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This paper examines scaling behaviors of urban landscape and street design metrics with respect to city population in Latin America. We used data from the SALURBAL project, which has compiled and harmonized data on health, social, and built environment for 371 Latin American cities above 100,000 inhabitants. These metrics included total urbanized area, effective mesh size, area in km2 and number of streets. We obtained scaling relations by regressing log(metric) on log (city population). The results show an overall sub-linear scaling behavior of most variables, indicating a relatively lower value of each variable in larger cities. We also explored the potential influence of colonization on the current built environment, by analyzing cities colonized by Portuguese (Brazilian cities) or Spaniards (Other cities in Latin America) separately. We found that the scaling behaviors are similar for both sets of cities.

The built environment of cities is complex and influences social and environmental determinants of health. In this study we, 1) identified city profiles based on the built landscape and street design characteristics of cities in Latin America and 2) evaluated the associations of city profiles with social determinants of health and air pollution. Landscape and street design profiles of 370 cities were identified using finite mixture modeling. For landscape, we measured fragmentation, isolation, and shape. For street design, we measured street connectivity, street length, and directness. We fitted a two-level linear mixed model to assess the association of social and environmental determinants of health with the profiles. We identified four profiles for landscape and four for the street design domain. The most common landscape profile was the "proximate stones" characterized by moderate fragmentation, isolation and patch size, and irregular shape. The most common street design profile was the "semi-hyperbolic grid" characterized by moderate connectivity, street length, and directness. The "semi-hyperbolic grid", "spiderweb" and "hyperbolic grid" profiles were positively associated with higher access to piped water and less overcrowding. The "semi-hyperbolic grid" and "spiderweb" profiles were associated with higher air pollution. The "proximate stones" and "proximate inkblots" profiles were associated with higher congestion. In conclusion, there is substantial heterogeneity in the urban landscape and street design profiles of Latin American cities. While we did not find a specific built environment profile that was consistently associated with lower air pollution and better social conditions, the different configurations of the built environments of cities should be considered when planning healthy and sustainable cities in Latin America.

Summary: Background: Latin America is one of the most unequal regions in the world, but evidence is lacking on the magnitude of health inequalities in urban areas of the region. Our objective was to examine inequalities in life expectancy in six large Latin American cities and its association with a measure of area-level socioeconomic status. Methods: In this ecological analysis, we used data from the Salud Urbana en America Latina (SALURBAL) study on six large cities in Latin America (Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama), comprising 266 subcity units, for the period 2011–15 (expect for Panama city, which was for 2012–16). We calculated average life expectancy at birth by sex and subcity unit with life tables using age-specific mortality rates estimated from a Bayesian model, and calculated the difference between the ninth and first decile of life expectancy at birth (P90–P10 gap) across subcity units in cities. We also analysed the association between life expectancy at birth and socioeconomic status at the subcity-unit level, using education as a proxy for socioeconomic status, and whether any geographical patterns existed in cities between subcity units. Findings: We found large spatial differences in average life expectancy at birth in Latin American cities, with the largest P90–P10 gaps observed in Panama City (15·0 years for men and 14·7 years for women), Santiago (8·9 years for men and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). Higher area-level socioeconomic status was associated with higher life expectancy, especially in Santiago (change in life expectancy per P90–P10 change unit-level of educational attainment 8·0 years [95% CI 5·8–10·3] for men and 11·8 years [7·1–16·4] for women) and Panama City (7·3 years [2·6–12·1] for men and 9·0 years [2·4–15·5] for women). We saw an increase in life expectancy at birth from east to west in Panama City and from north to south in core Mexico City, and a core-periphery divide in Buenos Aires and Santiago. Whereas for San José the central part of the city had the lowest life expectancy and in Belo Horizonte the central part of the city had the highest life expectancy. Interpretation: Large spatial differences in life expectancy in Latin American cities and their association with social factors highlight the importance of area-based approaches and policies that address social inequalities in improving health in cities of the region. Funding: Wellcome Trust.

