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La mortandad de la empresa familiar en México alcanza el 80 % en los primeros 10 años, y 7 de cada 10 de las que sobreviven ese primer periodo desaparecen después del fallecimiento del fundador. Solo entre el 10 % y 15 % de las empresas consiguen transitar a la siguiente generación. Si consideramos que las empresas familiares representan el 83 % de las organizaciones en México, es preocupante que la mayoría no tenga claridad sobre la estrategia de incorporación de la siguiente generación, que les permita contar con personas preparadas para lograr una tran­sición adecuada. Esta investigación tiene como objetivo identificar cuál es la percepción de los jóvenes que han vivido el proceso de incorporación a la empresa familiar; conocer sus prácticas favorables, su formación, sus dinámicas familiares y la­borales que incidieron para ello. A través de un estudio, con diseño exploratorio descriptivo, se aplicaron entre­vistas semiestructuradas, se aplicó un análisis de categorías para analizar su preparación como futuros líderes y perspec­tiva al sumarse a la empresa familiar. Se identificaron los mecanismos que más ayudaron en su incorporación a la empresa, sugerencias en el manejo de relaciones familia­res y si las funciones los están preparando para tomar el liderazgo de la empresa.

Introducción: La placenta succenturiata es una anomalía morfológica de la placenta que puede resultar en morbilidad y mortalidad significativas tanto para el feto como para la madre. Objetivo: describir un caso clínico de hemorragia anteparto asociado a placenta succenturiata. Materiales y métodos: se realizó un estudio descriptivo retrospectivo, presentación de caso clínico, se obtuvo consentimiento informado de paciente para tener acceso a la historia clínica y uso de imágenes correspondientes a la presente investigación. Caso clínico: se presenta el caso de una gestante de 33 semanas, que ingresa al area de emergencias, con hemorragia del tercer trimestre, en la ecografía se observó, presencia de un lóbulo que alcanza el nivel del orificio cervical interno, confundiéndose con placenta previa, paciente se encontraba estable y en observación, con monitorización fetal continua, hasta obtener maduración pulmonar completa, posteriormente presento dolor y sangrado ante parto por lo que fue intervenida quirúrgicamente mediante operación cesárea donde se constata la presencia de lóbulo succenturiado en placenta. La evolución de ambos fue favorable. Discusión: El presente artículo demuestra, una rara variedad de malformación placentaria que provoca múltiples complicaciones y pertenece al diferencial de otras patologías que provocan hemorragia del tercer trimestre, pudiendo estar asociadas con placenta previa, por lo que, hay que tener presente la placenta succenturiata como una causa de hemorragia del tercer trimestre, además tener en consideración que en el periodo postparto es causa de retención de una porción placentaria y puede ocasionar hemorragia o infección. Conclusiones: La placenta succenturiata es una anomalía de rara presentación, que forma parte del diagnóstico diferencial de las hemorragias ante parto y que debe ser diagnosticada en el periodo prenatal, para poder así, realizar un control prenatal y atención del parto de forma adecuada, además de dar una orientación a la paciente y su familia. Se recomienda en estos casos el parto por cesárea, con abordaje quirúrgico y tipo de incisión a elección, de acuerdo a comorbilidades y estado clínico de paciente.

The purpose of this perspective article is to emphasise the importance of the ‘First 2000 Days’ policy of life from conception to age five, and to propose new directions in which the policy’s implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families’ needs in the critical early years of life during and beyond the current pandemic.

Sleep disorders are a common comorbid condition in children diagnosed with autism spectrum disorder ("autism"). However, the relationship between the clinical features of autism and sleep disorders remains unclear. A better understanding of the inherent autism-related characteristics linked to comorbid sleep disorders would improve comprehensive assessment and management. This study examined the relationship between sociodemographics, autism symptoms, sleep problems, cognitive status, behavioral attributes, and sensory profiles. Using data from 1268 participants who took part in the Australian Autism Biobank, sleep-related measurements using the Child Sleep Habits Questionnaire (CSHQ) were compared between autistic children aged 2 to 17 (N = 969), their siblings (N = 188), and unrelated children without an autism diagnosis (N = 111). The known relationship between sleep problems and autism was further explored by including scores from the Autism Diagnostic Observation Schedule-2, Mullen Scales of Early Learning, Vineland Adaptive Behavioral Scale-II and the Short Sensory Profile-2; which were included in analyses for autistic participants who had a completed CSHQ. Multiple regression models were used to identify clinical/behavioral variables associated with CSHQ subscales. The autism group had a significantly higher total CSHQ score than the sibling and comparison groups (p 0.001), indicating worse sleep quality. Within the autism group, lower adaptive behaviors (i.e., VABS-II) and sensory issues (i.e., SSP-2 subclass scores) were positively associated with the severity of sleep problems (i.e., the CSHQ subclass scores) (p 0.001). The significant functional impact of poor sleep on autistic children warrants an assessment of sleep as a critical part of a holistic approach to supporting autistic children and their families. LAY SUMMARY: Autistic children generally have co-occurring conditions. Sleep disorders impact approximately 50%-80% of autistic children. The impact on the quality of life for both the children and their families can be significant. This study compares sleep problems in autistic children and adolescents with their siblings and children without a diagnosis of autism, and investigates the relationship between specific autistic traits, daily life behaviors and sleep problems. The findings highlight the importance of a holistic assessment for autistic children and matching appropriate sleep intervention and supports where indicated.

