1,672 allocated to BA and 1,869 to stent). The rate of cross-over from balloon to stent in the pooled population was 19%, and unsuccessful stent deployment occurred in 2% of the patients allocated to stent. The pooled rates of restenosis were 25.8% and 34.2% in patients allocated to stent and balloon, respectively (p = 0.003) (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.65 to 0.92). A smaller reference vessel diameter at baseline was associated with a higher risk reduction in the restenosis rate (y = -3.551 + 1.826 [x]; p = 0.012). Patients allocated to stent had lower rates of major adverse cardiac events (15.0% vs. 21.8%, p = 0.002; RR 0.70; 95% CI 0.57 to 0.87) and new target vessel revascularizations (12.5% vs. 17.0%, p = 0.004; RR 0.75, 95% CI 0.61 to 0.91).Conclusions: Elective stenting is superior to provisional stenting in small coronary arteries. This benefit is more evident in smaller coronary arteries. [Copyright &y& Elsevier]

This paper shows the works and actions that the National Institute of Statistics, Geography and Informatics have been done up to date, with the purpose to integrate the National Register of Images. Such register could allow improve the performance in the data reception and distribution through remote sensing. [ABSTRACT FROM AUTHOR]

This contribution show the proposal to conform the Registration Territory ID (CURT), a required way to integrate and share territorial data that different agencies of the three level of governance take or process. The design of the ID it looking for accomplishes with characteristics of independence of administrative classification, homogeneity, as well as inimitable at national level, taking in accounts as a base the geographical data generated in a cadastral survey. [ABSTRACT FROM AUTHOR]

Background and Objective: Contrast echocardiography has been recently introduced as a new technique for evaluating myocardial perfusion in a qualitative basis. The objective of this study was to test whether a visual subjective evaluation of myocardial perfusion by myocardial contrast echocardiography adequately matches the data obtained with an off-line quantification of myocardial perfusion. Methods: Sixty-one myocardial segments were evaluated by myocardial contrast echocardiography with Ultra-harmonic and Multiframe Triggering in 11 patients 3-7 days after an anterior myocardial infarction, using SH-U 563A (Levovistaˆ, Schering AG, Berlin, Germany) as contrast agent. Myocardial perfusion was classified as grade 1 (absent), 2 (patchy or incomplete) and 3 (complete) in each segment. The quantitative analysis was performed off-line by a different investigator blinded to the qualitative evaluation, using a commercially available software. The quantitative data on grey-scale obtained were compared between grade 1, 2 and 3 segments. Results: Of the 61 segments, 45 (73.8%) were classified as grade 3, whereas the remaining 16 (26.2%) were considered to be abnormally perfused (grade 2: n=12, 19.6%; grade 1: n=4, 6.6%). Segments with grade 1 perfusion had a significantly higher grey-scale value (123.6±41.3 vs. 70.1±34.3, p=0.004). However, there were no significant differences between segments with perfusion grade 2 and 3 (76.8±33.2 vs. 68.3±34.8, p=0.452). Conclusion: Qualitative assessment of myocardial perfusion by Ultra-harmonic and Multiframe Triggering is of limited value, since only myocardial segments with absent perfusion may be reliably identified. This findings support the need of quantification in the evaluation of myocardial perfusion by contrast echocardiography. [Copyright &y& Elsevier]

Background and objectives: In addition to the myocardium, the microvasculature may be also damaged in acute myocardial infarction. The aim was to evaluate the capability of myocardial contrast echocardiography in the detection of microvasculature damage after myocardial infarction. Patients and methods: Twelve patients with recent acute myocardial infarction and five control subjects with normal coronary arteries and without history of myocardial infarction were studied. Myocardial contrast echocardiography with power modulation was performed, and quantitative data were measured off-line. Power modulation uses a combination of low (0.1) and high (1.7) mechanical indexes, allowing a real-time evaluation of myocardial perfusion. Contrast agent was administered as a 3-min bolus. The quantitative analysis was performed off-line by a different blinded investigator. The refilling velocity was calculated as the difference between the peak myocardial refilling value and the value at 1 s after the impulse divided by the time from the first second after the impulse to the peak refilling value. Results: Eighty-one myocardial segments (75%) were analysed qualitatively and quantitatively in AMI patients, and 18 (60%) in control subjects (P=NS). The peak refilling intensity was not significantly different in patients and control subjects (6.62±5.85 vs. 7.53±4.06 dB, respectively). However, time to peak refilling intensity was significantly longer (5.25±1.57 vs. 4.00±0.53, P=0.004) and the velocity of refilling was significantly lower (2.74±5.34 vs. 6.58±8.02, P=0.028) in patients with myocardial infarction. Conclusion: There is microvasculature damage after myocardial infarction that is reflected as a delayed velocity of refilling in myocardial contrast echocardiography. [Copyright &y& Elsevier]

