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Aims Our primary objective was to improve risk assessment for fatal and non-fatal cardiovascular events in a working population, mostly young and healthy. Methods We conducted a prospective cohort study to derive a survival model to predict fatal and non-fatal 10-year cardiovascular risk. We recruited 992,523 workers, free of diagnosed cardiovascular disease at entry, over six years, from 2004–2009. We divided the sample into two independent cohorts: a derivation one (626,515 workers; from 2004–2006) and a temporal validation one (366,008 workers; over 2007–2009). Then, we followed both cohorts over 10 years and registered all fatal and non-fatal cardiovascular events. We built a new risk calculator using an estimation of cardiovascular biological age as a predictor and named it IberScore. There were remarkable differences between this new model and Systematic Coronary Risk Evaluation (SCORE) (in both the specification and the equation). Results Over the 10-year follow-up, we found 3762 first cardiovascular events (6‰) in the derivation cohort. Most of them (80.3%) were non-fatal ischaemic events. If we had been able to use our model at the beginning of the study, we had classified in the ‘high-risk’ or ‘very high-risk’ groups 82% of those who suffered a cardiovascular event during the follow-up. All the post-estimation tests showed superior performance (true positive rate: 81.8% vs 11.8%), higher discrimination power and better clinical utility (standardised net benefit: 58% vs 13%) for IberScore when compared to SCORE. Conclusion Risk assessment of fatal and non-fatal cardiovascular events in young and healthy workers was improved when compared to the previously used model (SCORE). The latter was not reliable to predict cardiovascular risk in our sample. The new model showed superior clinical utility and provided four useful measures for risk assessment. We gained valuable insight into cardiovascular ageing and its predictors.

Muscle injuries are frequent in the workplace. They are produced by sudden direct or indirect trauma that involves a rupture of the fibres, causing bruising. Currently, there is no single protocol-based model of treatment. We present the case of a patient diagnosed with complete muscular rupture of the plantaris muscle by an indirect traumatic mechanism (abrupt muscular elongation), with an associated large-volume hematoma. Clinical study consisted of ultrasound, magnetic resonance (MR), pain assessment (VAS) at the beginning and at the end of the treatment (3 weeks), as well as duration of occupational disability. The patient underwent extracorporeal shockwave therapy (ESWT) according to the protocol. At the end of treatment, the hematoma was resolved and there were no complications. ESWT could be a complementary therapeutic alternative to conventional treatment in this entity. However, there is a need for further, randomised controlled studies including a larger number of patients.

[Background and aims] We aimed to assess the prevalence of familial hypercholesterolaemia (FH) and to determine the incidence of cardiovascular events during a 10-year follow up in individuals with FH, compared to unaffected individuals in a working, middle-aged/young population., [Methods and results] 576,724 active workers (36 ± 10 years-old, 70% men) without cardiovascular disease were given regular health check-ups and followed for a median of 8.5 years (i.e., 4,123,927 person-years). The FH phenotype was defined according to validated low-density lipoprotein-cholesterol thresholds, adjusted for age and sex. The primary outcome was a first cardiovascular event, whether fatal or non-fatal. We found that 707 workers (0.12% or 1 in 816 individuals) met the criteria for a heterozygous FH phenotype. During the follow-up, cardiovascular events occurred in 23 of 707 (3.25%) subjects with the FH phenotype and in 3297 of 576,017 (0.57%) subjects without the FH phenotype (p, [Conclusions] Our findings confirmed the high incidence of cardiovascular disease in individuals with untreated FH. We showed that regular health check-ups in an active, and mostly young, working population could contribute to the early identification of FH. Therefore, this approach may provide an opportunity for early treatment., This work was supported by the Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional-FEDER (grant number PI12/02812), in 2012; by the Instituto de Salud Carlos III (grant number PI18/01809), in 2018; and by a grant awarded to the CTS-159 group of Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI).

Summary One of the main questions to answer while performing a geostatistical inversion is how many realizations need to be generated in the project. The required number of realizations depends on the selected criterion coming from the project objectives. Two approaches to define the number of realizations to be used to evaluate uncertainties were applied for different global and local criteria. The first method is an analysis of convergence graphs showing changes of the mean and standard deviations while increasing the number of realizations. And the uncertainty analysis where the number of realizations can be predicted with extrapolation techniques.

