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Mutations in the SARS-CoV-2 genome may negatively impact a diagnostic test, have no effect, or turn into an opportunity for rapid molecular screening of variants. Using an in-house Emergency Use Authorized RT-qPCR-based COVID-19 diagnostic assay, we combined sequence surveillance of viral variants and computed PCR efficiencies for mismatched templates. We found no significant mismatches for the N, E, and S set of assay primers until the Omicron variant emerged in late November 2021. We found a single mismatch between the Omicron sequence and one of our assay's primers caused a > 4 cycle delay during amplification without impacting overall assay performance. Starting in December 2021, clinical specimens received for COVID-19 diagnostic testing that generated a Cq delay greater than 4 cycles were sequenced and confirmed as Omicron. Clinical samples without a Cq delay were largely confirmed as the Delta variant. The primer-template mismatch was then used as a rapid surrogate marker for Omicron. Primers that correctly identified Omicron were designed and tested, which prepared us for the emergence of future variants with novel mismatches to our diagnostic assay's primers. Our experience demonstrates the importance of monitoring sequences, the need for predicting the impact of mismatches, their value as a surrogate marker, and the relevance of adapting one's molecular diagnostic test for evolving pathogens. Fralin Biomedical Research Institute; Department of General Services of the Commonwealth of Virginia [DGS-201020-UVT] Published version This work was supported by Fralin Biomedical Research Institute [Grant Number N/A]; Department of General Services of the Commonwealth of Virginia [Grant Number DGS-201020-UVT].

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Este proyecto que utilizó como diseño metodológico la investigación intervención desde el enfoque de lo sistémico – complejo y la cibernética de segundo orden nos permitió una comprensión amplia de la Institución Educativa Ciudad de Ipiales para desnaturalizar nuestras prácticas y reflexionar sobre las necesidades que emergieron de un proceso de caracterización, luego identificar y delimitar la problemática didáctica directamente relacionada con los procesos de enseñanza que para nuestro caso es la lectura, que se ha convertido en un reto para la educación, debido a que es el principal medio para la comprensión del mundo y está directamente relacionada con la adquisición de conocimientos; leer equivale a pensar, razonar y establecer relaciones con el otro. Por lo cual, requiere de estrategias didácticas innovadoras que generen motivación, interés y gusto por la lectura y que conlleven a un tipo de aprendizaje diferente. Según lo anterior se construyó una propuesta didáctica basada en la lectura compartida para enriquecer la reconstrucción del contenido de los textos al leer con otros y comentar lo leído, generar autonomía, libertad y gusto por la lectura. Esta propuesta fue estructurada mediante secuencias didácticas para la organización y articulación de las actividades facilitando la interpretación de los resultados tomando como referencia los aportes de diferentes autores para fundamentar nuestra investigación. http://www.ustadistancia.edu.co/?page_id=3956 Maestría

IntroductionIn Argentina, the national guidelines for lipid control emphasize the use of relatively inexpensive low- or moderate-potency statins by patients at high risk (>20%) of a cardiovascular event. The objective of this study was to compare the impact and costs of the current national CVD prevention guidelines with regard to morbidity and mortality in Argentina with the impact and costs of three strategies that incorporate high-potency statins.MethodsWe used the CVD Policy Model-Argentina to model the proposed interventions. This model is a national-scale, state-transition (Markov) computer simulation model of the CVD incidence, prevalence, mortality, and costs in adults 35-84 years of age. We modeled three scenarios: scenario 1 lowers the risk threshold for treatment to >10% according the Framingham Risk Score (FRS); scenario 2 intensifies statin potency under current treatment thresholds; and scenario 3 combines both scenarios by lowering the treatment threshold to ≥10% FRS and intensifying statin potency.ResultsScenario 1 would translate into 1400 fewer MIs and 500 fewer CHD deaths every year, a 3% and 2% reduction, respectively. Scenario 2 would lead to 2000 fewer MIs and 1000 fewer CHD deaths every year. Scenario 3 would result in the greatest reduction in MIs and CHD deaths, with 3400 fewer MIs and 1400 fewer CHD deaths every year, which translates to a 7% and 6% reduction, respectively. All scenarios were cost-effective if the cost of a high-potency statin pill was under US$0.25.ConclusionIncorporating those individuals with greater than 10% cardiovascular risk and the use of high-potency statins into Argentina's national lipid guidelines could result in fewer CHD deaths and events at a reasonable cost.