This study investigated maternal oxytocin, caregiving sensitivity and mother-to-infant bonding at 3-months postpartum as predictors of child behavior and psychological outcomes in the preschool years, when controlling for concurrent maternal negative emotional symptoms and adult attachment state-of-mind. Forty-five mother–child dyads were assessed at 3-months and 3.5 years postpartum using mix of questionnaires, observational, interview and biological methods. Results showed that lower levels of maternal baseline oxytocin at 3-months postpartum significantly predicted emotional reactivity in the child at 3.5 years. When maternal adult attachment state-of-mind and negative emotional symptoms were included, lower levels of maternal baseline oxytocin at 3-months postpartum significantly predicted withdrawn child behavior. In addition, unresolved adult attachment and maternal negative emotional symptoms were significantly associated child behavioral disturbance in a range of areas. Findings highlight maternal postnatal oxytocin as a potential indicator of children who may be more likely to show emotional reactivity and withdrawn behavior in the preschool years.

Olive oil production generates a large amount of wastewater called olive mill wastewater. This paper presents the study of the effect of transmembrane pressure and cross flow velocity on the decrease in permeate flux of different ultrafiltration membranes (material and pore size) when treating a two-phase olive mill wastewater (olive oil washing wastewater). Both semi-empirical models (Hermia models adapted to tangential filtration, combined model, and series resistance model), as well as statistical and machine learning methods (response surface methodology and artificial neural networks), were studied. Regarding the Hermia model, despite the good fit, the main drawback is that it does not consider the possibility that these mechanisms occur simultaneously in the same process. According to the accuracy of the fit of the models, in terms of R2 and SD, both the series resistance model and the combined model were able to represent the experimental data well. This indicates that both cake layer formation and pore blockage contributed to membrane fouling. The inorganic membranes showed a greater tendency to irreversible fouling, with higher values of the Ra/RT (adsorption/total resistance) ratio. Response surface methodology ANOVA showed that both cross flow velocity and transmembrane pressure are significant variables with respect to permeate flux for all membranes studied. Regarding artificial neural networks, the tansig function presented better results than the selu function, all presenting high R2, ranging from 0.96 to 0.99. However, the comparison of all the analyzed models showed that depending on the membrane, one model fits better than the others. Finally, through this work, it was possible to provide a better understanding of the data modelling of different ultrafiltration membranes used for the treatment of olive mill wastewater.

Introducción: La incidencia de las Tecnologías de la Información y la Comunicación (TIC) sobre la sociedad del conocimiento ha originado importantes cambios, especialmente en la forma de transmitirlo y el diseño del contenido, con un gran efecto masivo y multiplicador, de tal manera que el sentido del conocimiento se ha profundizado en todos los niveles sociales, resaltando que el mayor impacto registrado ha recaído sobre los procesos educativos, siendo en las instituciones escolares donde la tecnología ha ejercido la mayor influencia, así como también en la labor del docente, llegando a formar parte de los procesos de enseñanza tradicionales. Objetivo: Analizar el impacto de la incorporación de los entornos virtuales de aprendizaje (EVA) a la educación. Metodología: Por medio de una metodología cualitativa basada en una extensa revisión bibliográfica se analiza el impacto de los EVA sobre la educación, los tipos de herramientas tecnológicas disponibles actualmente, las diversas maneras de aplicación y los aportes que han realizado las TIC sobre los procesos educativos. Resultados: La revisión de literatura permite deducir que la incorporación de las TIC a la educación por medio de los entornos virtuales de aprendizaje (EVA) se ha convertido en un proceso fundamental que en su concepción va más allá de la simple aplicación de herramientas tecnológicas que forman parte del sistema educativo, se refiere a una construcción didáctica y la forma cómo se construye y consolida un aprendizaje significativo basado en la tecnología, por lo que en un sentido estrictamente pedagógico se habla del uso tecnológico a la educación. Conclusiones: Las herramientas tecnológicas como los EVA han incrementado el nivel de significancia y concepción educativa al establecer modelos novedosos de comunicación y generando espacios de formación, información, debate y reflexión, traspasando las barreras de los procesos educativos tradicionales, convirtiéndose en valiosos recursos para el aprendizaje y formación de estudiantes con elevados niveles de competencias personales y profesionales.