Importance Many shift workers have difficulty sleeping during the daytime owing to an inappropriately timed circadian drive for wakefulness. Objective To determine whether a dual hypocretin receptor antagonist would enable shift workers to have more daytime sleep. Design, Setting, and Participants This double-blind, placebo-controlled randomized clinical trial included 2 weeks of baseline data and 3 weeks of intervention data, from March 2016 to December 2018. Individuals were recruited through poster advertisements in the broader San Francisco Bay area in California. From an initial voluntary recruitment cohort of 38 shift workers, 19 individuals with self-reported difficulty sleeping during the daytime following night work shift were included. Data were analyzed from Janaury to March 2019. Interventions 1 week of 10 mg suvorexant or placebo, titrated upward to 20 mg suvorexant or placebo for 2 additional weeks. Main Outcomes and Measures Objective (ie, actigraphy) and subjective (ie, sleep logs) measures of sleep. Results Among 19 participants who completed the study (mean [SD] age, 37.7 [11.1] years; 13 [68%] men), 8 participants (42%) were assigned to the suvorexant group and 11 participants (58%) were assigned to the placebo group. Compared with individuals in the placebo group, individuals in the suvorexant group increased their objective total sleep time by a mean (SE) of 1.04 (0.53) hours (P = .05) at the end of 1 week of 10-mg doses and by 2.16 (0.75) hours (P = .004) by the end of the 2 weeks of 20-mg doses. Subjective sleep was similarly improved as, compared with the placebo group, individuals in the suvorexant group increased their subjective total sleep time by a mean (SE) of 2.08 (0.47) hours (P Conclusions and Relevance This pilot study found that the use of a dual hypocretin receptor antagonist in shift workers under real-world conditions resulted in more than 2 extra hours of daytime sleep per episode. Future research should confirm this pilot finding in a larger sample size and examine whether, over the long term, use of this medication has a concomitant improvement in medical and psychiatric health as well as workplace performance and safety. Trial Registration ClinicalTrials.gov Identifier:NCT02491788

Background and aims: To assess the impact of obesity and being overweight on sickness absence (SA) as a function of healthy/unhealthy metabolic phenotype. Methods and results: A total of 173 120 healthy workers who underwent a routine check-up, consisting of a structured interview, anthropometric measurements and blood pressure and fasting blood analysis, were included as the study sample (67.1% males; 49.2% manual workers; mean age 40.6 +/- 21.9 years). Workers were classified according to their body mass index (BMI) and metabolic phenotype. A metabolically unhealthy phenotype was defined as the presence of three or more of the following criteria: glycaemia >= 110 mg/dL or previously diagnosed type I/II diabetes or treatment for diabetes; triglycerides >= 150 mg/dL or lipid-lowering therapy; HDL = 130/85 mmHg or previously diagnosed hypertension or antihy-pertensive therapy; waist circumference >102/88 cm M/F. A one-year follow-up was conducted to evaluate the incidence of work-related and non-work-related SA (WRSA/NWRSA). The association of BMI with SA was tested using Poisson regression (standard error correction), segmenting on the basis of metabolic phenotype. The overall percentages of workers who were overweight, obese and/or had a metabolically unhealthy phenotype were 37.7%, 16.3% and 8.8%, respectively. BMI was associated with increased incidence of NWRSA in both phenotypes. It was also associated with WRSA in subjects with a BMI in the range of 35-39.99 kg/m(2)and in metabolically healthy individuals. WRSA was lower in subjects with a BMI >= 40 kg/m(2)and among metabolically unhealthy individuals. Conclusion: Obesity is associated with health problems that have a significant impact on SA. (C) 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Introduction Many shift workers have an inability to sleep during the daytime following a night shift not due to insomnia or lack of sleep pressure, but because a circadian signal promoting wakefulness is hampering their ability to maintain sleep. We have previously hypothesized that the neuropeptide hypocretin-1 is, in part, responsible for the physiologic expression of this circadian wake signal. As such, it was our intent to determine whether a pharmacologic blockade of hypocretin would enable shift workers to obtain more daytime sleep. Methods Nineteen shift workers took part in a placebo-controlled, double-blind field study of suvorexant. Following two weeks of baseline, participants received 10 mg suvorexant/placebo for one week and were titrated upward to 20 mg suvorexant/placebo for an additional two weeks. Subjective (diaries) and objective (actigraphy) sleep were monitored throughout. No restrictions were placed on participants’ schedules. Results Both subjective and objective measures of total sleep time significantly improved in the active vs. the placebo condition, increasing by 2.08 ± 0.47 hours (diary) or 1.04 ± 0.53 hours (actigraphy) by the end of the 10 mg condition, and increasing by 2.97 ± 0.56 hours (diary) or 2.16 ± 0.75 hours (actigraphy) by the end of the 20 mg condition. Physician ratings of change in the severity of symptoms similarly improved in the active group. There were no adverse events reported in the active condition. Conclusion Robust changes in total sleep time were observed after administration of suvorexant, a dual-hypocretin antagonist, prior to daytime sleep in a field study of shift workers. The very large changes in total sleep time, coupled with the permissive nature of the therapeutic mechanism (i.e., suppressing wake rather than inducing sleep) indicate that this could be a viable and important therapy for shift workers. Support Merck Sharpe and Dohme investigator-initiated study #53236

