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Abstract Deep single-cell multi-omic profiling offers a promising approach to understand and overcome drug resistance in relapsed or refractory (rr) acute myeloid leukemia (AML). Here, we combine single-cell ex vivo drug profiling (pharmacoscopy) with single-cell and bulk DNA, RNA, and protein analyses, alongside clinical data from 21 rrAML patients. Unsupervised data integration reveals reduced ex vivo response to the Bcl-2 inhibitor venetoclax (VEN) in patients treated with both a hypomethylating agent (HMA) and VEN, compared to those pre-exposed to chemotherapy or HMA alone. Integrative analysis identifies both known and unreported mechanisms of innate and treatment-related VEN resistance and suggests alternative treatments, like targeting increased proliferation with the PLK inhibitor volasertib. Additionally, high CD36 expression in VEN-resistant blasts associates with sensitivity to CD36-targeted antibody treatment ex vivo. This study demonstrates how single-cell multi-omic profiling can uncover drug resistance mechanisms and treatment vulnerabilities, providing a valuable resource for future AML research.

Accurate estimates of greenhouse gas emissions and sinks are critical for understanding the carbon cycle and identifying key drivers of anthropogenic climate change. In this study, we investigate the variability in CO and CO2 concentrations and their ratio over the Mexico City metropolitan area (MCMA) using long-term, time-resolved columnar measurements at three stations, employing solar-absorption Fourier transform infrared spectroscopy (FTIR). Using a simple model and the mixed-layer height derived from a ceilometer, we determined the CO and CO2 concentrations in the mixed layer from the total column measurements and found good agreement with surface cavity ring-down spectroscopy measurements. In addition, we used the diurnal pattern of CO columnar measurements at specific time intervals to estimate an average growth rate that, when combined with the space-based Tropospheric Monitoring Instrument (TROPOMI) CO measurements, allowed for the derivation of annual CO and CO2 MCMA emissions from 2016 to 2021. A CO emission decrease of more than 50 % was found during the COVID-19 lockdown period with respect to the year 2018. These results demonstrate the feasibility of using long-term EM27/SUN column measurements to monitor the annual variability in the anthropogenic CO2 and CO emissions in Mexico City without recourse to complex transport models. This simple methodology could be adapted to other urban areas if the orography of the regions favours low ventilation for several hours per day and the column growth rate is dominated by the emission flux.

Second language learning is closely linked to the attitude of the learners. Positive attitudes contribute exponentially to effective learning. Likewise, negative attitudes can hinder learning. The aims of this study are, firstly, to check whether negative attitudes towards second language learning exist and, secondly, to analyse the effect that the use of an educational portfolio can have on these attitudes. Research shows that e-portfolios are useful tools in language learning, however there is scarce scientific evidence that relate the use of e-portfolios with attitude. This paper aims to fill this gap in relation to the effect e-portfolios may have on students’ attitudes. The Mahara e-portfolio was used along with a sample of 207 students pursuing the degree in early childhood education. They were administered a questionnaire to measure a range of attitudinal factors before and after the use of the e-portfolio. A descriptive analysis and comparison analysis of the independent samples was carried out using the non-parametric Mann-Whitney U test. The results show that there are indeed negative attitudes related to language learning and that the use of an e-portfolio contributes to mitigating them. It is also an effective tool for the promotion of positive attitudes and, therefore, using an e-portfolio in language classrooms can be very beneficial for both students and teachers since it will help generating a better classroom atmosphere which will eventually lead to a better learning. These findings are expected to bring light to stakeholders to consider e-portfolio to encourage students’ motivation and pleasantness.

This study examines the microstructural evolution, elemental distribution, phase composition, and hardness variations in multi-material samples fabricated using Laser Powder Bed Fusion (LPBF) with Invar and Ti6Al4V with compositional gradients mediated by copper. A range of compositional transitions from Invar to Ti6Al4V with different copper fractions are reported. Defects such as gas and keyhole pores were detected in well-deep keyhole mode areas, while lack of fusion defects were observed in samples with pure Cu interlayers due to poor wettability and processing parameter variations. Crack formation between interlayer gradient zones and Invar regions was linked to FeNi and CuNi intermetallic phases. Intermetallic compounds (e.g., FeNi, CuNi, TiFe, TiNi) significantly influenced the microstructure and mechanical performance. Vickers hardness testing shows varying hardness across different builds, with the highest hardness being observed in the gradient zone enabled by pure copper (approximately 620 HV). This study also underscores the need for tailored component design linking build processing parameters and compositional transitions in multi-material LPBF to achieve desired properties and component structural behaviour.

Metabolic-associated steatotic liver disease (MASLD) and its pathological version, metabolic dysfunction-associated steatohepatitis (MASH), are becoming the main leading causes of chronic liver disease almost worldwide and are the fastest growing aetiology of hepatocellular carcinoma (HCC), especially in the Western countries. The combination of high incidence and morbidity with limited treatment options for both MASH and HCC highlights an urgent need for the discovery of novel therapeutic candidates to inform drug development. The importance of lysosomes and cathepsins, their most abundant hydrolases, has been overlooked for decades. They were considered organelles only involved in the recycling of macromolecules, with cathepsins simply being their effectors. Contrary to this traditional view, recent findings have shed new light on the lysosome and its enzymes as drivers of essential cellular processes, such as apoptosis and autophagy. Bringing lysosomal activity and the regulation of cathepsins into the spotlight of MASH and HCC research can open new avenues for the development of novel drugs based on targeting cathepsin-driven lysosomal activity and its associated pathological processes. This review comprehensively summarises the current knowledge on the role and contribution of lysosomal cathepsins to MASLD/MASH and HCC progression.

Brown tumors (BT) are rare reactive bone lesions associated with hyperparathyroidism, often posing a diagnostic challenge due to their imaging similarity to multiple myeloma and lytic metastases. In this case, we present a 45-year-old woman with right-sided hip pain who underwent imaging studies showing numerous lytic hypermetabolic lesions initially suggestive of secondary neoplastic involvement vs multiple myeloma, necessitating several imaging tests for the conclusive diagnosis of BT. This case report aims to provide a contemporary overview of BT, elucidating differentiators from alternative diagnoses such as multiple myeloma.

Introduction Dengue disease represents a large and growing global threat to public health, accounting for a significant burden to health systems of endemic countries. The World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) and the European Medicines Agency (EMA) currently recommend the use of TAK-003 dengue vaccine in high dengue burden and transmission settings for countries considering vaccination as part of their integrated management strategy for prevention and control of Dengue.Areas covered This paper describes the main conclusions of a workshop held by the Arbovirus Committee of the Latin American Society of Pediatric Infectious Diseases (SLIPE) in November 2023, to generate consensus recommendations on the introduction of this new vaccine in the region. Considerations were made regarding the molecular epidemiology of dengue infection in the Americas and the need for more precise phylogenetic classification and correlation with clinical outcome and disease severity.Expert opinion Introduction of dengue vaccine should be considered as an strategy for health entities in the region, with participation of social sectors, scientific societies, and ministries of health that could be able to create a successful vaccination program.