Young people in Out of Home Care (OoHC) have complex mental health and psychosocial needs due to a range of individual, systemic and intergenerational factors that may limit the effectiveness of usual clinic-based services. To address this, in 2017 an assertive-integrated service (AIS) model of care was adopted by the Child and Adolescent Mental Health Service (CAMHS) in South Western Sydney Local Health District (SWSLHD), Australia, through outreach to the young person in the community. This paper outlines the study protocol comparing AIS with clinic-based CAMHS usual care to meet the physical, mental health and wellbeing needs of young people in OoHC. Using routinely collected outcome data, the AIS model will be compared to clinic-based CAMHS treatment as usual care. Measures of overall functioning (e.g. Global Assessment Scale [CGAS]), psychological functioning (e.g. Strength and Difficulties Questionnaire [SDQ]), general health and social functioning (e.g. Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]) and other relevant socio-demographic and clinical variables will be collected at intake and at 3-month intervals until discharge from the respective services. Semi-structured interviews will also be conducted with young people, their carers, and service providers, to examine qualitative themes about the suitability of service provision. It is expected that a better understanding of the key indicators of functioning for young people accessing AIS and clinic-based services will help inform what works for these young people so that they can receive targeted and tailored support from the start of service engagement.

Acute variceal bleeding is a complication of portal hypertension, usually due to cirrhosis, with high morbidity and mortality. There are 3 scenarios for endoscopic treatment of esophageal varices: prevention of first variceal bleed, treatment of active variceal bleed, and prevention of rebleeding. Patients with cirrhosis should be screened for esophageal varices. Recommended endoscopic therapy for acute variceal bleeding is endoscopic variceal banding. Although banding is the first-choice treatment, sclerotherapy may have a role. Treatment with Sengstaken-Blakemore tube or self-expanding covered metallic esophageal stent can be used for acute variceal bleeding refractory to standard pharmacologic and endoscopic therapy.

Contemporary theories of early development and emerging child psychopathology all posit a major, if not central role for physiological responsiveness. To understand infants’ potential risk for emergent psychopathology, consideration is needed to both autonomic reactivity and environmental contexts (e.g., parent–child interactions). The current study maps infants’ arousal during the face-to-face still-face paradigm using skin conductance (n = 255 ethnically-diverse mother–infant dyads; 52.5% girls, mean infant age = 7.4 months; SD = 0.9 months). A novel statistical approach was designed to model the potential build-up of nonlinear counter electromotive force over the course of the task. Results showed a significant increase in infants’ skin conductance between the Baseline Free-play and the Still-Face phase, and a significant decrease in skin conductance during the Reunion Play when compared to the Still-Face phase. Skin conductance during the Reunion Play phase remained significantly higher than during the Baseline Play phase; indicating that infants had not fully recovered from the mild social stressor. These results further our understanding of infant arousal during dyadic interactions, and the role of caregivers in the development of emotion regulation during infancy.

Integrated school-based health services have potential to address the unmet health needs of children experiencing disadvantage, yet these models remain poorly evaluated. The current article examines an integrated social and healthcare hub located on the grounds of a regional Australian public primary school, the Our Mia Mia Wellbeing Hub, to identify critical success factors for this service and others like it.Semi-structured qualitative interviews were conducted with N=55 multi-sector stakeholders comprising parents, students, school staff, social and healthcare providers, and local Aboriginal community members. Interview transcripts were analysed according to a grounded theory approach.Six themes emerged from the analysis, reflecting important success factors for the model: service accessibility; service coordination; integration of education and health systems; trust; community partnerships; and perceptions of health.Findings highlighted Our Mia Mia as a promising model of care, yet also revealed important challenges for the service as it responds to the varied priorities of the stakeholders it serves. SO WHAT?: Through capturing the perspectives of a large number of stakeholders, the current study provides valuable insight into key challenges and success factors for Our Mia Mia; these learnings can guide the development of other emerging school-based health services and integrated care hubs. This article is protected by copyright. All rights reserved.

Spatially-resolved transcriptomics is revolutionizing our understanding of complex tissues, but their current use for the exploration of a few sections is not representative of their 3-dimensional architecture. In this work we present a low-cost strategy for manufacturing molecularly double-barcoded DNA arrays, enabling large-scale spatially-resolved transcriptomics studies. We applied this technique to spatially resolve gene expression in several human brain organoids, including the reconstruction of a 3-dimensional view from multiple consecutive sections, revealing gene expression divergencies throughout the tissue.

El presente artículo tiene como objetivo estudiar la representación femenina en el poema “Beso para la mujer de Lot” de Carlos Martínez Rivas. En tal manifestación, puede advertirse una postura frente a ciertos modelos de feminidad. Por ello, me propongo hacer una lectura crítica, mostrando cómo se configura una visión de la mujer con base en la reescritura del mito. Así, se ha considerado trabajar a partir de un eje analítico: la intertextualidad e hipertextualidad, lo cual dará una perspectiva amplia sobre la reflexión del concepto desde la propia literatura. Destaco, asimismo, que el abordaje de la imagen femenina es una puesta en perspectiva de algunos ideales dentro del imaginario judeocristiano. Intertextuality and hypertextuality in “Beso para la mujer de Lot” by Carlos Martínez Rivas This article aims to investigate the female representation in the poem “Beso para la mujer de Lot” by Carlos Martínez Rivas. In such a manifestation, a position can be seen against certain models of femininity. For this reason, I propose to do a critical reading, showing how a vision of women is configured based on the rewriting of the myth. Thus, it has been considered to work from an analytical axis: intertextuality and hypertextuality, which would give a broad perspective on the reflection of the concept from the literature itself. I also emphasize that the approach to the female image is a perspective of some ideals within the Judeo-Christian imaginary. Recibido: 28 de octubre de 2022.Dictaminado: 28 de noviembre de 2022.Aceptado: 2 de diciembre de 2022.