Objectives The guidelines of the American College of Cardiology/American Heart Association, the British National Institute for Health and Clinical Excellence and the European Guidelines on cardiovascular disease prevention are worldwide disseminated. They recommend the use of different tables to estimate cardiovascular risk: atherosclerotic cardiovascular disease risk-ASCVD, the QRISK2 and the SCORE. ASCVD and QRISK2 measure risk of cardiovascular morbidity and mortality due to atherosclerosis disease and due to coronary heart disease and stroke, respectively, and SCORE measures risk of cardiovascular death. According to ASCVD a high-risk person is considered when risk is >7.5%, according to QRISK2 >10% and according to SCORE >5%, in the next ten years. The objective was to evaluate and compare the impact of using the American, the British and the European guidelines on the identification of high risk patients and on the percentage of patients requiring statin therapy in a Spanish working population. Method Observational study conducted among Spanish workers whose companies had contracted health monitoring services from the Sociedad de Prevencion de Ibermutuamur, who underwent a medical examination between 2004–2007. Cardiovascular risk was calculated for each worker using the SCORE cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines. Diabetic patients were excluded. Following the recommendations of the European Guidelines on Cardiovascular Prevention, treatment targets for patients at high (SCORE 5%–9%) or very high risk (SCORE >10%) are LDL-C concentrations of 190 mg/dl, regardless the cardiovascular risk. Results A total of 227 371 workers between 40 and 65 years were included (75.54% men; mean age, 47.96 years; 42.62% were smokers; 10.1% were hypertensives; 11.0% had dyslipidemia; 7.2% were treated with antihypertensive drugs; 3.7% were treated with lipid lowering drugs). Individuals at high risk was found in 4.42% of the population according to the SCORE tables and in 17.79% and 26.02% according to the British and American tables, respectively. Lipid lowering treatment would be recommended in these high risk patients, except for the American Guidelines that the percentage would increase up to 33.74% (after including non-high risk patients with LDL-C >190 mg/dl). Conclusions We observed marked differences on the percentages of high risk patients when comparing the three different cardiovascular risk charts. The application of the American and British compare to the European guidelines would result in identifying more high risk patients and in treating a larger fraction of the population with lipid lowering drugs and with other intensive preventive pharmacotherapy such as use aspirin and anti-hypertensive agents, which would result in substantially increase costs. Clinicians may need to interpret cardiovascular risk estimates with caution in order to avoid overestimation of risk and overtreatment.

Muscle injuries are frequent in the workplace. They are produced by sudden direct or indirect trauma that involves a rupture of the fibres, causing bruising. Currently, there is no single protocol-based model of treatment. We present the case of a patient diagnosed with complete muscular rupture of the plantaris muscle by an indirect traumatic mechanism (abrupt muscular elongation), with an associated large-volume hematoma. Clinical study consisted of ultrasound, magnetic resonance (MR), pain assessment (VAS) at the beginning and at the end of the treatment (3 weeks), as well as duration of occupational disability. The patient underwent extracorporeal shockwave therapy (ESWT) according to the protocol. At the end of treatment, the hematoma was resolved and there were no complications. ESWT could be a complementary therapeutic alternative to conventional treatment in this entity. However, there is a need for further, randomised controlled studies including a larger number of patients.

Objective:To conduct an external validation of the modified SCORE (Systematic COronary Risk Evaluation) model for low-risk regions to estimate risk of fatal and non-fatal events among asymptomatic individuals (primary prevention).Design and method:Nationally cross-sectional examination in an occupat

This study aims to investigate the influence of estimated glomerular filtration rate (eGFR) with two equations (and by one or two separate measurements), on the prevalence of chronic kidney disease (CKD) and its association with blood pressure, and cardiovascular and metabolic risk factors.Between January 2010 and October 2011, the Ibermutuamur CArdiovascular RIsk Assessment project included 128 588 workers (77.2% men, mean age 39.3 years, range 16-75), who underwent two consecutive yearly medical check-ups and had information for eGFR according to the MDRD-IDMS and CKD-EPI equations (serum creatinine was measured by a isotope-dilution mass spectrometry traceable method in a single central laboratory). CKD was defined by an eGFR less than 60 ml/min per 1.73 m. Subclinical (occult) renal disease was defined as an eGFR less than 60 ml/min per 1.73 m in patients with serum creatinine below 1.3 mg/dl and below 1.2 mg/dl in men and women, respectively.In this working population, prevalence of CKD was very low, but two to six times lower when two separate eGFRs below 60 ml/min per 1.73 m were used. The prevalence of CKD was significantly lower with the CKD-EPI compared to the MDRD-IDMS equation. The same applies to occult CKD. In male workers, occult CKD was practically nonexistent.Multivariate analyses show that blood pressure, total serum cholesterol, and serum glucose (positively), and high-density lipoprotein and low-density lipoprotein (negatively) were associated with CKD, with both equations. Another metabolic factor (waist circumference) was only associated (positively) with CKD defined by the CKD-EPI equation, which appears to be associated with most components of the metabolic syndrome.The CKD-EPI formula, calculated on the basis of two reported blood samples, may provide the most specific definition of CKD.