Abstract Background During the first wave of the COVID‐19 pandemic, the availability of mechanical ventilators was very limited and ad hoc recommendations establishing age to be used for patient triage for having access to intensive care beds (ICBs) were proposed. No reports have evaluated how this policy impacted ICB admission in Western countries. Aims We analyzed the age‐related probability of ICB admission during first COVID‐19 pandemic wave. Materials and Methods We included all patients ≥65 years attended in 42 Spanish emergency departments (EDs) covering around 22% of the Spanish population during 1‐week of the first wave of the COVID‐19 pandemic (9128 ED visits) and compared the probability of ICB admission respect to patients coming to these EDs 1‐week of 1‐year earlier (24,128 ED visits). Results We found that compared with patients aged 65, the probability of ICB admission was significantly reduced from 79 years and up during the pandemic period (odds ratio [OR] = 0.60 for patients aged 79, 95% confidence interval [CI] = 0.39–0.94), while a significant reduction of ICB admission probabilities was found from 88 years and up during the pre‐COVID‐19 period (OR = 0.66 for patients aged 88, 95% CI = 0.45–0.95) (p

Abstract Background Repetitive Transcranial Magnetic Stimulation (rTMS) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson’s disease (PD). However, the effects of their combination are unknown. Our objective was to determine the immediate and short-term effects on motor and non-motor symptoms, and neurophysiological measures, of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD. Methods A randomized, single-blinded controlled trial with 4 arms was conducted. Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over the Primary Motor Cortices; Group B received eight 30-minute EEG-guided neurofeedback sessions focused on reducing average bilateral alpha and beta bands; Group C received a combination of A and B; Group D did not receive any therapy. The primary outcome measure was the UPDRS-III at post-intervention and two weeks later. Secondary outcomes were functional mobility, limits of stability, depression, health-related quality-of-life and cortical silent periods. Treatment effects were obtained by longitudinal analysis of covariance mixed-effects models. Results Forty people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1–3). Group C showed the largest effect on motor symptoms, health-related quality-of-life and cortical silent periods, followed by Group A and Group B. Negligible differences between Groups A-C and Group D for functional mobility or limits of stability were found. Conclusions The combination of rTMS and EEG-guided neurofeedback diminished overall motor symptoms and increased quality-of-life, but this was not reflected by changes in functional mobility, postural stability or depression levels. Trial registration NCT04017481.

Abstract As major terrestrial carbon sinks, forests play an important role in mitigating climate change. The relationship between the seasonal uptake of carbon and its allocation to woody biomass remains poorly understood, leaving a significant gap in our capacity to predict carbon sequestration by forests. Here, we compare the intra-annual dynamics of carbon fluxes and wood formation across the Northern hemisphere, from carbon assimilation and the formation of non-structural carbon compounds to their incorporation in woody tissues. We show temporally coupled seasonal peaks of carbon assimilation (GPP) and wood cell differentiation, while the two processes are substantially decoupled during off-peak periods. Peaks of cambial activity occur substantially earlier compared to GPP, suggesting the buffer role of non-structural carbohydrates between the processes of carbon assimilation and allocation to wood. Our findings suggest that high-resolution seasonal data of ecosystem carbon fluxes, wood formation and the associated physiological processes may reduce uncertainties in carbon source-sink relationships at different spatial scales, from stand to ecosystem levels.

Paved roads are a solution for communication between human societies, but at the same time, their expansion is detrimental to wildlife. In this work, vertebrate mortality events due to traffic collisions on National Route N° 5, in a 50 km stretch from the town of Pozo Colorado to the east, are evaluated. Vehicle journeys were carried out at a constant speed of 40 km/h every two months, from November 2020 to May 2022. All findings of roadkill were recorded by photograph. To analyse spatial patterns, the Kernel density was estimated, assessing the randomness of Ripley's K collisions and standardised roadkill rates were assessed for each species. A total of 272 individuals were recorded, corresponding to 87 amphibians, 38 birds and 35 mammals. In terms of the number of species, the composition was as follows: reptiles with 20 species, birds with 13 species, mammals with 11 and amphibians with at least 12 species. The species with the highest number of dead individuals was the common toad (Rhinella diptycha), followed by snakes. According to the standardised roadkill rates, the most affected animals are Cerdocyon thous, Rhinella diptycha, Caiman yacare and Dryophylax hypoconia with more than 200 individuals per kilometre per year. A bat, Lasiurus ega, was identified for the first time for Paraguay. Climatic conditions seems to have no strong effect on the occurrence pattern of the different taxa, with the exception of birds that decrease with stronger winds. The greatest coincidences occurred in three sections: km 5–5.5, km 33.5–34.5 and km 40–43. There was a correlation with crossroads areas, watercourses and forest islands. In view of the road development policy in the region, it is necessary to carry out studies of its impacts in the longer term.

Abstract Objectives To measure regulatory T cell (Treg) levels in the peripheral blood of children with juvenile idiopathic arthritis (JIA) and analyse the association of this measure with disease activity, quality of life, adjustment of treatment, and hospitalisation. Methods We conducted a two-phase study (cross-sectional and prospective), including consecutive children with a JIA diagnosis according to ILAR criteria. Our independent variables were Tregs, Th1, Th2, and cytokines in peripheral blood, and our dependent variables in the cross-sectional phase were arthritis category, JIA activity, and patient-reported outcomes. To test associations, we used Spearman’s correlation coefficient and the Mann-Whitney U test. In the prospective phase, we explored the probability of treatment adjustment and hospitalisation for JIA during follow-up according to Tregs levels at baseline, using Cox proportional regression. Results Our sample included 87 participants (median age 11 years, 63.2% girls). Tregs were not associated with most variables of interest. However, we found that higher Tregs concentration was associated with lower erythrocyte sedimentation rate (ESR) and better subjective disease status and course, while higher IL-10 and TGF-β levels were associated with lower ESR, less pain, and better subjective disease status We found no association between Tregs and treatment adjustments or hospitalisation. Conclusions Higher baseline Treg levels in the peripheral blood of children with JIA may be associated with reduced disease activity and better quality of life, though were not informative on the inflammatory progression on the follow-up.

El presente estudio examinó la relación entre la autoeficacia y los logros de aprendizaje en el marco de la Comunidad de Investigación (CdI) para evaluar la calidad del aprendizaje en línea de 115 profesores universitarios de una Facultad de Ciencias de la Educación y Humanidades de una universidad de la Amazonía peruana. A través de una investigación cuantitativa con un diseño no experimental transversal, se encontró una relación significativa entre la calidad del aprendizaje en línea y la autoeficacia docente (p < 0.05) en la que los logros de aprendizaje percibidos mediaban parcialmente esta relación. Los resultados revelaron que los profesores que participaron en un programa de DPLP en línea tenían un mayor sentido de eficacia. Se concluye que las Comunidades de Aprendizaje Profesional son importantes en el desarrollo de la autoeficacia, el éxito académico de los profesores e importantes para evaluar la calidad del aprendizaje en línea.