Background:Significant challenges remain in the early identification of child developmental conditions in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics. Methods:A qualitative research methodology (semi-structured interviews and thematic analysis) was utilised in this study. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software.Inductive interpretive approach was adopted and data were analysed thematically. Results:Twenty-three GPs across the two sites (NSW: n=11; Victoria: n=12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded nine major themes and highlighted common enablers such as the role of GPs in early identification and intervention, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental conditions, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services. Conclusions: The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental conditions including autism.

ObjectivesImplementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents’/caregivers’ experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting.DesignThis qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, ‘General Practice Surveillance for Autism’, a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically.ParticipantsTwelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed.SettingsAll interviews were completed over the phone.ResultsThere were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient–doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers.ConclusionThe findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting.Trial registration numberANZCTR (ACTRN12619001200178).

En la mayoría de las ciudades se enfrentan a diversos problemas ocasionados por el tráfico vehicular, afectando la movilidad laboral, convirtiéndose en uno de los principales factores que inciden en la productividad y la calidad de vida de los trabajadores. El propósito del presente trabajo es analizar la movilidad laboral como uno de los principales factores que inciden en la productividad organizacional y la calidad de vida de los trabajadores en la Cd. de Hermosillo, Sonora, México, que es una urbe en desarrollo, dedicada a la industria y al servicio principalmente y poder específicamente responder a cuáles son los principales medios de transporte que utiliza el trabajador para su traslado a su empleo y su repercusión en la productividad en las organizaciones, además conocer los tiempos de traslado del trabajador a su empleo y sus efectos en el bienestar del mismo, así mismo la problemática de vialidad que se presenta en la localidad objeto de estudio.

En este capítulo se hace una evaluación de la tributación territorial de Colombia abordando diferentes ámbitos de impacto. En tal sentido, con el perfil del recaudo departamental y municipal se describe la representatividad que tienen los impuestos en la financiación del gasto público y se analiza la conformación de la canasta para el periodo 1990-2020, identificando los tributos que más contribuyen a ella. La eficiencia tributaria en este contexto se expresa desde la perspectiva del aporte que hacen los impuestos locales a la dinámica económica, el producto interno bruto nacional y local y las actividades gubernamentales en municipios y departamentos. El papel que cumplen los tributos en el escenario regional se complementa con la descripción del impacto que tienen en el contexto macroeconómico, tanto por su incidencia en la financiación total del gasto público como por su participación en la creación de riqueza en el concierto de los países de América Latina.

En América Latina, los problemas que afrontan los sistemas tributarios son comunes a todos los países: bajo recaudo, aumento de la brecha fiscal (mayor gasto y menor ingreso), desorganización y congestión administrativa, ineficiencia en la ejecución de los recursos y proliferación de tributos que hacen dispendiosa la gestión del recaudo.

Este capítulo hace un aporte a la discusión sobre la eficiencia del gasto público en Colombia, considerando las principales recomendaciones que han hecho diferentes investigaciones sobre la eficiencia y eficacia del gasto público en el país. Muchas de ellas no solo siguen vigentes, sino que aún no se han implementado, de manera que adoptarlas solucionaría en gran medida la presión por mayores ingresos y la tentativa de cubrirlos con nuevas reformas de impuestos, haría más eficiente el gasto y reduciría las presiones que hacen en muchos casos aún inviable su ejecución.

Este libro aborda el análisis descriptivo del recaudo de los impuestos territoriales para evaluar su eficiencia a la hora de crear valor y ser fuente de crecimiento económico para los departamentos y municipios. Se ha concebido, por tanto, como un texto de referencia sobre la historia reciente de la tributación en las regiones, así como sobre su eficiencia para aportar a la creación de nuevos ingresos destinados a financiar bienes y servicios públicos conforme avanza la descentración fiscal y estos territorios han ido ganando autonomía en diferentes ámbitos de su gestión. Se analiza la eficiencia fiscal, buscando identificar en las estadísticas el cumplimiento de reglas como la de progresividad de los impuestos locales para impactar positivamente el crecimiento económico de los territorios, la evolución autónoma y creciente de los recursos fiscales propios o la menor dependencia de las transferencias de la nación. El lector puede constatar el cumplimiento de estos aspectos en cada región a partir de las estadísticas y los indicadores aportados, y así obtener reflexiones respecto a la pertinencia de las reformas tributarias para fortalecer los diferentes ámbitos de la eficiencia fiscal. El libro está organizado en cinco capítulos que en conjunto pretenden que el lector identifique si la tributación en las regiones evoluciona al ritmo de las necesidades de las administraciones locales, siendo garante de una progresiva autonomía fiscal y fuente de crecimiento económico, o si, más bien, esta es rezagada, no representa las demandas sociales y es una barrera para la dinámica productiva de los territorios. Primera edición Agradecimientos. Presentación. Capítulo 1. Caracterización del ingreso público regional en Colombia. Capítulo 2. La eficiencia tributaria en un contexto teórico y descriptivo. Capítulo 3. Estado del arte de la eficiencia tributaria. Capítulo 4. Estudios sobre el ingreso y el gasto público en Colombia. Capítulo 5. Fuentes de crecimiento económico regional. Bibliografía