Objective:Hypertension is one of the most important cardiovascular risk factors and its control is essential in order to prevent cardiovascular diseases. The objective of the study was to describe the changes in the clinical variables of workers with hypertension (HT) between 2005 and 2016.Design an

Objective:Sociodemographic and clinical profile of hypertensive patients have changed significantly over the past decade, especially in women. The objective of this study was to describe the changes in cardiovascular risk factors (CVRF) in hypertensive women between 2005–2016.Design and method:We an

Objective:The aim of this study was to implement an expert system (ES) to help professionals in clinical decision-making by providing an assessment of the health of workers at very high cardiovascular risk (CVR), in a Mutual insurance company that collaborates with the National Social Security.Desig

Resumen Objetivos Conocer la pertinencia o no de prescribir antibioticos profilacticos en usuarios de lentes de contacto terapeuticas (LCT). Metodos Se procedio a realizar un estudio microbiologico sobre 33 LCT de 33 pacientes portadores de LCT. Se valoraron las resistencias de los germenes aislados a los antibioticos a partir de los estudios publicados en nuestra region sanitaria durante el ano 2010. Valoramos lo mismo en el supuesto que las LCT se encontraran contaminadas por los germenes con mayor potencial patogeno segun la literatura medica en usuarios de lentes de contacto convencionales. Resultados De las 33 LCT estudiadas en 17 (52%) no se aislo ningun germen. En las 16 LCT restantes (48%) se aislo en diez (62%) Staphylococcus coagulasa negativo, en cuatro (25%) Propionibacterium acnes y en dos (13%) Corynebacterium. Conclusiones El elevado numero de cultivos negativos y la presencia de germenes saprofitos indican que no es preciso el tratamiento antibiotico profilactico. Los germenes con mayor potencial patogeno en usuarios de lentes de contacto presentan severas resistencias a los antibioticos comercializados en forma de colirio.

Background To describe the benefits and optimum use of prophylactic antibiotics in users of therapeutic contact lenses (TCL). Methods A microbiological study was carried out on samples from 33 patients who continuously wore TCL. The resistance to antibiotics of bacteria isolated in our health region was also reviewed. An assessment was also made on whether there were microorganisms of a higher pathogenic potential in TCL than conventional contact lenses, as reported in the literature. Results No bacteria were isolated from 17 (52%) of the 33 lenses studied. From the 16 (48%) remaining lenses, coagulase negative Staphylococci were isolated from 10 (62%), Propionibacterium acnes from 4 (25%), and Corynebacterium from 2 (13%). Conclusions The high number of negative cultures and the presence of saprophytic bacteria indicate that prophylactic antibiotic treatment is not precise. The most frequent pathogenic bacteria found in contact lenses are strongly resistant to the current commercially available antibiotics.

Strains of Leptospira serogroup Pomona are known to cause widespread animal infections in many parts of the world. Forty-three isolates retrieved from domestic animals and wild small mammals suggest that serogroup Pomona is epidemiologically relevant in Spain. This is supported by the high prevalence of serovar Pomona antibodies in livestock and wild animals. In this study, the strains were serologically and genetically characterized in an attempt to elucidate their epidemiology. Serological typing was based on the microscopic agglutination test but molecular typing involved species-specific polymerase chain reaction, restriction endonuclease analysis, and multiple-locus variable-number tandem repeat analysis. The study revealed that the infections are caused by two serovars, namely Pomona and Mozdok. Serovar Pomona was derived only from farm animals and may be adapted to pigs, which are recognized as the maintenance host. The results demonstrated that serovar Pomona is genetically heterogeneous and three different types were recognized. This heterogeneity was correlated with different geographical distributions of the isolates. All strains derived from small wild mammals were identified as serovar Mozdok. Some isolates of this serovar retrieved from cattle confirm that this serovar may also be the cause of infections in food-producing animals for which these wild species may be source of infection.

We studied the effect of ant herbivory on the establishment and survival of the annual plant Schismus barbatus. We hypothesized that ants may control this species when biomass of native plants is generally low during their vegetative period. We predicted that ant herbivory will decrease plant survival and reproduction. We tested our prediction with an insect exclosure experiment in a sandy desert of Northern-Central Monte. We found more than 12 000 established seedlings per square meter on early May, after two consecutive rain pulses of ca. 20 mm each. Overall, we found that almost 75% of recruited plants survived by the end of the cool season (September), and that 22–24% of the initially established plants survived as mature reproductive plants by the end of the growing season (December). Contrary to our expectation, insect herbivory did not affect plant establishment, plant survival or the proportion of flowering and fruiting individuals of S. barbatus. The large number of seedlings reported, the ability to exploit a temporal window free of plant competitors and enemies, and the availability of microsites where this species can succeed, all suggest that S. barbatus may have the potential to become an important plant invader in the Monte Desert.