Abstract People living in poverty inhabit the outskirts of Mexican cities. They struggle and survive but cannot overcome poverty. The present article seeks to understand how the survival tactics of the urban poor keep them in poverty and, with this understanding, inform future interventions. A study based on qualitative grounded theory was conducted in 10 impoverished neighbourhoods in three main regions and cities in Mexico. Observational accounts and in-depth individual and group interviews were conducted with diverse social actors for 115 participants (75 women and 40 men) aged between 12 and 76 years. The data were analysed using an interpretative thematic analysis. Research findings revealed that the urban poor tackle adversities, such as a lack of basic services, health, education, environment, and nutrition. The strength, patience, and hard work employed by these individuals to survive were evident, but their actions to tackle these threats were costly. Ultimately, the urban poor remain in a cycle of poverty, or poverty traps. Interventions to fight poverty, improve life conditions, and general development must include integrated and participatory plans that consider the knowledge and strengths of the urban poor.

Sports diplomacy through soccer has played a key role in the Islamic Republic of Iran's penetration strategy in Latin America since 1982. This strategy has been carefully developed, backed by ideological affinities with the Latin American left. The consolidation of this relationship was significantly marked with the rise to power of Hugo Chavez in Venezuela in 1999. This led to close diplomatic and economic collaboration between Iran and Venezuela, even overcoming obstacles related to economic sanctions, and manifested itself in tangible ways through military and political support. In this sense, the soft power of soccer appears as a ratification mechanism for these agreements. The methodology applied is a mixed one, combining quantitative and qualitative analysis. In the quantitative analysis, the historical data of the Iranian national team's friendly matches have been examined in detail, identifying patterns in the choice of opponents and their possible relationship with political events. While, in the qualitative analysis, a thorough review of academic papers, government reports and political speeches has been conducted. This has allowed us to identify political discourses and narratives, as well as to understand the political motivations and objectives that influenced the choice of rivals. Ultimately, this research concludes that the choice of opponents for Iran's friendly soccer matches has not been random, but a meticulously planned diplomatic strategy. This undeniable relationship between soccer and politics reflects the importance of sport as an instrument of soft power and international projection in the Islamic Republic of Iran. Sports diplomacy, in this context, has been a crucial resource in both the internal legitimization and external projection of the Iranian regime, contributing significantly to its strategic presence in Latin America.

Abstract Aims To evaluate the feasibility of a transthoracic echocardiogram using an apical-subcostal protocol in invasive mechanical ventilation (IMV) and prone position. Methods Prospective study of adults who required a prone position during IMV. A pillow was placed only under the left hemithorax in the prone position to elevate and ease the apical and subcostal windows. A critical care cardiologist (prone group) acquired and evaluated the images using the apical-subcostal protocol. Besides, we used ambulatory echocardiograms performed as a comparative group (supine group). Results 86 patients were included, 43 in the prone and 43 in the supine. In the prone group, the indication to perform an echocardiogram was hemodynamic monitoring. All patients were ventilated with protective parameters, and the mean end-expiratory pressure was 10.6 cmH2O. The protocol was performed entirely in 42 of 43 patients in the prone group because one patient did not have any acoustic window. In the 43 patients in the prone group analyzed and compared to the supine group, global biventricular function was assessed in 97.7% (p = 1.0), severe heart valve disease in 88.4% (p = 0.055), ruled out of the presence of pulmonary hypertension in 76.7% (p = 0.80), pericardial effusion in 93% (p = 0.12), and volume status by inferior vena cava in 93% (p = 0.48). Comparing prone versus supine position, a statistical difference was found when evaluating the left ventricle apical 2-chamber view (65.1 versus 100%, p

En la sociedad del Renacimiento, el adulterio fue considerado como un pecado y un delito que debía ser castigado de manera severa. La expectativa de género de la época influyó de manera decisiva en el rechazo social y en la respuesta jurídica frente a las infidelidades, sancionándose de manera diferente dependiendo del sexo del adúltero. En este trabajo se profundizará en el fenómeno del adulterio en la Navarra del Renacimiento. A través del análisis de las fuentes documentales y de la historiografía relacionada con el tema, se tratará de plasmar una visión poliédrica sobre el adulterio, y sobre cómo estas relaciones ilícitas parecieron verse drásticamente contestadas por parte de la sociedad y de los marcos jurídicos. De esta manera, mediante el presente artículo se tratará de ofrecer una visión antropocéntrica de las pasiones humanas que llevaron a cometer un pecado de tan grave consideración.

Abstract Phytophthora cinnamomi Rands is a highly prevalent phytopathogen worldwide, ranking among the top ten in terms of distribution. It inflicts crown rot, canker, and root rot on numerous plant species, significantly impacting the biodiversity of both flora and fauna within affected environments. With a host range spanning over 5,000 species, including important plants like Quercus suber, Quercus ilex, Castanea sativa, and commercially significant crops such as avocado (Persea americana), maize (Zea mays), and tomato (Solanum lycopersicum), Phytophthora cinnamomi poses a substantial threat to agriculture and ecosystems. The efficient dissemination of the oomycete relies on its short-lived asexually motile zoospores, which depend on water currents to infect host roots. However, managing these zoospores in the laboratory has long been challenging due to the complexity of the life cycle. Current protocols involve intricate procedures, including alternating cycles of growth, drought, and flooding. Unfortunately, these artificial conditions often result in a rapid decline in virulence, necessitating additional steps to maintain infectivity during cultivation. In our research, we sought to address this challenge by investigating zoospore survival under various conditions. Our goal was to develop a stable stock of zoospores that is both easily deployable and highly infective. Through direct freezing in liquid nitrogen, we have successfully preserved their virulence. This breakthrough eliminates the need for repeated culture transfers, simplifying the process of plant inoculation. Moreover, it enables more comprehensive studies of Phytophthora cinnamomi and its interactions with host plants.