Objectives: This study aimed to evaluate the effect of primary angioplasty (PA) over the risk of free wall rupture (FWR) in reperfused acute myocardial infarction (AMI).Background: It has been suggested that PA reduces the risk of FWR compared with thrombolysis. However, few studies have evaluated this issue, and there are no data demonstrating this hypothesis.Methods: A total of 1,375 patients with AMI treated with PA (n = 762, 55.4%) or thrombolysis (n = 613, 44.6%) within 12 h after symptoms onset were included. The diagnosis of FWR was made either in the presence of sudden death due to electromechanical dissociation with large pericardial effusion on an echocardiogram or when demonstrated post mortem or at surgery. A multivariable analysis was performed including type of reperfusion strategy.Results: The overall incidence of FWR was 2.5% (n = 34): 1.8% and 3.3% in patients treated with PA and with thrombolysis, respectively (p = 0.686). The following characteristics were associated with a higher rate of FWR in the univariable analysis: age >70 (5.2% vs. 1.2%, p < 0.001), female gender (5.1% vs. 1.8%, p = 0.006), anterior location (3.3% vs. 1.4%, p = 0.020) and treatment >2 h after symptoms onset (3.6% vs. 1.7%, p = 0.043). In the multivariable analysis, age >70 (odds ratio [OR]: 4.12, 95% confidence interval [CI]: 2.04 to 8.62, p < 0.001) and anterior location (OR: 2.91, 95% CI: 1.36 to 6.63, p = 0.008) were independent risk factors of FWR, whereas treatment with PA was an independent protective factor (OR: 0.46, 95% CI: 0.22 to 0.96, p = 0.0371).Conclusions: In patients with AMI, PA reduces the risk of FWR in comparison with thrombolysis. [ABSTRACT FROM AUTHOR]

: ObjectivesThis study aimed to evaluate the effect of primary angioplasty (PA) over the risk of free wall rupture (FWR) in reperfused acute myocardial infarction (AMI).: BackgroundIt has been suggested that PA reduces the risk of FWR compared with thrombolysis. However, few studies have evaluated this issue, and there are no data demonstrating this hypothesis.: MethodsA total of 1,375 patients with AMI treated with PA (n = 762, 55.4%) or thrombolysis (n = 613, 44.6%) within 12 h after symptoms onset were included. The diagnosis of FWR was made either in the presence of sudden death due to electromechanical dissociation with large pericardial effusion on an echocardiogram or when demonstrated post mortem or at surgery. A multivariable analysis was performed including type of reperfusion strategy.: ResultsThe overall incidence of FWR was 2.5% (n = 34): 1.8% and 3.3% in patients treated with PA and with thrombolysis, respectively (p = 0.686). The following characteristics were associated with a higher rate of FWR in the univariable analysis: age >70 (5.2% vs. 1.2%, p < 0.001), female gender (5.1% vs. 1.8%, p = 0.006), anterior location (3.3% vs. 1.4%, p = 0.020) and treatment >2 h after symptoms onset (3.6% vs. 1.7%, p = 0.043). In the multivariable analysis, age >70 (odds ratio [OR]: 4.12, 95% confidence interval [CI]: 2.04 to 8.62, p < 0.001) and anterior location (OR: 2.91, 95% CI: 1.36 to 6.63, p = 0.008) were independent risk factors of FWR, whereas treatment with PA was an independent protective factor (OR: 0.46, 95% CI: 0.22 to 0.96, p = 0.0371).: ConclusionsIn patients with AMI, PA reduces the risk of FWR in comparison with thrombolysis. [Copyright &y& Elsevier]