Biological invasions are a major threat for natural ecosystems. Deserts are characterized by their scarce, highly variable rainfall and thus considerably susceptible to invasions, especially by annual plants that can quickly capitalize sporadic rainfall events. In this study we evaluated the potential of an invasive winter-annual species native to the Mediterranean region (Schismus barbatus) to invade a summer-rainfall desert in the Central-Northern Monte Phytogeographical Province, Argentina, where the native annual flora is mainly composed of summer species. We recorded the number of germinated seeds from soil samples collected in four seasons (during one year) coinciding with four important life-stages of Schismus (pre-germination, post-germination I and II and post-dispersal), and contrasted our results with data obtained from the literature. Almost 33,000 Schismus seeds were estimated to germinate per m2, and about 90% percent of them germinated from samples collected in the pre-germination stage. Compared to deserts in USA and Australia, where Schismus has been a successful invader, the density of germinated seeds we observed was especially high even though the amount of rainfall for the vegetative period of Schismus was considerable lower. Our results suggest that S. barbatus has a great invasive potential in the Central-Northern Monte. The low number of annual plant populations that are able to compete for highly variable cool-season rains may be a key feature determining the invasibility of these deserts during the winter.

Introduction Intratumour heterogeneity has been observed in multiple cancers and has been postulated as a critical aspect for tumour metastasis and treatment resistance. Therefore, a further characterisation of its role in cancer progression and metastasis has become essential. Pancreatic cancer in humans has a dismal prognosis with only 8% of patients surviving more than 5 years after diagnosis. Mouse models of pancreatic cancer, based on the expression of an oncogenic version of Kras in the pancreas, have been widely used to study the molecular pathways involved in pancreatic cancer progression, nevertheless there is still controversy about their utility to study the genetic complexity observed in the human tumours. Material and methods We have performed multi-sampling exome and genome sequencing in primary and metastatic lesions, as well as in primary cell cultures generated in an oncogenic Kras -mediated mouse model of pancreatic cancer. Results and discussions We have observed that murine tumours recapitulate the genetic complexity observed in the human tumours like a monofocal origin of the aggressive disease, multi-clonal intratumour heterogeneity with clone convergent evolution, independent waves of metastatic colonisation and the presence of chromotripsis. Conclusion Our results show that the oncogenic Kras -based mouse model is a very good tool for the study of the dynamics of intratumour heterogeneity and that it also reflects faithfully the genomic processes observed in human pancreatic tumours. Consequently, we propose that a deeper genomic study of these murine tumours could provide a better understanding of the role of intratumour heterogeneity in tumour progression and metastasis.

We addressed the effects of growing-season rainfall of two consecutive years and of two microhabitats on seed density and floristic composition of the germinable seed bank of annual plants in a sandy desert. We hypothesised that seed composition and density is affected by the presence of vegetated patches, but that this effect varies according to rainfall. We predict an overall lower soil-seed density with higher values under shrubs after a dry growing season. We found significant effects of interyear variability and microhabitat on the germinable soil seed bank of annual plants. Twice as many germinable seeds were present in soil after the rainy summer than after the drier summer. Moreover, seed density under shrubs was 1.3 times greater than on bare ground. Although we found no statistic interaction between factors affecting the germinable soil seed density, the relative amount of germinable seeds under shrubs increased after a drier growing season. Species composition showed non-additive effects for the interaction of precedent growing-season rainfall and microhabitat, resulting in four species-assemblages. Altogether, our findings suggest that shrub patches and rainfall events of the precedent growing season may affect the abundance and identity of ephemeral and annual plant species in the germinable seed bank.

Aim To study the prevalence, risk factors, and vascular disease associated with moderate and severe hypertriglyceridemia in an active working population. Design and Methods Cross-sectional study of 594,701 workers from all Spanish geographical areas, occupation sectors, ages, and sexes who underwent a yearly routine checkup. Data collected from participants included age, sex, anthropometric measurements, vascular risk factors, lipidic profile and basic biochemical analysis, from a fasting blood sample. A cardiovascular risk assessment was performed. Results The study population included 428,334 males and 166,367 females, mean age 36 ± 10 years. A total of 95,673 (16%) workers had mild hypertriglyceridemia (HTg) (Tg 150–399 mg/dL), 7,081 (1.1%) had moderate HTg (400–999 mg/dL), and 224 (0.03%) had severe HTg (≥1000 mg/dL). Of workers with hypertriglyceridemia, 90% were male. Age, obesity, type 1 and 2 diabetes, alcohol consumption, and vascular disease were associated with hypertriglyceridemia. Cardiovascular risk gradually increased for each HTg category. Amongst risk factors, the major independent predictor of mild-HTg was obesity (OR 2.42, CI 95% 2.37–2.48), whereas diabetes was a predictor of moderate HTg (OR 3.64, CI 95% 3.17–4.18) and severe HTg (OR 7.35, CI 95% 4.27–12.66). In multivariate analyses, HTg was gradually associated with vascular disease, even after adjusting for other risk factors. Conclusion In this working population, preventive programs for HTg and associated vascular disease should consider obesity–diabetes control as its first objective.