Strongyloidiasis is a disease caused by an infection with a soil-transmitted helminth that affects, according to largely varying estimates, between 30 million and 370 million people worldwide [1,2]. Not officially listed as a neglected tropical disease (NTD), strongyloidiasis stands out as particularly overlooked [3]. Indeed, there is a paucity of research and public health efforts pertaining to strongyloidiasis. Hence, clinical, diagnostic, epidemiologic, treatment, and control aspects are not adequately addressed to allow for an effective management of the disease, both in clinical medicine and in public health programs [4]. The manifold signs and symptoms caused by Strongyloides stercoralis infection, coupled with the helminth’s unique potential to cause lifelong, persistent infection, make strongyloidiasis relevant beyond tropical and subtropical geographic regions, where, however, most of the disease burden is concentrated. Indeed, strongyloidiasis is acquired through contact with contaminated soil, and the infection is, thus, primarily transmitted in areas with poor sanitation, inadequate access to clean water, and lack of hygiene. While the actual morbidity of chronically infected, immunocompetent individuals is subtle and difficult to appreciate [5], the particular importance of this parasitic worm is linked to its potential for maintaining lifelong autoinfections and causing a life-threatening hyperinfection syndrome in immunocompromised individuals [6]. Lack of point-of-care (POC) diagnostics and poor availability of, and access to, ivermectin (the current treatment of choice) are the two most significant bottlenecks that hinder effective management of the disease both in clinical and in public health settings. Examples of the management and importance of strongyloidiasis in two clinical contexts (in a tropical setting and a high-income country) and from a public health perspective are given in Boxes 1–3. Box 1. Individual Living in an Endemic Area with Diarrhea, Abdominal Pain, Pruritus, and Significant Dermatological Manifestations [10] A 43-year-old male farmer, living in the rural eastern part of Preah Vihear province, northern Cambodia, was diagnosed with a heavy Strongyloides stercoralis infection (924 and 478 larvae present in two Baermann examinations). Additionally, larvae and adult S. stercoralis were detected in Koga agar plate culture examinations of the stools. The patient was co-infected with hookworm and presented with abdominal pain, diarrhea, nausea, vomiting, fever, and a pronounced and persistent skin rash, which had been present with extensive itching for more than two years. The rash was observed on the back, chest, abdomen, and extremities and, due to frequent and intense scratching, showed signs of focal infection. Three weeks after treatment with a single oral dose of ivermectin (200 μg/kg) and a single oral dose of mebendazole, the patient’s rash had almost disappeared, and he was free of episodes of intensive itching.

The objective of this study was to compare the chemical composition and ruminal degradation of whole pod, exomesocarp, endocarp and seed fractions of red and white mesquite pods. The pods contained on average 220 g free sugars, 78 g crude protein, 21 g fat per kg dry matter (DM), and a potential DM degradation of 163 g/kg. Contaminant fungi (mostly Aspegillus spp.) count was low. Unsaturated fatty acids, mainly linoleic acid, were the predominant (~50%) fatty acids in whole pods and seeds. Sucrose was the largest free sugar proportion. The highest fibre content was found in the endocarp, the highest free sugar was found in the exomesocarp, and the highest crude protein content was found in the seeds. Tannins were more abundant in red pods (0.4 mg/100 g DM) than in white ones. Some differences in nutritional values were found between red and white pods and their components (exomesocarp, endocarp and seeds), although both have a potentially high nutritive value. Whole pods and the endocarp can be used by ruminants; seeds can be used by simple stomach animals; and the exomesocarp can be used in human nutrition because of its low glycaemic index propertiesKeywords: Degradation rate, fatty acids, sugar, tannins