Background: Neighborhood transportation infrastructure and public recreational facilities are theorized to improve the activity, weight, and cardiometabolic profiles of individuals living in close proximity to these resources. However, owing to data limitations, there has not been adequate study of the influence of timing and placement of new infrastructure on health over time. Methods: This protocol details methods of the Four Cities Study to perform retrospective field audits in order to capitalize on existing longitudinal health data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We developed and verified measures of recreation facilities (trails, parks) and transportation infrastructure (bus, light rail, bicycle parking, bicycle paths) in Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA. We identify introductions, renovations, and closures between 1985-2010 to develop measures of facility and infrastructure change. Ultimately, these data were linked to CARDIA sites’ respondents’ geographic locations over the 25-year study period to examine associations with health behaviors and outcomes. Results: Data available for retrospective audits was inconsistent by city, primarily due to record-keeping differences. We found large increases in bicycle infrastructure, with the exception of Birmingham, AL. Excluding the addition of a new rail line in Minneapolis, MN, few changes occurred in bus service, rail, and parks. Conclusion: Our method represents innovation toward the collection of retrospective neighborhood data for use in longitudinal analyses. The data produced give insight into the way neighborhood infrastructure has changed over time and the potential relationship between these changes and health behaviors.

Summary: Background: Little is known about the effect of changes in mobility at the subcity level on subsequent COVID-19 incidence, which is particularly relevant in Latin America, where substantial barriers prevent COVID-19 vaccine access and non-pharmaceutical interventions are essential to mitigation efforts. We aimed to examine the longitudinal associations between population mobility and COVID-19 incidence at the subcity level across a large number of Latin American cities. Methods: In this longitudinal ecological study, we compiled aggregated mobile phone location data, daily confirmed COVID-19 cases, and features of urban and social environments to analyse population mobility and COVID-19 incidence at the subcity level among cities with more than 100 000 inhabitants in Argentina, Brazil, Colombia, Guatemala, and Mexico, from March 2 to Aug 29, 2020. Spatially aggregated mobile phone data were provided by the UN Development Programme in Latin America and the Caribbean and Grandata; confirmed COVID-19 cases were from national government reports and population and socioeconomic factors were from the latest national census in each country. We used mixed-effects negative binomial regression for a time-series analysis, to examine longitudinal associations between weekly mobility changes from baseline (prepandemic week of March 2–9, 2020) and subsequent COVID-19 incidence (lagged by 1–6 weeks) at the subcity level, adjusting for urban environmental and socioeconomic factors (time-invariant educational attainment, residential overcrowding, population density [all at the subcity level], and country). Findings: We included 1031 subcity areas, representing 314 Latin American cities, in Argentina (107 subcity areas), Brazil (416), Colombia (82), Guatemala (20), and Mexico (406). In the main adjusted model, we observed an incidence rate ratio (IRR) of 2·35 (95% CI 2·12–2·60) for COVID-19 incidence per log unit increase in the mobility ratio (vs baseline) during the previous week. Thus, 10% lower weekly mobility was associated with 8·6% (95% CI 7·6–9·6) lower incidence of COVID-19 in the following week. This association gradually weakened as the lag between mobility and COVID-19 incidence increased and was not different from null at a 6-week lag. Interpretation: Reduced population movement within a subcity area is associated with a subsequent decrease in COVID-19 incidence among residents of that subcity area. Policies that reduce population mobility at the subcity level might be an effective COVID-19 mitigation strategy, although they should be combined with strategies that mitigate any adverse social and economic consequences of reduced mobility for the most vulnerable groups. Funding: Wellcome Trust. Translation: For the Spanish translation of the abstract see Supplementary Materials section.