El manejo reproductivo adecuado es fundamental para alcanzar índices óptimos en un sistema de producción de bovinos. Sin embargo, existen numerosas causas para la disminución de la fertilidad, como las de orden genético, que pueden afectar gravemente el sistema. Entre estas, las anormalidades cromosómicas causan baja fertilidad, debido principalmente a muerte temprana de embriones desbalanceados. Por tanto, es importante diagnosticar la presencia de estas anomalías en las unidades de producción ganaderas. Con el propósito de establecer la posible existencia de bovinos portadores de anormalidades cromosómicas en fincas de Norte de Santander, se tomaron muestras de sangre periférica a 31 bovinos puros y cruzados, pertenecientes a quince municipios del departamento. Se realizaron cultivos de linfocitos de sangre periférica, para obtener cromosomas; se analizaron 25 células de cada animal, en metafase, en un microscopio de luz convencional, para determinar el número cromosómico y la presencia de anormalidades cromosómicas. Enseguida, se estableció que, en su totalidad, los individuos analizados presentaron el número cromosómico nor- mal para la especie (2n=60) y en ninguno se visualizaron anomalías en el cariotipo. Asimismo, se evidenció la presencia de un cromosoma Y de tipo acrocéntrico en todos los machos analizados, cromosoma característico de las razas cebuinas. Este resultado confirma el tipo racial prevaleciente en Norte de Santander: cruces Bos taurus x Bos indicus. proper reproductive management is essential to achieve optimal rates in a cattle production system. However, there are many causes for decreased fertility, such as genetic causes, which can seriously affect the system. Among these, chromosomal abnormalities cause low fertility, mainly due to unbalanced embryos early death. It is therefore important to diagnose the presence of such anomalies in livestock production units. In order to establish the possible existence of cattle carrying chromosomal abnormalities in farms in Norte de Santander, peripheral blood samples were taken from 31 pure and crossed cattle, belonging to fifteen municipalities in the department. Peripheral blood lymphocyte cultures were performed to obtain chromosomes; 25 cells from each animal were analyzed, in a metaphase, under a conventional light microscope, to determine the chromosomal number and the presence of chromosomal abnormalities. Then, it was established that all of the individuals analyzed presented the normal chromosome number for the species (2n=60) and none presented abnormalities in the karyotype visualized. Likewise, the presence of a Y acrocentric type chromosome in all the males analyzed and a chromosome characteristic of the zebu cattle were evidenced. This result confirms the prevailing racial type in Norte de Santander: Bos taurus x Bos indicus crosses

Recent data show that a Glasgow-Blatchford Bleeding Score (GBS)gt;2 does not identify patients with upper gastrointestinal (GI) bleeding who benefit from inpatient esophagogastroduodenoscopy (EGD). This study aimed to determine the rate of endoscopic hemostatic interventions (HI) in patients with nonvariceal acute GI bleeding (NVAUGIB) admitted with a GBSgt;2. Secondary aims included comparison of clinical outcomes in patients with and without HI and cost of nontherapeutic EGDs.We conducted a retrospective review of medical records of patients admitted to a referral hospital for NVAUGIB from January 2015 to December 2017. Mortality, blood transfusion rates, length of stay, length of intensive care unit stay, and cost of a nontherapeutic EGD were outcomes of interest. Patients 18 years of age and older of both sexes were included. The accuracy of the GBSgt;2 cutoff was determined using receiver operating characteristic curve analysis.A total of 357 patients were included and only 58 (16.2%) required HI. The area under the curve for GBSgt;2 as a predictor of HI was 0.57. The performance of HI did not influence mortality (iP =/i0.33), blood transfusion rates (iP =/i0.51), length of stay (iP =/i0.2), or length of intensive care unit stay (iP =/i0.36). The estimated cost of performing nontherapeutic EGD was approximately $855,000 for the 299 patients who did not need HI.A GBS cutoff ofgt;2 is not an accurate criterion to triage patients with NVAUGIB for inpatient emergent EGD. More clinically meaningful and cost-effective methods to triage these patients are necessary.

BACKGROUND Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). OBJECTIVE The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. METHODS This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person’s mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. RESULTS Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). CONCLUSIONS Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use–related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.