Bolivia implemented an extensive reform of their forestry sector during the 1990s. Starting five years later, we evaluated the degree of adoption of sustainable forest management practices (SFM) by timber concessionaires in Bolivia and investigated the factors influencing their adoption. Data were obtained from surveys that quantified the level of adoption of 11 SFM practices in 23 concessions. The study revealed that concessionaires adopted some practices more than others. It found that regulation plays a critical role in promoting adoption. Adoption of SFM practices was also more frequent among operators that had been in the forestry business for a longer time, had larger concessions, harvested and processed larger volumes, utilized a wider set of species, were located closer to markets, had received more technical assistance, had trained their employees, and had made other investments. The owners' perception that SFM practices contributed to ecological sustainability was also an important factor in their decision to adopt these practices.

Resumen La enfermedad coronaria (EC) es la principal causa de muerte en muchos paises. El electrocardiograma (ECG) de esfuerzo permite evaluar la isquemia miocardica y agrega valor pronostico, con rendimiento limitado en presencia de alteraciones electricas basales. La SPECT (single photon emission computed tomography ‘tomografia computarizada por emision de foton unico’) en esfuerzo se utiliza para evaluacion de EC, con reconocido buen rendimiento, que requiere interpretacion independiente del ECG y de las imagenes miocardicas. Objetivo Analizar la concordancia en la interpretacion del ECG de esfuerzo entre observadores en entrenamiento, incluyendo alumnos de pre y posgrado de Medicina, con un cardiologo experimentado y con SPECT miocardica. Metodo Se incluyeron 95 pacientes enviados para evaluacion de EC, edad: 61 ± 9,3 anos (rango: 42–85), 56%: hombres. Se calculo la concordancia entre la SPECT de perfusion sincronizada con 99mTc-Sestamibi y ECG de esfuerzo segun resultado normal/anormal, necrosis, isquemia o patron mixto. Se efectuo un analisis interobservador kappa (k). Resultados Fueron anormales el 49,5% de los ECG de esfuerzo segun informe inicial y el 45% de los estudios SPECT; la concordancia para normal/anormal fue del 62,1% (κ: 0,24) y para isquemia del 58,9% (κ: 0,14). La concordancia entre informe ECG de esfuerzo inicial y el del cardiologo independiente fue del 89,5% (κ: 0,78). Las concordancias interobservador con este informe variaron entre el 62,1 y el 48,4%; para ECG basal, entre el 41,1 y el 90,5% considerando normal/anormal; y entre el 80 y el 93,7% (κ: 0,59–0,87) para isquemia entre este y otros observadores. Conclusion En la interpretacion del ECG de esfuerzo se encontro adecuada reproducibilidad entre observadores, con mayor acuerdo en los mas experimentados, lo que confirma la importancia del entrenamiento.

Coronary artery disease (CAD) is the leading cause of death in many countries. Stress electrocardiogram (ECG) is able to detect myocardial ischemia and also has prognostic value, which may be impaired in presence of electrical baseline abnormalities. Stress myocardial single photon emission tomography (SPECT) has recognized good yield in assessment of CAD, requiring independent interpretation of ECG and nuclear images. Purpose To analyze stress ECG interpretation reproducibility among observers with different training level compared to experienced ones and also with SPECT. Method We studied 95 patients under CAD evaluation, mean age 61 ± 9.3 years (range: 42-85), 56% male. We calculated interobserver correlation kappa (κ) between perfusion gated 99m Tc-Sestamibi SPECT and exercise ECG. Interpretation was normal/abnormal, presence of necrosis, ischemia or mixed pattern and was performed by under and postgraduate medicine students. Results 49.5% stress ECG and 45% SPECT studies were abnormal at the initial report with 62.1% concordance (κ: 0.24) for normal/abnormal and 58.9% for ischemia (κ: 0.14). Agreement between stress ECG initial report and independent cardiologist was 89.5% (κ: 0.78). The correlation between independent observers and the initial report ranged between 62.1% and 48.4%, for baseline ECG between 41.1% and 90.5% considering normal/abnormal, and between 80% and 93.7% (κ: 0.59-0.87) for the presence of ischemia. Conclusion Stress ECG interpretation presented adequate interobserver reproducibility with greater agreement in the most experienced observers, confirming the importance of training.