Introduction: Breast augmentation, a popular cosmetic surgery using devices like silicone implants, can lead to a common issue called capsular contracture (CC). This condition involves the formation of fibrous tissue around the implants and can be influenced by variables like immunological and bacterial factors. This study aimed to explore the impact of autoimmune diseases (ADs) on CC along with other factors influencing future clinical decisions. Methods: A systematic review of electronic databases was conducted using PubMed, Web of Science, Scopus, EMBASE, and involving adult patients (>18) with CC and ADs after breast surgery using MeSH terminology using a broad search strategy. All searches were performed and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and duplicates were removed with Rayyan. Two independent investigators extracted and assessed the data involving demographics and baseline data related to CC and AD. Results: The incidence of CC varied (2.3%-4.1%). Subglandular placement and older device age raised risk. SERI Surgical Scaffold complications included necrosis, seroma, hematoma, implant loss, and infection; CC was associated with necrosis. Natrelle 410 implants showed lower 10-year CC risk than round gel implants. Acellular dermal matrix implant-based breast reconstruction with radiotherapy (RT) correlated with 20.7% post-RT CC. Previous research demonstrated no significant connection between silicone gel implants and ADs. Biofilm, surgical site infection, implant features, and interventions emerged as frequent CC risk factors. Conclusion: Finding appropriate techniques to reduce the risk factors associated with CC together with providing comprehensive patient counseling on these factors will definitely improve the patient-centered outcome of breast implant surgery.

Abstract Inherited hearing impairment is a remarkably heterogeneous monogenic condition, involving hundreds of genes, most of them with very small ( 90 dB SPL) that correlates with specific structural abnormalities in the cochlea. We show that Gjb2 expression is nearly abolished and its protein product, Cx26, is nearly absent all throughout the cochlea, unlike previous conditional knockouts in which Gjb2 ablation was not obtained in all cell types. The Dfnb1 em274 model recapitulates the clinical presentation of patients harbouring the del(GJB6-D13S1830) variant and thus it is a valuable tool to study the pathological mechanisms of DFNB1 and to assay therapies for this most frequent type of human ARNSHI.

El presente ensayo se centra en un elemento primordial pero poco estudiado de las producciones audiovisuales: el poster que sirve para mucho más que mero atrezo en las películas y series. Se combinan dos metodologías, por un lado, la entrevista cualitativa a cinco profesionales del sector en activo; y por otro, la semiótica multimodal. El ensayo propone un diseño metodológico cotejado por unanimidad por los profesionales y aplicable en el análisis de cualquier escena que contenga un poster.

Microbiota ambiental del Departamento de Neonatología en el Instituto Nacional Materno Perinatal, Lima, Perú

Se describe la experiencia en 10 años en el tratamiento de los traumatismos graves de hígado con la oclusión selectiva arterial extrahepátlca como alternativa de hemostasia. En 13 pacientes se efecutaron 12 oclusiones satisfactorias y hubo fracaso en 1. Las complicaciones hepáticas post-operatorias relacionadas a la aplicación del método fue de 23%; dentro de las extrahepáticas, las respiratorias alcanzan el 61.3%. La mortalidad relacionada con la lesión del higado fue por hemorragia hepática persistente en el 7.6%; la extrahepática por pancreatitis y lesión neurológica en el 15,2%. Esta experiencia demuestra que este procedimiento de excepción de hemostasia hepática es altamente confiable, de baja morbimortalidad, rápido, aplicable en lesiones penetrantes o no, poco visibles o Inaccesibles o en las que existe además lesiones de viscera hueca. Se puede aplicar tambien este procedimiento cuando fallan otros métodos de hemostasia hepática. Está al alcance de cuulquler cirujano entrenado y no requiere de Instrumental especializado. No se puede aplicar en hemorragias provenientes de lesiones de venas perihepáticas y en hemorragias no mecanicas.

Bruxism is a complex orofacial behavior that can occur during sleep or wakefulness, characterized by the involuntary grinding or clenching of teeth, involving repetitive activity of the jaw muscles. Its etiology is multifactorial, influenced by genetic, psychological, physiological, and lifestyle factors. While the mild bruxism may not necessitate treatment, severe bruxism can lead to significant consequences, including tooth damage, jaw pain, fatigue, and headaches. The bruxism has been associated with medical conditions, such as stress, anxiety, sleep disorders, and various neurological disorders; however, the exact pathophysiology remains elusive. Although the central nervous system is strongly implicated in the development of bruxism, specific neural substrates have not yet been conclusively established. Furthermore, there is evidence to suggest that individuals with bruxism may exhibit neural plasticity, resulting in the establishment of distinct neural circuitry that control the jaw movements. The application of various neurophysiological techniques in both clinical and pre-clinical studies provides valuable insights into the neural mechanisms underlying bruxism. This review aims to comprehensively examine the current literature on the neural pathways involved in bruxism, with the goal of improving the clinical approach and therapeutics for this condition. A deeper understanding of the neural circuitry controlling bruxism holds the potential to advance future treatment approaches and improve the management of patients with bruxism.

Fundamento: en la actualidad junto a los cambios tecnológicos es necesario transformar el el proceso enseñanza aprendizaje en todos los niveles de enseñanza. Objetivo: evaluar el impacto del Curso “Creación de cursos virtuales en la plataforma Moodle”, impartido a los docentes de la Facultad de Ciencias Médicas “Calixto García”. Métodos: se realizó un estudio descriptivo en el período comprendido: enero 2020-2021. Se utilizaron métodos teóricos para la fundamentación de la investigación, y empírico: un cuestionario virtual cuyas variables: Datos generales (categoría docente, categoría científica y departamento) y con las dimensiones siguientes: Contenido del Curso (5 indicadores), Interacción y Participación (2 indicadores), Evaluación y Retroalimentación (3 indicadores) y Aspectos Positivos y Negativos. El tratamiento de los datos se realizó mediante el empleo de un software SPSS. Resultados: el impacto del curso fue positivo para 62 cursistas (87 %) y negativo para 9 (13 %), por lo que se puede considerar como adecuado. Los resultados obtenidos en el cuestionario permitieron identificar las sugerencias para mejorar próximas ediciones. Conclusiones: esta innovación educativa fue percibida por los profesores participantes como una experiencia de impacto en su formación, y alertó sobre la necesidad de mejorar la orientación de las actividades, e incidir mucho más en los aspectos evaluativos a lo referente a la plataforma.

El presente artículo analizará los procesos de implantación de los sistemas de organización científica del trabajo en el tejido industrial español desarrollados durante la dictadura franquista desde una perspectiva de género. Para ello, examinaremos la extensión y aplicación del sistema Bedaux en las principales factorías vitorianas que contaban con abundante mano de obra femenina durante la década de los 50 y 60 del pasado siglo. A tenor de los resultados, hemos podido constatar cómo este sistema de racionalización de la producción y el trabajo, discriminaba deliberadamente las categorías, oficios o tareas desempeñadas por las mujeres, bien otorgándolas escaso valor o bien sometiéndolas a unos ritmos de trabajo acelerados. Este agravio llevará a las obreras de estas factorías a desplegar diferentes estrategias al objeto de recuperar su autonomía sobre el proceso productivo.