Exposure to adverse childhood experiences substantially increases the risk of chronic health problems. Originally designed to treat child conduct problems, parent management training programs have been shown to be effective in preventing children from being exposed to further adversity and supporting children's recovery from adversity; however, there are increasing concerns that a core component of these programs, the discipline strategy time-out, may be harmful for children with a history of exposure to adversity.To investigate the comparative benefits and potential harms to children exposed to adversity that are associated with parenting programs that include time-out.This nonrandomized waiting list-controlled clinical study was conducted at a specialist clinic for the treatment of conduct problems in Sydney, Australia. The self-referred sample included children with conduct problems and their caregivers. Eligibility was confirmed through clinician-administered interviews. Data were collected between February 14, 2018, and February 1, 2021.Caregivers participated in a 10-session, social learning-based parent management training program. Caregivers were provided with parenting strategies aimed at encouraging desired behaviors through effective reinforcement and managing misbehavior through consistent limit setting, including the use of time-outs.The primary outcome was the parent-reported Strengths and Difficulties Questionnaire score, and secondary outcomes included subscale scores from the clinician-administered Diagnostic Interview Schedule for Children, Adolescents, and Parents. Multi-informant measures of child adversity were collected using the parent-reported Adverse Life Experiences Scale and the clinician-rated Maltreatment Index.A total of 205 children were included in analysis (156 in the full intervention and 49 in the control condition; 158 boys [77.1%]; mean [SD] age, 5.6 [1.8] years [range, 2-9 years]). Compared with children with low adversity exposure, children with high adversity exposure showed greater reductions in the Strengths and Difficulties Questionnaire score from baseline (mean difference, 3.46 [95% CI, 1.51-5.41]; P .001) to after treatment (mean difference, 1.49 [95% CI, -0.46 to 3.44]; P = .13) and in the internalizing symptom subscale score (baseline mean difference, 1.00 [95% CI, -2,00 to 0.00]; P = .50; posttreatment mean difference, 0.06 [95% CI, -0.82 to 0.94]; P = .90). No significant differences in the externalizing symptom subscale score were found.In this nonrandomized clinical study, children with high exposure to adversity experienced equivalent, if not greater, benefits associated with parenting programs that include time-out compared with children with low exposure to adversity. Results suggest that time-out was an effective component of parenting programs for children exposed to adversity.anzctr.org.au Identifier: ACTRN12617001472369.

Contamination by radioactive elements and their transfer through the trophic chain can have harmful effects on ecosystems and human health, therefore its continuous monitoring is important. The present study aimed to characterize the concentration of radionuclides of natural and anthropogenic origin in marine sediments from three areas in the northwest of Antarctica, Orca Seamount, Admiralty Bay and Mackellar Inlet, in order to evaluate possible risk levels, sources and transportation routes. Measurements were made using a high-resolution Canberra spectrometer and methodological precision and accuracy was assessed by analyzing reference materials certified by the International Atomic Energy Agency (IAEA), SOIL-6 and Moss SOIL-447. The results showed a low concentration of 137Cs activity in the marine sediments, decreasing towards the deep zone, validating the atmospheric pathway as the main transport route for this radionuclide of anthropic origin. The activity concentration of radionuclides of natural origin 226Ra and 40K, confirm the volcanic origin of the region, corroborating the geological evolution stages of the sector, and the changes in the source of material to the mantle. The calculated radiation hazard indexes showed that current activity concentrations of radioactive elements do not pose a health risk. It is important in the future to improve the understanding of the relationship between hydrothermalism in the area and the activity concentration of radionuclides of natural origin. RESUMEN La contaminación por elementos radioactivos y su transferencia a través de la cadena trófica puede llegar a tener efectos nocivos en los ecosistemas y la salud humana siendo por ello importante su monitoreo continuo. El presente estudio tuvo como objetivo caracterizar la concentración de radionúclidos de origen natural y antropogénico en sedimentos marinos de tres áreas en el noroccidente de la Antártica, monte submarino Orca, bahía Almirantazgo y ensenada Mackellar, con el fin de evaluar posibles niveles de riesgo, fuentes y rutas de transporte. Las mediciones se realizaron usando un espectrómetro Canberra de alta resolución y la precisión y exactitud metodológica fue evaluada mediante el análisis de materiales de referencia certificada del Organismo Internacional de Energía Atómica (OIEA), SOIL-6 y Moss SOIL-447. Los resultados mostraron una baja concentración de actividad del 137Cs en los sedimentos marino, disminuyendo hacia la zona profunda, validando la vía atmosférica como ruta principal de transporte de este radionúclido de origen antrópico. La concentración de actividad de los radionúclidos de origen natural 226Ra y 40K, confirman el origen volcánico de la región, corroborando las etapas de evolución geológica del sector, y los cambios en la fuente de material al manto. Los índices de peligro de radiación calculados mostraron que las concentraciones de actividad actuales de los elementos radioactivos no representan un riesgo para la salud. Resulta importante a futuro mejorar el entendimiento de la relación del hidrotermalismo en la zona con la concentración de actividad de radionúclidos de origen natural.