Background: Greenness has been found to be associated with reduced mortality and morbidity and improved wellbeing, with recent evidence further linking it to narrower health inequalities. However, results come mostly from high-income countries and thus might not be generalisable to other settings. In this preliminary analysis, we address this gap by examining whether education inequalities in life expectancy in Latin American cities vary by area-level greenness. Methods: We used data from the Salud Urbana en America Latina (SALURBAL) study. The analysis sample included 28 large cities in nine Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, Panama, and El Salvador), comprising 671 sub-city units (>10 per city), for the period 2012–16. We used sub-city data on life expectancy, education (percentage of residents with high school or university education, as an indicator for socioeconomic status), and greenness (as calculated by the satellite image-derived normalised difference vegetation index). We used multilevel linear models of sub-cities nested within cities, with country fixed effects to predict life expectancy by education, greenness, and their interaction, while accounting for covariates at the city and sub-city levels. Findings: Higher education was associated with higher life expectancy in both sexes (men: standardised regression coefficient b=0·51 [95% CI 0·36–0·65]; women: 0·34 [0·23–0·45]), whereas increased area-level greenness was associated with higher life expectancy among men (0·39 [0·03–0·75]). The educational gradient in life expectancy was steeper in greener areas for both sexes (men: b for interaction=0·20 [0·08–0·32]; women: 0·15 [0·05–0·24]). Interpretation: Contrary to evidence from high-income countries, our initial results from Latin America suggest education disparities in life expectancy might increase with greater levels of green space. Given the already wide intra-urban inequalities in Latin American cities, and the sparse and unequal distribution of urban green spaces, greening policies need to make a concerted effort to ensure that unequal access to green spaces does not exacerbate existing health inequalities. Funding: Wellcome Trust (205177/Z/16/Z).

Background: Urban design features are often studied in relation to health and behavioural outcomes. They can also have major implications for environmental outcomes. However, the impact of these features on both health and environmental outcomes (co-benefits) is rarely examined. We investigated how urban landscape and street design profiles are related to jointly occurring health and environmental outcomes in Latin America cities. Methods: We used data from the Salud Urbana en América Latina (SALURBAL) project, which has compiled and harmonised data on built environment, environmental exposures, and health outcomes for 370 cities in 11 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, and Peru. Eight city profiles were identified using finite mixture models. Four urban-landscape profiles were defined measuring patch (contiguous area of urban development) fragmentation, shape, and isolation, and four street-design profiles were defined using street connectivity, length, and directness. Multilevel regression models were used to assess associations between the city profiles and several health and environmental outcomes. Findings: Our preliminary results show that compared with the urban-landscape profile labelled scattered pixels (comprising low fragmentation, compact shape, and high isolation), the proximate-stones profile (moderate fragmentation, irregular shape, and moderate isolation) had significantly higher levels of PM2·5 and nitrogen dioxide (NO2), and the proximate-inkblots profile (moderate-to-high fragmentation, complex shape, and moderate isolation) had significantly higher levels of violence-related deaths. Compared with the labyrinthine street design profile (low connectivity, moderate length, and moderate directness), the semi-hyperbolic grid (moderate connectivity, moderate length, and moderate directness) and spiderweb (high connectivity, low length, and moderate directness) profiles had significantly higher levels of PM2·5 and NO2, whereas the hyperbolic grid profile (moderate connectivity, high length, and low directness) had significantly higher levels of NO2 and lower levels of obesity. Interpretation: Identifying how city profiles are related to environment and health outcomes can shed light on the urban policies that could have the greatest environment and health co-benefits. Funding: The SALURBAL/Urban Health in Latin America project is funded by the Wellcome Trust (205177/Z/16/Z).

This work presents the development of a new approach to EMAT finite element method (FEM) simulations by using a novel coupled electromagnetic-mechanical equation system. Validation is performed within the limits of the un-coupled equations using commercially available FEM codes. The advantages and drawbacks of the new method versus the traditional un-coupled approach are evaluated for various EMAT patterns. Numerical FEM analyses use a sparse direct solver with either Euler or Crank-Nicolson implicit time integration methods. [ABSTRACT FROM AUTHOR]

Background Endoscopic ultrasound (EUS)-guided biliary rendezvous (RV) is an EUS-assisted technique described as a rescue method in cases of failed biliary cannulation via endoscopic retrograde cholangiography (ERC). Current literature remains unclear regarding its current role. The study aim was to evaluate the effectiveness for biliary EUS-RV, and comparison between benign vs malignant biliopancreatic disorders.Methods Retrospective observational study with prospective consecutive inclusion in a specific database from a tertiary-center. All patients with biliopancreatic diseases that underwent a EUS-assisted ERC between October-2010 and November-2022 for failed ERC were included. Main outcomes were technical/overall success. Secondary outcomes were safety, potential factors related to failure/success or safety; and a comparative analysis between EUS-RV and EUS-guided transmural drainage (TMD) in malignant cases.Results A total of 69 patients who underwent EUS-RV procedures, with benign and malignant pathologies (n = 40 vs n = 29), were included. Technical / overall success and related-adverse events (AEs) were 79.7% (95%CI, 68.3-88.4) / 74% (95%CI, 61-83.7) and 24% (95%CI, 15.1-36.5), respectively. Failed cases were mainly related with guidewire manipulation. Seven failed RV were successfully rescued by EUS-TMD. On multivariable analysis, EUS-RV and malignant pathology was associated with a greater failure rate (technical success: OR,0.21; 95%CI,0.05-0.72; p = 0.017), and higher AEs rate (OR,3.46; 95%CI,1.13-11.5; p = 0.034). Also, the EUS-TMD group had greater technical success (OR,16.96; 95%CI,4.69-81.62; p