The development of reduced models provide efficient methods that can be used to perform short term experimental data analysis or narrow down the parametric range of more sophisticated numerical approaches. Reduced models are derived by simplifying the physics description with the goal of retaining only the essential ingredients required to reproduce the phenomena under study. This is the role of the gyro-fluid code FAR3d, dedicated to analyze the linear and nonlinear stability of Alfvén Eigenmodes (AE), Energetic Particle Modes (EPM) and magnetic-hydrodynamic modes as pressure gradient driven mode (PGDM) and current driven modes (CDM) in nuclear fusion devices. Such analysis is valuable for improving the plasma heating efficiency and confinement; this can enhance the overall device performance. The present review is dedicated to a description of the most important contributions of the FAR3d code in the field of energetic particles (EP) and AE/EPM stability. FAR3d is used to model and characterize the AE/EPM activity measured in fusion devices as LHD, JET, DIII-D, EAST, TJ-II and Heliotron J. In addition, the computational efficiency of FAR3d facilitates performing massive parametric studies leading to the identification of optimization trends with respect to the AE/EPM stability. This can aid in identifying operational regimes where AE/EPM activity is avoided or minimized. This technique is applied to the analysis of optimized configurations with respect to the thermal plasma parameters, magnetic field configuration, external actuators and the effect of multiple EP populations. In addition, the AE/EPM saturation phase is analyzed, taking into account both steady-state phases and bursting activity observed in LHD and DIII-D devices. The nonlinear calculations provide: the induced EP transport, the generation of zonal structures as well as the energy transfer towards the thermal plasma and between different toroidal/helical families. Finally, FAR3d is used to forecast the AE/EPM stability in operational scenarios of future devices as ITER, CFETR, JT60SA and CFQS as well as possible approaches to optimization with respect to variations in the most important plasma parameters.

Background and objectives: Fibrosis contributes to 45% of deaths in industrialized nations and is characterized by an abnormal accumulation of extracellular matrix (ECM). There are no specific anti-fibrotic treatments for liver fibrosis, and previous unsuccessful attempts at drug development have focused on preventing ECM deposition. Because liver fibrosis is largely acknowledged to be reversible, regulating fibrosis resolution could offer novel therapeutical options. However, little is known about the mechanisms controlling ECM remodeling during resolution. Changes in proteolytic activity are essential for ECM homeostasis and macrophages are an important source of proteases. Herein, in this study we evaluate the role of macrophage-derived cathepsin D (CtsD) during liver fibrosis. Methods: CtsD expression and associated pathways were characterized in single-cell RNA sequencing and transcriptomic datasets in human cirrhosis. Liver fibrosis progression, reversion and functional characterization were assessed in novel myeloid-CtsD and hepatocyte-CtsD knock-out mice. Results: Analysis of single-cell RNA sequencing datasets demonstrated CtsD was expressed in macrophages and hepatocytes in human cirrhosis. Liver fibrosis progression, reversion and functional characterization were assessed in novel myeloid-CtsD (CtsDΔMyel) and hepatocyte-CtsD knock-out mice. CtsD deletion in macrophages, but not in hepatocytes, resulted in enhanced liver fibrosis. Both inflammatory and matrisome proteomic signatures were enriched in fibrotic CtsDΔMyel livers. Besides, CtsDΔMyel liver macrophages displayed functional, phenotypical and secretomic changes, which resulted in a degradomic phenotypical shift, responsible for the defective proteolytic processing of collagen I in vitro and impaired collagen remodeling during fibrosis resolution in vivo. Finally, CtsD-expressing mononuclear phagocytes of cirrhotic human livers were enriched in lysosomal and ECM degradative signaling pathways. Conclusions: Our work describes for the first-time CtsD-driven lysosomal activity as a central hub for restorative macrophage function during fibrosis resolution and opens new avenues to explore their degradome landscape to inform drug development.

Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures, including reconstruction, implantation, and craniofacial surgery. Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures, with the former demonstrating superior cost-effectiveness and reduced comorbidity rates, particularly in cases involving donor zones. However, a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens, with existing tools often yielding coarse particles at a high cost. Consequently, commercial bone xenograft solutions are frequently favored despite lower standards. This technical note introduces a novel technique for swiftly, safely, and efficiently obtaining autologous particulate bone specimens. The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles. The continuous irrigation with saline maintains a clear surgical field during the milling process. The collected bone particles are then transferred to a metal capsule for further use. This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods, providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.

RESUMEN El uso de las nuevas tecnologías en diferentes contextos de actividad ha supuesto un cambio social con fuertes implicaciones en la educación. Esto hace necesario un compromiso activo de las escuelas y de sus agentes educativos. Para ello, el objetivo de este estudio es analizar la introducción de las TIC en la escuela y, en especial, el papel del Smartphone dentro del aula. Tras un análisis teórico sobre la materia, se ofrecen algunas consideraciones e indicaciones relevantes para que profesionales del ámbito educativo puedan profundizar en la introducción del smartphone en las aulas.

Introduction: Total body irradiation (TBI) is part of the myeloablative conditioning for hematopoietic stem cell transplantation (HSCT) in malignant hematologic disorders. This therapy has recently shown improved survival in acute lymphoblastic leukemia (ALL) compared to chemotherapy-based regimens. However, side effects are a significant limitation, especially in the pediatric population. Patients and methods: We retrospectively analyzed the survival of patients with ALL who underwent an HSCT at a tertiary hospital between 1996 and 2009 (N = 69 HSCT in 57 patients). We differentiated a cohort that received TBI (N = 44) from another that did not (N = 25). Subsequently, we interviewed the survivors from the TBI group with a minimum of 10 years of follow-up (N = 18), asking about the presence of side effects. Results: The overall survival (OS) at 2 and 5 years was 79.1% and 65.2% respectively for the TBI group and 66.2% and 55.8% for the non-TBI group, although this difference was not significant (P=.31). The event-free survival (EFS) at 2 and 5 years was 77.3% and 63.6% respectively for the TBI group and 56% and 32% for the non-TBI group (P=.02). The probability of relapse (PR) at 2 years for those who received TBI was 10% compared to 28.6% for those who did not receive TBI (P=.005). Survivors who received TBI developed secondary neoplasms (39%), dyslipidemia (67%), cognitive impairments affecting memory (44%), recurrent respiratory infections (39%), thyroid abnormalities (45%), premature ovarian failure (89%), cataracts (22%), and psychological problems (44%). However, the quality of life, as self-assessed by the patients, was considered good for 83% of the participants.. Conclusions: Patients who received TBI had significantly higher EFS and lower PR. However, adverse effects are frequent and significant, although they do not subjectively affect quality of life. Resumen: Introducción: La irradiación corporal total (ICT) forma parte del acondicionamiento mieloablativo del trasplante de progenitores hematopoyéticos (TPH) en hemopatías malignas. Esta terapia ha demostrado recientemente mayor supervivencia en leucemia linfoblástica aguda (LLA) frente a regímenes basados en quimioterapia. Sin embargo, los efectos secundarios son una limitación importante, especialmente en la población pediátrica. Pacientes y métodos: Analizamos retrospectivamente la supervivencia de pacientes con LLA que recibieron un TPH en un hospital terciario entre 1996 a 2009 (N = 69 TPH en 57 pacientes). Diferenciamos una cohorte que había recibido ICT (N = 44) y otra que no (N = 25). Posteriormente entrevistamos a los supervivientes del grupo ICT con un mínimo de 10 años de seguimiento (N = 18), preguntando acerca de la presencia de efectos secundarios. Resultados: La supervivencia global (SG) a los 2 y 5 años fue del 79.1% y 65.2% respectivamente para el grupo ICT y del 66.2% y 55.8% para el grupo no ICT, aunque esta diferencia no fue significativa (p = 0.31). La supervivencia libre de evento (SLE), a los 2 y 5 años fue del 77.3% y 63.6% respectivamente para el grupo ICT y del 56% y 32% para el grupo no ICT (p = 0.02). La probabilidad de recidiva (PR) a los 2 años habiendo recibido ICT fue del 10% y sin haber recibido ICT del 28.6% (p = 0.005). Los supervivientes que recibieron ICT desarrollaron neoplasias secundarias (39%), dislipemia (67%), alteraciones cognitivas (44%), infecciones respiratorias de repetición (39%), alteraciones tiroideas (45%), insuficiencia ovárica precoz (89%), cataratas (22%) y problemas psicológicos (44%), aunque la calidad de vida, valorada por ellos mismos, fue considerada como buena para el 83% de los encuestados. Conclusiones: Los pacientes que recibieron ICT tuvieron significativamente mayor SLE y menor PR. Sin embargo, los efectos adversos son frecuentes e importantes, aunque no afectan subjetivamente a la calidad de vida.