In deserts and semi-deserts dominant plants seldom rely on a persistent seed bank to ensure their recruitment from sexual reproduction, which is generally based on the seeds produced in the last reproductive event. We studied pre- and post-dispersal seed loss of Bulnesia retama , a dominant shrub of the sandy Monte deserts (western Argentina). We hypothesised that pre- and post-dispersal seed depletion in B. retama regulate soil seed density and in turn decrease soil seed reserves. We also hypothesised that spatial patches induced by standing vegetation and other microsites additionally affect post-dispersal seed loss and soil seed density. We observed that as much as half the total seed production was lost due to pre-dispersal seed predation. Seed dispersal plus predation showed a negative exponential function with 61% of seeds falling during the first 28 days, and 99% after 90 days, when 34% of the seeds remained inside excluded branches. A significant patch effect was observed on soil seed density and seed dynamics, with a greater number of seeds and increased seed depletion rates below B. retama shrubs. However, spatial patches did not affect seed germination although they increased with burial time, from 22% to 70% after 75 and 276 days, respectively. Likewise, a similar trend was found in potential seed germination; seeds collected directly from mother plants had a low germination rate (less than 25%), which increased to 75% after 276 days of soil burial. About 15% of the dispersed seeds should persist to the next rainy season, thus contributing to a low-density but persistent seed bank. The delay in seed germination and temporal decrease in soil seed density that we observed for B. retama suggest that a set of mechanisms have been developed promoting germination events whenever soil water is available, at any moment of the year.

Resumen Introduccion y objetivos La interpretacion de la tomografia de emision de foton unico (SPECT) de perfusion miocardica requiere conocer la reproducibilidad de la tecnica. El objetivo fue analizar la correlacion interobservadores de distinta experiencia en interpretacion de SPECT en pacientes post-infarto agudo de miocardio (IAM) en un contexto de mejora de la calidad de nuestros centros. Metodos Se incluyeron 60 casos (56 ± 11 anos, 87% hombres) con infarto transmural reciente sometidos a trombolisis exitosa. Una semana despues del IAM se efectuo perfusion de reposo con 99m Tc-sestamibi. Analisis Semicuantitativo mediante lectura ciega por 2 especialistas independientes y 5 observadores utilizando 17 segmentos. La fraccion de eyeccion ventricular izquierda (FEVI) promedio medida con ventriculografia isotopica al mes fue del 38%. Resultados En analisis consensuado, el promedio de segmentos comprometidos/paciente fue 9,3 ± 4 y la sumatoria de severidad 25 ± 13; los otros observadores variaron entre: 7 ± 3,7-9,4 ± 3,9 y 16,7 ± 9,7-24,6 ± 13, respectivamente, concordando con los especialistas entre 0,779 y 0,871 (kappa: 0,565-0,741). No hubo diferencia significativa en el 40 % de los analisis para el numero de segmentos comprometidos y en el 60% para intensidad, en observadores con mayor experiencia. La correlacion con consenso para el numero de segmentos vario entre 0,84 y 0,94, y para severidad entre 0,79 y 0,89. La asignacion de arterias fue adecuada (r: 0,612-0,683 y kappas 0,629-0,656). La correlacion de segmentos comprometidos y su severidad con la FEVI efectuada al mes del IAM fueron de 0,73 y 0,74, respectivamente. Conclusiones Existio buena correlacion en interpretacion de SPECT, con mejor ajuste en observadores experimentados. Este ejercicio sirvio para mejorar habilidades de interpretacion en cardiologia.

Background Some studies showed abnormalities in brain magnetic resonance imaging (MRI) of relapsing neuromyelitis optica (R-NMO) from 12 to 46%. These abnormalities are described as compatible/non-compatible with multiple sclerosis (MS). Objective To describe the abnormal brain MRI lesions in R-NMO with imaging studies conducted with more sensitive white matter change techniques. Methods Thirty patients with R-NMO were selected. All MRI brain studies were performed with a 1.5-T Siemens MRI system according to the Standardized MR Imaging Protocol for Multiple Sclerosis from the Consortium of MS Centers Consensus Guidelines. Results Brain MRI images were evaluated in 29 R-NMO cases because in one case the MRI images were not appropriate for the study. Of these 29 brain MRI studies, 19 cases (65.5%) had at least one or more lesions (1–57) and 10 were negative (34.4%). Brain MRI findings in 19 cases were characterized in T2/fluid-attenuated inversion-recovery (FLAIR) by the presence of subcortical/deep white matter lesions in 16 (84.2%) cases (1–50), most of them < 3 mm and without juxtacortical localization. Periventricular lesions were observed in 13 (68.4%) cases, but morphologically they were not oval, ovoid or perpendicularly orientated. Infratentorial lesions, all >3 mm, were observed in 4 (21.05%) cases without cerebellar involvement. T1 studies demonstrated absence of hypointense regions. Optic nerve enhancement was observed in 6/19 patients (31.5%). None of the brain MRI abnormalities observed were compatible with Barkhof et al. criteria of MS. Conclusions This study, based on a Cuban patient population, with long duration of disease, good sample size and detailed characterization by MRI, demonstrated the brain MRI pattern of R-NMO patients, which is different from MS. Multiple Sclerosis 2007; 13: 186–192. http://msj.sagepub.com