At the beginning of the 21st century, approximately 2.3 million US adults had atrial fibrillation (AF), and there has been a 60% increase in hospital admissions for AF. Given that the expectancy is a continuous increase in incidence, it portends a severe healthcare problem. Considerable evidence supports the immune system and inflammatory response in cardiac tissue, and circulatory processes are involved in the physiopathology of AF. In this regard, finding novel inflammatory biomarkers that predict AF recurrence after catheter ablation (CA) is a prime importance global healthcare problem. Many inflammatory biomarkers and natriuretic peptides came out and were shown to have predictive capabilities for AF recurrence in patients undergoing CA. In this regard, some studies have shown that red blood cell distribution width (RDW) is associated with the risk of incident AF. This review aimed to provide an update on the evidence of the RDW as a biomarker of red cell dysfunction and its association with high systemic inflammation, and with the risk of incident AF. Through the literature review, we will highlight the most relevant studies of the RDW related to AF recurrence after CA. Many studies demonstrated that RDW is associated with all cause-mortality, heart failure, cardiovascular disease, and AF, probably because RDW is a biomarker of red blood cell dysfunction associated with high systemic inflammation, reflecting an advanced heart disease with prognostic implications in heart failure and cardiovascular disease. Thus, suggesting that could be a potential predictor for AF recurrence after CA. Moreover, the RDW is a parameter included in routine full blood count, which is low-cost, quick, and easy to obtain. We provided an update on the evidence of the most relevant studies of the RDW related to AF recurrence after CA, as well as the mechanism of the high RDW and its association with high systemic inflammation and prognostic marker in cardiovascular disease and heart failure. [ABSTRACT FROM AUTHOR]

In the present work, different algorithms for contact detection in multibody systems based on smooth contact modelling approaches are presented. Beginning with the simplest ones, some difficult interactions are subsequently introduced. In addition, a brief overview on the different kinds of contact/impact modelling is provided and an underlining of the advantages and the drawbacks of each of them is determined. Finally, some practical examples of each interaction are presented and analyzed and an outline of the issues arisen during the design process and how they have been solved in order to obtain stable and accurate results is given. The main goal of this paper is to provide a resource for the early-stage researchers in the field that serves as an introduction to the modelling of simple contact/impact events in the context of multibody system dynamics. [ABSTRACT FROM AUTHOR]

Source Citation: Brouwer J, Nijenhuis VJ, Delewi R, et al. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med. 2020;383:1447-57. 32865376. [ABSTRACT FROM AUTHOR]

• Typological segmentation of brittle fracture surfaces using pretrained CNN. • Area fraction of intergranular and transgranular fracture is measured quantitatively. • The network, trained on MgAl 2 O 4 can be used for other ceramics without further training. The science of fractography revolves around the correlation between topographic characteristics of the fracture surface and the mechanisms and external conditions leading to their creation. While being a topic of investigation for centuries, it has remained mostly qualitative to date. A quantitative analysis of fracture surfaces is of prime interest for both the scientific community and the industrial sector, bearing the potential for improved understanding on the mechanisms controlling the fracture process and at the same time assessing the reliability of computational models currently being used for material design. With new advances in the field of image analysis, and specifically with machine learning tools becoming more accessible and reliable, it is now feasible to automate the process of extracting meaningful information from fracture surface images. Here, we propose a method of identifying and quantifying the relative appearance of intergranular and transgranular fracture events from scanning electron microscope images. The newly proposed method is based on a convolutional neural network algorithm for semantic segmentation. The proposed method is extensively tested and evaluated against two ceramic material systems ( Al 2 O 3 , MgAl 2 O 4 ) and shows high prediction accuracy, despite being trained on only one material system ( MgAl 2 O 4 ). While here attention is focused on brittle fracture characteristics, the method can be easily extended to account for other fracture morphologies, such as dimples, fatigue striations, etc. [ABSTRACT FROM AUTHOR]

It is estimated that 50 million people in the world live with dementia, 60–70% of whom suffer from Alzheimer's disease (AD). Different factors are involved in the development of AD, including a reduction in the cholinergic neurotransmission level. The Amaryllidaceae plant family contains an exclusive, large, and still understudied alkaloid group characterized by a singular skeleton arrangement and a broad spectrum of biological activities. The chemistry and biodiversity of Ecuadorian representatives of the Phaedranassa genus (Amaryllidaceae) have not been widely studied. In this work, five Ecuadorian Phaedranassa species were examined in vitro for their activity towards the enzymes acetyl- (AChE) and butyrylcholinesterase (BuChE), and the alkaloid profile of bulb extracts was analyzed by GC-MS. The species Phaedranassa cuencana and Phaedranassa dubia showed the most AChE and BuChE inhibitory activity, respectively. To obtain insight into the potential role of the identified alkaloids in these inhibitory effects, docking experiments were carried out, and cantabricine showed in silico inhibitory activity against both cholinesterase structures. Our results show that Amaryllidaceae species from Ecuador are a potential source of new drugs for the palliative treatment of AD. [ABSTRACT FROM AUTHOR]