Introduction: dental caries is caused by poor oral hygiene, so it is necessary to have adequate hygiene. The objective of the study was to determine the practice of toothbrushing in Peruvian children under 12 years of age between 2019 and 2021. Methods: a cross sectional, analytical, and retrospective analysis was used by applying the 2019,2020 and 2021 Demographic and Family Health Survey databases. 38 203 records were obtained in 2019, 18 613 in 2020, and 35 759 in 2021. The variables were general, daily , and minimum two times a day toothbrushing, natural region, area and place of residence, altitude, wealth index, health insurance coverage, age, and sex. A descriptive, bivariate, and multivariate statistical evaluation was carried out. Results: t hat gene ral toothbrushing was 94.93% (n=83,032), daily toothbrushing was 86.32% (n=67,753), and at least twice a day was 82.93% (n=53,824). In multivariate form, the year 2020 showed a negative association with daily toothbrushing (RPa: 0.97; 95% CI: 0.96 0.99; p< 0.001) and at least twice a day (RPa: 0.96; 95% CI: 0.95 0.98; p

Introducción. En el 2021, la Secretaría de Salud de México y la Organización Panamericana de la Salud lanzaron una iniciativa para interrumpir la transmisión vectorial intradomiciliaria de Trypanosoma cruzi, fundamentada en la prevalencia de la enfermedad de Chagas en la población infantil. El estado mexicano de Veracruz fue el pionero de esta iniciativa. Objetivo. Estimar la seroprevalencia de infección por T. cruzi en menores de 15 años de localidades rurales de Veracruz, México. Materiales y métodos. Se identificaron ocho localidades prioritarias para la serología basal del municipio de Tempoal, Veracruz. Entre junio y agosto de 2017, se recolectaron muestras de sangre en papel filtro de 817 individuos para su tamizaje mediante un inmunoensayo enzimático de tercera generación. Los casos reactivos del tamizaje se confirmaron mediante pruebas de hemaglutinación indirecta, ensayo de inmunoabsorción ligado a enzimas e inmunofluorescencia indirecta en muestras de suero. Se calculó la seroprevalencia y su intervalo de confianza (IC) del 95 %. Resultados. En las localidades de Citlaltépetl, Cornizuelo, Cruz de Palma y Rancho Nuevo se confirmaron casos de la enfermedad de Chagas en menores de 15 años con una seroprevalencia de 1,9 % (IC 95 % = 1,12-3,16). Conclusiones. Los resultados indican que estas comunidades presentan transmisión reciente de T. cruzi y permiten establecer una línea epidemiológica de base para el diseño e implementación de un modelo dirigido a aquellas áreas geográficas con transmisión activa. Se espera que dicho modelo contribuya a la eliminación de la transmisión vectorial intradomiciliaria del tripanosomátido en México.

Objective: This study compared third molar angulation and eruption status in Class I and II malocclusions after orthodontic treatment with and without first premolar extractions. Methods: The sample comprised 93 patients divided into four groups: Group 1, Class I malocclusion treated with first premolar extractions; Group 2, Class I malocclusion treated without extractions; Group 3, Class II malocclusion treated with first premolar extractions; and Group 4, Class II malocclusion treated without extractions. Panoramic radiographs were used to evaluate the third molar mesiodistal angulations at T1 (pretreatment), T2 (posttreatment), and T3 (long-term posttreatment). Third molar eruption status was assessed in dental casts. Intergroup angulations and eruption status comparisons were performed using one-way analysis of variance (ANOVA), followed by Tukey’s test and Kruskal-Wallis test, respectively. Results: Significantly greater mesial angulation and percentage of erupted right maxillary third molars were observed in the Class I extraction group. Significantly greater eruption status of the right mandibular third molars was observed in the Class I and Class II malocclusion extraction groups. Conclusion: Class I and II malocclusion extraction treatment exhibited more favorable angulations and a greater number of erupted third molars than non-extraction treatment. The non-extraction groups exhibited a greater percentage of unerupted third molars.

Background While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. Methods We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes. Results During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years—mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80–0.82) for 30-day mortality. Conclusion Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.

Novel trophic associations have sometimes resulted in fortuitous and significant biological control. After the invasion of North America by the South American cactus moth, Cactoblastis cactorum (Berg) (Pyralidae: Phycitinae), it is pertinent to characterize the assemblage of local natural enemies that could utilize this moth in new host-parasitoid associations. Herein we report on Apanteles mimoristae Muesebeck (Braconidae: Microgastrinae), a North American gregarious endoparasitoid wasp attacking the caterpillar of the phycitine cactus moth Melitara cf. nephelepasa (Dyar) (Pyralidae: Phycitinae, also known as zebra worm), also native to North America; both collected in Opuntia ficus-indica (L.) Mill. (Cactaceae) cultivated fields at rural areas of Mexico City. We provide an updated morphological account for A. mimoristae visualized with light microscopy and scanning electron microscope (SEM); a fragment of its cytochrome oxidase subunit I (COI) gene sequence data is reported for the first time. Additionally, we analyze its taxonomical position relative to other Apanteles species from the Americas including those attacking cactus-feeding moths. Our analyses place A. mimoristae (from Mexico) in a clade with A. esthercentenoae Fernández-Triana (from Costa Rica), a parasitoid of both Cromarcha stroudagnesia Solis (Pyralidae) and Palpita venatalis (Schaus) (Crambidae) (non cactus-feeding), and in a sister clade to A. opuntiarum Martínez & Berta (from Argentina) and A. alexanderi Brèthes (from Argentina and Uruguay), parasitoids of the cactus-feeding phycitines Cactoblastis and Tucumania respectively. Finally, we provide an updated key for the identification of Apanteles species recorded parasitizing cactus moth caterpillars in the American continent.