In this paper we present results on the effect of medical experience on the economic evaluation of health policies utilizing the method of discrete choice experiments. Subjects in two split samples were asked about choice situations involving alternative profiles defined by the attributes of an innovative program for cervical cancer screening. The first sample was formed by expert medical practitioners who were familiar with the illness and its potential treatments. A second sample was formed by young undergraduate students in social sciences who were not familiar with the illness or with the potential benefits of screening programmes. The statistical comparison between both subsamples utilizes a robust method for discrete choice models which shows that there are no significant differences in the structural models and the parameter estimates. The main implication is that background medical information and familiarity with the process of illness might not have a relevant impact on the valuation of health policies with discrete choice experiments.

Background Recent guidelines recommend assessment of lifetime cardiovascular risk on the basis of traditional risk factors in adults who are not at high short-term risk. The aim of this study is to determine the implications of estimating the lifetime cardiovascular risk in individuals in a large occupational cohort in Spain. Design National cross-sectional study in an occupational cohort with an in-person interview including laboratory tests. Methods Volunteer workers who were examined between January 2011 and December 2011 were included. A total of 580,236 workers were eligible during this year and 259,834 were examined (participation rate of 44.7%). Short-term (10-year) and lifetime cardiovascular risk were estimated using the American College of Cardiology (ACC) and the American Heart Association (AHA) tool and the QRISK2 and QRISK. Results Sixty-eight per cent were male, mean age was 39 years, with an age range of 16 to 75 years. Total number of individuals included in this study was 258,676. The percentage of patients at high short-term risk was 6.85% (95% confidence interval (CI) 6.75%-6.95% and 20.83% (95% CI 20.60%-21.07%) with the QRISK2, and the ACC/AHA risk equations, respectively. Of the percentage of patients classified as not at high risk with the different tools 1.61% (95% CI 1.55%-1.66%) were high lifetime risk on QRISK, and 27.41% (95% CI 27.11%-27.70%) on ACC/AHA risk. Conclusions Application of lifetime cardiovascular risk engages greater numbers of individuals at high risk with substantial differences between the different methods available. These differences can have important clinical implications specifically in the percentage of candidates for lifestyle changes and eventually lipid lowering drugs.

The aim of this study was to assess the prevalence of atherogenic dyslipidemia (AD) and the lipid triad (LT) in the working population in Spain, their associated variables and how far they are linked to cardiovascular risk (CVR).Observational cross-sectional study of 70,609 workers (71.5% male (M), 28.5% female (F), mean age 39.2 ± 10), who attended medical checkups and agreed to participate. Plasma samples were analysed in a central laboratory. AD definition used was: triglycerides ≥150 mg/dl and HDL cholesterol40 mg/dl (M)/50 mg/dl (F) and LT when LDL cholesterol 160 mg/dl is further added. Univariate comparisons in the absence and presence of AD and LT and the probability of AD according to different parameters and their possible association with CVR were assessed. CVR was stratified following the European SCORE model for low risk-population.5.7% (95% CI 4.7-6.9) of the working population have AD and 1.1% (95% CI 1.0-1.2) LT. In univariate analysis, workers with AD and LT had a higher prevalence of obesity, hypertension, smoking and diabetes than those who had not (p 0.001). In multivariate analysis, BMI, sex, age 40-49, diabetes, tobacco, uric acid, LDL or blood pressure significantly influenced the risk of AD. AD was significantly associated with CVR after adjusting for alcohol and obesity. However, most of the AD subjects (91.8%) were classified as low risk.About 6% of the working population in Spain meets AD criteria. Assuming that these subjects have increased CVR, AD allows to identify additional 5% of subjects with increased CVR to that one the SCORE model detects, helping to improve cardiovascular risk stratification.

Video-on-demand (VoD) is today's standard for viewing and sharing video content over the Internet. However, the conventional client-server approach to video on demand consumes a significant amount bandwidth, pushing content publishers and content delivery networks to examine other approaches such as the use of peer-to-peer (P2P) technologies to assist in video distribution. We studied the performance impact of peer localization strategies aimed at limiting traffic exchanges between autonomous systems (ASes), and our findings suggest that peer localization can improve streaming performance while reducing inter-AS traffic, to the potential benefit of users and providers, respectively. Using a hybrid adaptive localization strategy (HALS), we allow external peers into a local mix when a swarm is outside its peak, in order to ensure a steady supply of pieces and to maintain structural robustness. Though HALS introduces additional inter-domain traffic compared to a purely localized approach, its download performance is at par or slightly better, while further reducing the content publisher's total upload volume.