[EN] According to previous research, it has been proved that wastewater treatment plants (WWTPs) can retain more than 90 % of the MPs contained in wastewater. However, a significant fraction of the MPs removed in WWTPs is retained in the sludge floc and this may lead to an environmental issue since biosolids can be used as fertilizers. The purpose of this research was to evaluate how the presence of polyethylene (PE) could interfere with the activated sludge performance. For this, a sequencing batch reactor (SBR) was continuously fed during 93 days with synthetic sewage and PE microbeads. It was observed that 98 +/- 2% of the total amount of MPs that entered SBR was accumulated in the activated sludge. Despite the high accumulation of MPs in the sludge, the depuration performance of the reactor was not compromised. However, the presence of MPs decreased the richness (Chao1) and abundance-based coverage estimators (ACE) and diversity (Shannon) of the bacterial community on day 93. Based on the analysis of the diversity indices and the relative abundances of microbial taxa, it was concluded that MPs had selective effects on activated sludge microbial community. However, MPs did not affect the abundance of nitrifying and denitrifying bacteria in the sludge., Authors thank the Spanish Ministry of Science, Innovation and Universities for the financial support (Reference of the project: RTI2018-096916-B-I00)

IntroductionContinuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. ‘Integrated health-social care hubs’ are physical hubs where health and social services are co-located, with shared referral pathways and care navigation.AimOur study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants.Materials and methodsThis study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated.Ethics and disseminationEthical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences.Trial registration numberACTRN12621001088831.

IntroductionThe increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services.Methods and analysisThe proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a ‘Watch Me Grow Integrated’ (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations.Ethics and disseminationThe South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications.Trial registration numberANZCTR12621000680864.

Doel: In twee gerandomiseerde, gecontroleerde studies is onderzoek gedaan naar de effectiviteit van een online- versus face-to-face (FTF) interventie voor ouders van kinderen met gedragsproblemen. Beide interventies zijn erop gericht om de gedragsproblemen bij kinderen te verminderen, en op de verbetering van nog wat andere ouder- en kind uitkomsten. Methode: Voor studie 1 kwamen gezinnen (n = 133) met een kind van tussen de drie en negen jaar met een volledige of subklinische diagnose van oppositioneel opstandige of een gedragsstoornis naar Sidney (Australie). Daar vond een taxatie plaats en een randomisatie voor ofwel AccessEI – een zes tot tien weken durend therapeut begeleid online ouderprogramma – of voor hetzelfde programma, maar dan face-to-face (FTF) van een week. Om te controleren voor onontkoombare verschillen in de behandeldosis van deze twee behandelprogramma’s, is een tweede studie gedaan. Hierin werden stedelijke gezinnen (n = 73) met een kind van tussen de drie en veertien jaar – gezinnen die voldeden aan dezelfde criteria als in studie 1 – willekeurig toegewezen aan de AccessEI- of de FTF-behandeling. Resultaten: Beide studies laten grote effectgroottes zien op de verbetering wat betreft de diagnose van het kind, en op de scores die de moeders in vragenlijsten geven voor het gedrag van hun kind. Dit effect geldt voor beide interventies na de behandeling en bij de follow-up na drie maanden, zonder verschil tussen de twee behandelcondities. Daarnaast zijn middelmatige effectgroottes gevonden voor verbetering van de psychische gezondheid van de ouders, met ook daarin geen verschil tussen de behandelcondities. Conclusie: de effecten van de online therapeut begeleide ouderinterventie – gericht op de behandeling van gedragsproblemen bij kinderen – waren vergelijkbaar met die van een FTF-interventie. Dit impliceert dat de voor landelijk gevestigde gezinnen meer toegankelijke online behandeling evengoed effectief is.

Introduction Studies of Gaming Disorder (GD) consistently identify co-morbidity with various psychiatric disorders including major depression, obsessive compulsive disorder and anxiety disorders. One of the strongest associations has been with Attention Deficit Hyperactivity Disorder (ADHD). We present a systematic review of this association by pooling and integrating available evidence. Methods PubMed, EMBASE, PsychInfo and CINHAHL were searched for articles that reported a quantitative association between GD and ADHD and its dimensions, using equivalent search terms. Quality appraisal was done using criteria adapted from the Critical Appraisal Skills Package (CASP) checklists. Results 1028 articles were identified, of which 29 studies were included for systematic review (n = 56650 participants). Most of these studies were observational in nature, and were of moderate quality, with deficits particularly in the domains of generalisability and confounding. Community surveys (n = 18) of purposive samples constituted the majority, with fewer clinic-based samples (n = 11). While ADHD symptoms were consistently associated with GD, More frequent associations were displayed with inattention associations with GD than other ADHD subscales. There were no conclusive findings regarding the type of game on severity of either condition, or on completion of treatment. Conclusions The findings suggest an association between ADHD and GD, although the direction of the relationship is unclear. This has implications for clinical practice, policy and research. We recommend that ADHD is screened for when evaluating IGD as part of routine practice.”