Abstract This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB) treatment with lingual spurs and build-ups (SBU) versus spurs only (S) approaches. Children (7–11 years) with AOB were randomly allocated into two treatment groups (SBU or S). The Child Perception Questionnaire (CPQ8–10) was applied 1 and 12 months after installation of the appliances. Questionnaires evaluating functional adaptation and discomfort during the first month of treatment were also applied. A visual analog scale (VAS) was used in these questionnaires. Generalized mixed models were used for analyzing OHRQOL and discomfort data. Generalized linear models were used to assess adaptation outcomes (α = 0.05). The SBU group included 24 patients (7 males and 17 females; mean age 8.2 years) and the S group included 25 patients (11 males and 14 females; mean age 8.3 years). Regardless of the treatment type, overall OHRQOL scores at 12 months were 0.69 times those recorded at 1 month after the appliances installation (i.e., ~ 31% reduction; exp (β) = 0.69; 95% CI: 0.55, 0.88). A significant interaction between treatment and time was detected for the ‘functional limitations’ domain. For this domain, a significant improvement from the first to the twelfth month was observed in the S group (P

The territory of Lima, Peru, is the result of thousands of years of history of prehispanic cultures. A strategic management of ecological and social resources disrupted by colonization and modernity. Nowadays, the South American metropolis struggles with inefficient public policy enforcement to manage its territory, and close to 256 archaeological sites (called by the quechua word huacas) are located in peri-urban areas of the valleys, most of them neglected by local governments, lacking a proper assessment of their significance, and characterization of their context. The landscape of the southeastern side of San Juan de Lurigancho is a testimony of the past relationship between the agricultural economy of the lower Rimac Valley; and hunting-gathering activities and ranching in the surrounding mountains of the present peri-urban interface of Lima. Here, the participation of grassroots organizations, in the conservation of ancient monuments and their landscape, has been crucial for over a decade. The objective of this paper is to trace a biography of the landscape in the south east of San Juan de Lurigancho, and to highlight the role of community involvement in its present conservation. The results show the need to include this type of community action into urban planning and to empower grassroots organizations, to bridge the gap between current policy making and its implementation in the conservation of prehispanic landscapes in urban interstices.

Economic impact estimates of the initial lockdowns due to the COVID-19 pandemic showed a significant reduction in economic activities globally. However, the succeeding impacts and their spatiotemporal distribution within countries remain unknown. Studies showed that nighttime light data (NTL) has effectively revealed the spatiotemporal dimensions of the economic effects of COVID-19. Thus, this study used NTL data to determine the medium-term regional monthly economic impacts of the pandemic in the Philippines in terms of the Economic Activity Reduction (EAR) index. We generated a spatial error model, regressing pre-pandemic NTL on mean temperature, maximum rainfall, and built-up area. This model explained 81.6% of the pre-pandemic NTL and was used to estimate the counterfactual NTL. We subtracted the actual from the counterfactual to compute the EAR. Then, the EAR was regressed on regional factors to determine which ones influence the impacts. Results showed uneven distribution of EAR across space and time. The EAR was generally higher in urban regions than in rural ones. Overall, more regions in the south had higher EAR. Temporally, the EAR showed a dynamic pattern, increasing in less urban regions and decreasing in highly urbanized regions. Regional analysis showed that urbanization level, population density, and poverty incidence had a significant positive relationship with the EAR. Beyond the immediate impacts, NTL effectively revealed spatiotemporal dimensions of the economic effects of a long-term global hazard.

The increasing interest in digital preservation of cultural heritage has led to ARTDET, a machine learning software for automated detection of deterioration in easel paintings. This web application uses a pre-trained Mask R-CNN model to detect Lacune (areas of missing paint, resulting in visible support panel) from the loss of the Painting Layer (LPL) and stucco repairs. ARTDET leverages high-resolution images annotated by expert restorers. The software achieved 80.4 % recall for LPL and stucco, with a 99 % confidence score in detected damages. Available as open access resource, ARTDET aids conservators and researchers in preserving invaluable artworks.

Abstract In many animal species, larger body size is positively correlated with male mating success and female fecundity. However, in the case of insects, in high seasonality environments, natural selection favors a faster maturation that decreases the risk of pre‐reproductive death. However, this advantageous adaptation comes at a tradeoff, resulting in a reduction in body size. Maturation time is influenced by environmental factors, such as temperature, season length, and food availability during the rains. The geographic variation in these parameters provides an opportunity to study their impact on the adaptive evolution of body size in Pyrgomorphidae grasshoppers. These grasshoppers exhibit remarkable variation in body size and wing development and can be found in diverse plant communities across Africa, Asia, Australia, and tropical America. In this study, we utilized a phylogenetic approach to examine the evolution of body size, considering climatic factors, and the influence of sexual selection on size differences between males and females. We found a positive correlation between mean annual temperature and sexual size dimorphism (SSD). Remarkably, species exhibiting a strong bias toward larger females were found to be adapted to regions with higher temperatures. In the Pyrgomorphidae family, an intermediate body size was identified as the ancestral trait. Additionally, winged male and female grasshoppers were observed to be larger than their wingless counterparts. Despite the potential conflicting pressures on body size in males and females, these grasshoppers adhere to Rench's Rule, suggesting that sexual selection on males' body size may explain the evolution of SSD.