To determine the peri-operative outcomes of men undergoing salvage robot-assisted prostatectomy (RARP) and to examine the complications, functional consequences and need for additional treatments after salvage RARP.At total of 51 consecutive patients underwent salvage RARP after previous failed local therapy. Biochemical recurrence (BCR) was defined as two postoperative PSA measurements ≥0.2 ng/mL. Complications at any time postoperatively were recorded prospectively using a modified Clavien system. The Kaplan-Meier method was used for survival estimation, and regression models were used to identify the predictors of BCR or progression-free survival (PFS) and complications.The median age at salvage RARP was 68 years and a median of 68 months had elapsed from the time of primary treatment. The median follow-up was 36 months. The median operation duration was 179 min with a median estimated blood loss of 175 mL. In all, 50% of patients had pathological stage 3 disease and positive surgical margins were found in 31% of patients. The estimated 3-year BCR-free or PFS was 57%. The overall complication rate was 47%, with a 35% major complication rate (Grade III-V). Potency was maintained in 23% of preoperatively potent patients and 45% of all patients regained urinary control. No clinical variables were predictive of major complications, but all patients with postoperative bladder neck contracture were incontinent. A higher PSA level and extracapsular extension were significantly associated with BCR or progression (P0.01).Salvage RARP provides oncological control with potential avoidance of systemic non-curative therapy. Complication, incontinence and erectile dysfunction rates are significant but frequently correctable. This reinforces the need for proper patient counselling and selection.

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WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Extended pelvic lymphadenectomy is the present standard of care according to European Association of Urology guidelines. Extended dissection improves staging, removes more metastatic lymph nodes, and potentially has therapeutic benefits. Previous reports have examined the morbidity of extended dissection compared with a more limited dissection in the open and laparoscopic setting. While some have suggested an increased complication rate with extended node dissection, others have not. This represents the first study focused on comparing the complications associated with the extent of node dissection using the modified Clavien system and Martin criteria in the literature on robot-assisted surgery. In a single surgeon series, we found no statistically significant differences in complications. With careful anatomic dissection, robot-assisted extended lymph node dissection can be performed safely and effectively, although operating time and length of hospital of stay are slightly increased.To compare the perioperative course of patients undergoing robot-assisted limited lymph node dissection (LLND) or extended lymph node dissection (ELND) for prostate cancer. To examine the differential lymph node counts and rates of detection of lymph node metastases.Between 2008 and 2012, 406 consecutive patients with D'Amico intermediate- or high-risk prostate cancer underwent either bilateral LLND (n = 204) or ELND (n = 202) and robot-assisted laparoscopic radical prostatectomy by a single surgeon. The region of dissection was the obturator fossa for LLND, while ELND included, in addition, the common iliac, external iliac and internal iliac lymph nodes. All complications within 90 days of surgery were recorded according to a modified Clavien system. Clinical variables were summarized and compared. Logistic regression was used to identify predictors of complications.There were no differences in demographics when comparing patients who underwent ELND with those who underwent LLND. The median operating time was 3.0 h for the ELND cohort and 2.8 h in the LLND cohort (P0.001). Intraoperative blood loss was 200 mL in both cohorts. Hospital stay was longer for a small percentage of patients in the ELND cohort, with 75% of ELND patients and 85% of LLND patients staying 1 day (P = 0.004). No significant difference was found in the overall or major complication rates between LLND (21.6% overall; 6.9% major) and ELND (22.8% overall; 4.5% major). No difference was seen in the symptomatic lymphocele rate between LLND and ELND, 2.9 vs 2.5%, respectively. Overall, the lymph-node-positive rate was 12% compared with 4% for the ELND and LLND groups, respectively (P = 0.002). A higher Charlson comorbidity index score was associated with the development of major complications.ELND at the time of robot-assisted radical prostatectomy can be performed safely with minimal additional morbidity. Long-term oncological and functional outcomes require further study.

Este estudio analiza la calidad de vida relacionada con la salud en pacientes diagnosticados de cirrosis hepática (CH) en los tres estadios Child-Pugh (A, B y C) y en pacientes trasplantados (OLT). La calidad de vida ha sido cuantificada por la prueba psicométrica multidimensional PLC (Siegrits, Boer and Junge, 1996). En general, los pacientes CH y OLT presentaron peores puntuaciones que el grupo control en las dimensiones de Capacidad física, Función física, Ánimo positivo, Ánimo negativo y Bienestar psicológico. Aunque los pacientes OLT mostraron mejor calidad de vida que los pacientes con estados avanzados de cirrosis (Child B y C) en las escalas que evalúan las funciones física, psicológica y social. El grupo OLT presentan puntuaciones más altas en la dimensión Ánimo positivo respecto al grupo de pacientes cirróticos en estadio Child A. Nuestros resultados sugieren que la calidad de vida en pacientes OLT no alcanza los niveles de la población sana, pero es significativamente mejor que en pacientes CH especialmente en fases avanzadas.