OBJECTIVES The aim of this study was to compare a standard versus segmental withdrawal during screening colonoscopy and its effect on the adenoma detection rate (ADR). METHODS We performed a single-center clinical trial of average-risk patients 50 years of age and older undergoing screening colonoscopy. Patients were randomized into four groups: a standard withdrawal of at least 6 or 8 minutes and a segmental withdrawal, in which ≥3 or ≥4 minutes were dedicated to the right side of the colon, with a minimum withdrawal time of at least 6 or 8 minutes, respectively. RESULTS There were 311 patients in the study. There was no difference in ADR between the standard and segmental groups (relative ratio [RR] 0.91, P = 0.50), even after stratifying for right-sided adenomas. During standard withdrawal, an increased continuous withdrawal time was associated with a higher ADR (RR 1.08, P

BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy (DEN) for pancreatic walled-off necrosis (WON). However, significant technical heterogeneity still exists among endoscopists. AIM To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies. METHODS Medical records of patients with WON who underwent DEN from September 2016 - May 2019 were queried for the following information: Age, gender, ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events (AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent (LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months (mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables, frequency and proportion for categorical variables, and median and range for interval data. RESULTS A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance, dilated the same day of deployment and removed after a mean of 27 ± 11 d. Routine cross-sectional imaging immediately after drainage was not performed. The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis (2), stent migration (1), stent maldeployment (1), perforation (1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed. CONCLUSION Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.

La crisis que comienza en 2008 ha tenido, y todavía tiene, efectos y consecuencias que hacen que nuestra sociedad esté en continuo cambio. El sector financiero en general, y la banca en particular, se han visto muy castigados por esta crisis que ha puesto en entredicho sus hasta entonces virtudes de estabilidad, transparencia y fiabilidad. En el momento actual se hace imprescindible para las entidades financieras reconquistar la confianza del cliente. Pero ¿cómo lograrlo?

Background and study aims Mucinous pancreatic cystic lesions (PCLs) have the potential for malignant transformation, for which the only accepted curative modality is surgery. A novel intracystic therapy with large surface area microparticle paclitaxel (LSAM-PTX) may treat PCLs without local or systemic toxicities. Safety and preliminary efficacy of LSAM-PTX for the treatment of PCLs administered by endoscopic ultrasound-guided fine-needle injection (EUS-FNI) was evaluated. Patients and methods Ten subjects with confirmed PCLs (size > 1.5 cm) received intracystic LSAM-PTX via EUS-FNI at volumes equal to those aspirated from the cyst in sequential cohorts at 6, 10, and 15 mg/mL in a standard “3 + 3” dose-escalation protocol. The highest dose with acceptable safety and tolerability was taken into the confirmatory phase where nine additional subjects received two injections of LSAM-PTX 12 weeks apart. Subjects were followed for 6 months after initial LSAM-PTX treatment for endpoints including: adverse events (AEs), tolerability, pharmacokinetic analysis of systemic paclitaxel drug levels, and change in cyst volume. Results Nineteen subjects completed the study. No dose-limiting toxicities, treatment-related serious AEs, or clinically significant laboratory changes were reported. Systemic paclitaxel concentrations did not exceed 3.5 ng/mL at any timepoint measured and fell below 1 ng/mL by Week 2, supporting the lack of systemic toxicity. By Week 24 a cyst volume reduction (10–78 %) was seen in 70.6 % of subjects. Conclusions Intracystic injection of LSAM-PTX into mucinous PCLs resulted in no significant AEs, a lack of systemic absorption, and resulted in reduction of cyst volume over a 6 month period.

UNSTRUCTURED This is a corrigendum.

Background Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). Objective The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. Methods This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person’s mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. Results Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). Conclusions Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use–related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.

Academic centers report better outcomes for pancreatic ductal adenocarcinoma. We hypothesized that treatment outcomes for mucinous cysts differ according to institution type.Using the National Cancer Data Base, we analyzed data on patients with mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs).Of 3278 identified patients, 2622 (80%) had IPMNs and 656 (20%) had MCNs. While most academic/research programs (ARCPs, 84.9%) treated more than 10 patients/year, this was true for only 59% of integrated network cancer programs, 37.3% of comprehensive community cancer programs, and 0% of community cancer programs (P0.001). Surgery was used more often in ARCPs and for smaller tumors. The ARCPs had higher rates of margin negative resections with retrieval of 15 or more nodes with the lowest 30- and 90-day mortality rates. The median overall survival was better in ARCPs (110.3 months) than comprehensive community cancer programs (75.1 mo), community cancer programs (75.1 mo), or integrated network cancer programs (100.8 mo, P0.001).Treatment of MCNs and IPMNs of the pancreas at academic centers is associated with a higher probability of pancreatectomy, disease identification in a noninvasive stage, and better overall survival. Centralization of care for mucinous pancreatic cysts will lead to improved outcomes.