El aprovechamiento incontrolado de los recursos de Phytelephas macrocarpa y la deforestación han disminuido las poblaciones naturales de la especie cercanas a los centros poblados. En este estudio nos propusimos evaluar la morfología vegetativa de Phytelephas macrocarpa para comprender la variabilidad de sus poblaciones al noroeste de la Amazonía peruana. Para ello, se tuvieron en cuenta 28 caracteres (18 cuantitativos y 10 cualitativos) de 180 individuos adultos, que se compararon mediante las pruebas ANOVA y Kruskal-Wallis y se sometieron a análisis multivariados de agrupamiento jerárquico y de componentes principales. Por último, con un análisis de correlación de Spearman se estimó la asociación entre caracteres, la mayoría de los cuales presentaron una gran variación (

PURPOSEThis study aimed to identify, evaluate, and rank suitable safety innovations developed during the COVID-19 pandemic in Latin American and Caribbean (LAC) radiation oncology centers.METHODSWe conducted a multimodal participatory engagement collaboration with the Latin-American and Caribbean Society of Medical Oncology. The study consisted of four phases. Innovations were collected from a panel of radiotherapy experts representing a diverse group of 11 countries from LAC (Phase I). Next, a medical scientific team compared the innovations against international standards regarding their potential impact on risk of infection, clinical operation, and continuity of quality cancer care (Phase II). Their findings were supplied to the country representatives who rated the innovations for acceptability in their cancer centers (Phase III), resulting in a final report of the panel's recommendations (Phase IV).RESULTSA total of 81 innovations were reported by the country representatives and merged by the medical scientific team into 24 innovations that combined similar innovations. The 24 innovations were grouped into six categories including practices aimed at (1) reducing clinic crowding (n = 3), (2) increasing screening and vaccinations for COVID-19 disease (n = 5), (3) implementing social distancing (n = 6), (4) strengthening personal infection equipment and disinfection (n = 6), (5) avoiding delaying or shortening treatment protocols (n = 2), and (6) mixed procedures (n = 2). The medical scientific team found nearly all innovations were supported by international recommendations and rated as safe, efficient, and acceptable.CONCLUSIONBy using the lessons learned from the Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated study, a manual of scalable practices in radiation oncology clinics may be developed to guide actions during future large-scale public health crises in low- and middle-income countries of LAC.

Introduction The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. Core outcome sets (COS) appropriate for the study of multimorbidity in LMICs do not presently exist. These are required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at preventing and treating multimorbidity in adults in LMICs.Methods To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals and policymakers) with representation from 33 countries. Consensus meetings were used to reach agreement on the two final COS. Registration: https://www.comet-initiative.org/Studies/Details/1580.Results The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention and 6 treatment outcomes were added from Delphi round 1. Delphi round 2 surveys were completed by 95 of 132 round 1 participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) adverse events, (2) development of new comorbidity, (3) health risk behaviour and (4) quality of life; and four for the treatment COS: (1) adherence to treatment, (2) adverse events, (3) out-of-pocket expenditure and (4) quality of life.Conclusion Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to adults in LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs.PROSPERO registration number CRD42020197293.

BackgroundAmerican Cutaneous Leishmaniasis (ACL) shows variable response to therapy, but data on species-specific treatment efficacy is scarce. We describe the clinical characteristics and outcome of patients with ACL imported to a tertiary centre in Germany and determine whether species-specific therapy according to the 2014 "LeishMan" group recommendations is associated with cure.MethodsA retrospective chart review was conducted at the Charité Institute of International Health in Berlin. We analysed data on PCR-confirmed ACL cases collected between 2000 and 2023. Systemic therapy included liposomal amphotericin B, miltefosine, pentavalent antimony, ketoconazole or itraconazole. Localized therapy included perilesional pentavalent antimony or paromomycin ointment. Cure was defined as re-epithelialization of ulcers or disappearance of papular-nodular lesions after 3 months of treatment. Logistic regression models were used to quantify the effect of species-specific systemic therapy on the outcome.Results75 cases were analysed. Most patients were male (62%), median age was 35 years, no patient had a history of immunosuppression. The most common reason for travel was tourism (60%), the most common destination was Costa Rica (28%), the median duration of illness was 8 weeks, and most patients presented with ulcers (87%). Lesions were complex in 43%. The most common Leishmania (L.) species was L. braziliensis (28%), followed by L. panamensis (21%). 51/73 (70%) patients were cured after initial therapy and 17/21 (81%) after secondary therapy. Cure after systemic therapy was more frequent when species-specific treatment recommendations were followed (33/45; 73%), compared to when not followed, (6/17; 35%, P = 0.008). This association was independent of age, sex, previous therapy, complex lesions, and Leishmania species (adjusted OR, 5.06; 95% CI, 1.22-24.16).ConclusionsACL is a rare, imported disease in Germany. Complex lesions were common, challenging successful therapy. This study highlights the importance of identifying the parasite species and suggests that a species-specific approach to treatment leads to better outcomes.

Joining dissimilar metals is a major challenge in joining technology; the weldability of immiscible systems is especially challenging. In this study, a design methodology for dissimilar welding is suggested. The Miedema model and Toop model are developed to calculate the thermodynamics of quaternary alloy systems (Mg-Fe-Al-Cu). Finite element modelling (FEM) of temperature fields and the calculation of phase diagrams (CALPHAD) are combined to provide prerequisite information for modelling. As a test subject, laser welded lap configuration joints of AZ31B magnesium alloy and DP590 steel with a copper coating were put into the design scheme. The interfacial elemental diffusion and formation of intermetallics (IMCs) along the interface during the welding process are predicted. This simulation design scheme predicts the interfacial reaction kinetics and identifies whether the intermediate element works or not. The effects of the Cu coating thickness on the weld constitution, interfacial microstructures and mechanical properties were studied. Cu coating promotes the weld formation fostering the metallurgical reaction of the fusion zone (FZ) with the steel brazing interface. The mechanism of interfacial reactions during the welding-brazing process has been clarified. The Vickers hardness distribution across the interface shows that the Cu-IMCs are ductile.

Objective:. Our aim was to assess whether complications after pancreatoduodenectomy (PD) impact long-term quality of life (QoL) and functional outcomes. Background:. There is an increasing number of long-term post-PD survivors, but few studies have evaluated long-term QoL outcomes. Methods:. The EORTC QLQ-C30 and QLQ-PAN26 questionnaires were administered to patients who survived >5 years post-PD. Clinical relevance (CR) was scored as small (5–10), moderate (10–20), or large (>20). Patients were stratified based on whether they experienced a complication during the index hospitalization. Results:. Of 305 patients >5 years post-PD survivors, with valid contact information, 248 completed the questionnaires, and 231 had complication data available. Twenty-nine percent of patients experienced a complication, of which 17 (7.4%) were grade 1, 27 (11.7%) were grade 2, and 25 (10.8%) were grade 3. Global health status and functional domain scores were similar between both groups. Patients experiencing complications reported lower fatigue (21.4 vs 28.1, P < 0.05, CR small) and diarrhea (15.9 vs 23.1, P < 0.05, CR small) symptom scores when compared to patients without complications. Patients experiencing complications also reported lower pancreatic pain (38.2 vs 43.4, P < 0.05, CR small) and altered bowel habits (30.1 vs 40.7, P < 0.01, CR moderate) symptom scores. There was a lower prevalence of worrying (36.2% vs 60.5%, P < 0.05) and bloating (42.0% vs 56.2%, P < 0.05) among PD survivors with complications. Conclusions:. Post-PD complication rates were not associated with long-term global QoL or functionality, and may be associated with less severe pancreas-specific symptoms.