The Wiener-Hopf theory of optimum linear systems is applied to the determination of the stable pulse response of a monotone hydrologic system from coincident records of input and output in the form of discrete time series. In application to the rainfall runoff system, linear programming methods are used in the solution of the Wiener-Hopf equations to obtain physically realizable unit hydrographs.

Mapas, ilustraciones En el año de 1943, el gobierno de los Estados Unidos organizó y costeó, en la ciudad de Medellín, un curso preparatorio en la técnica de Meteorología, el cual funcionó bajo el nombre de Instituto Interamericano de Meteorología. El autor de este cursillo sobre Ecuaciones Diferenciales Ordinarias, catedrático por varios años en la Facultad Nacional de Minas, fue en ese entonces profesor de Análisis Matemático en este Instituto, para el cual hubo de elaborar unas breves notas como complemento de tal materia en el campo de las Ecuaciones Diferenciales. (Texto tomado de la fuente)

The objective of this investigation was to evaluate the usefulness of self-reported measures of height and weight under the hypothesis that they under-estimate the prevalence of obesity. A cross-sectional study was carried out on a random sample of the adult population of the province of León, Spain. The study involved 572 participants (262 men and 310 women). All participants were interviewed and questioned about socio-cultural characteristics plus their weight and height. All respondents were later weighted and measured for height using standard methods. A Quetelet or body mass index (BMI)or = 30 kg/m2 was used as the index for obesity. Many people were unaware of their weight and/or height. Self-reported BMI could not be calculated in 40 men (15%) and 107 women participants (35%). This occurrence was more frequent in women than in men (chi 2 = 3.98; P0.05). The prevalence of obesity, based on measured weight and height, was 1.8 times that from self-reported values in men and 2.5 times that from self-reported values in women. If we consider only the measured values for those individuals who supplied self-reported heights and weights, these prevalences fall to 1.7 and 1.6 times those from self-reported values respectively. In addition, the difference between measured and self-reported height increase with age. All these differences are statistically significant. We believe that the use of self-reported values of weight and height in epidemiological studies should be avoided in an elderly population. These measurements could, however, be used on a younger population.

In mammalian females, germ cells remain arrested as primordial follicles. Resumption of meiosis is heralded by germinal vesicle breakdown, condensation of chromosomes, and their eventual alignment on metaphase plates. At the first meiotic division, anaphase-promoting complex/cyclosome associated with Cdc20 (APC/C) activates separase and thereby destroys cohesion along chromosome arms. Because cohesion around centromeres is protected by shugoshin-2, sister chromatids remain attached through centromeric/pericentromeric cohesin. We show here that, by promoting proteolysis of cyclins and Cdc25B at the germinal vesicle (GV) stage, APC/C associated with the Cdh1 protein (APC/C) delays the increase in Cdk1 activity, leading to germinal vesicle breakdown (GVBD). More surprisingly, by moderating the rate at which Cdk1 is activated following GVBD, APC/C creates conditions necessary for the removal of shugoshin-2 from chromosome arms by the Aurora B/C kinase, an event crucial for the efficient resolution of chiasmata., A.R., R.B.M., and M. Hopkins were supported by PhD fellowships from the Boehringer Ingelheim Fonds, Barbour Foundation, and EPSRC (EP/G03706X/1), respectively. A.M.P. is supported by Ministerio de Economia y Competitividad (MINECO) (grant number: BFU-2014-59307); M. Herbert is funded by the Medical Research Council (MR/J003603/1), Wellcome Trust (096919), and European Community’s Horizon 2020 Research and Innovation Programme under grant agreement 634113 (GermAge); and B.N. is supported by a BBSRC Strategic LoLa grant (BB/M00354X/1). The European Community’s Seventh Framework MitoSys (241548), Medical Research Council (84673), and Wellcome Trust (019859/Z/10/Z) funded this project. Open Access funded by Wellcome Trust.