Abstract Pituitary neuroendocrine tumors (PitNET) represent the vast majority of sellar masses. Some behave aggressively, growing rapidly and invading surrounding tissues, with high rates of recurrence and resistance to therapy. Our aim was to establish patterns of genomic, transcriptomic and methylomic evolution throughout time in primary and recurrent tumors from the same patient. Therefore, we performed transcriptome- and exome-sequencing and methylome microarrays of aggressive, primary, and recurrent PitNET from the same patient. Primary and recurrent tumors showed a similar exome profile, potentially indicating a stable genome over time. In contrast, the transcriptome of primary and recurrent PitNET was dissimilar. Gonadotroph, silent corticotroph, as well as metastatic corticotroph and a somatotroph PitNET expressed genes related to fatty acid biosynthesis and metabolism, phosphatidylinositol signaling, glycerophospholipid and phospholipase D signaling, respectively. Diacylglycerol kinase gamma (DGKG), a key enzyme in glycerophospholipid metabolism and phosphatidylinositol signaling pathways, was differentially expressed between primary and recurrent PitNET. These alterations did not seem to be regulated by DNA methylation, but rather by several transcription factors. Molecular docking showed that dasatinib, a small molecule tyrosine kinase inhibitor used in the treatment of chronic lymphocytic and acute lymphoblastic leukemia, could target DGKG. Dasatinib induced apoptosis and decreased proliferation in GH3 cells. Our data indicate that pituitary tumorigenesis could be driven by transcriptomically heterogeneous clones, and we describe alternative pharmacological therapies for aggressive and recurrent PitNET.

Abstract This project compared the effectiveness of two evidence‐based models of culturally competent diabetes health promotion: the diabetes self‐management support empowerment model (DSMS) and the chronic care model (CCM). Our primary outcome was improvement in patient capacity for diabetes self‐management as measured by the diabetes knowledge questionnaire (DKQ) and the patient activation measure (PAM). Our secondary outcome was patient success at diabetes self‐management as measured by improvement in A1c, depression scores using the PHQ‐9, and body mass index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set. We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latinx diabetes patients from low‐income households. Participants were enrolled as dyads—a patient participant (n = 226) and a social support participant (n = 226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self‐management and education program design may deliver benefit for patients, especially for patients with higher A1c levels. Key Points The team was interdisciplinary. The information presented describes results of both qualitative and quantitative data and involves interpretations that are interdisciplinary in nature. The study design used methods from multiple disciplines.

Newborn disease screening increases survival, improves quality of life and reduces treatment costs for healthcare systems. Mass spectrometry (MS) is an effective method for metabolic screening. However, conventional analytical methods require biofluid handling and cooling conditions during transport, making the logistics difficult and expensive, especially for remote regions. ’Paper-spray’ (PS) ionization generates a charged solvent spray from samples deposited on paper strips. Therefore, samples can be applied on a suitable matrix and shipped as dried spots to diagnostic laboratories with standard postal or messenger services. We built a robotic platform, the ’Open SprayBot’, to automatically analyze paper-deposited samples via PS-MS and increase the sample throughput. The system is operated via RUMBA32 and Arduino Mega boards. A commercial syringe pump and power supply provide solvent application and electrical current required for PS-MS. The usability of the Open SprayBot was demonstrated by quantifying palmitoyl-l-carnitine, a common biomarker in newborn screening.

Abstract Background Transportation policies can impact health outcomes while simultaneously promoting social equity and environmental sustainability. We developed an agent-based model (ABM) to simulate the impacts of fare subsidies and congestion taxes on commuter decision-making and travel patterns. We report effects on mode share, travel time and transport-related physical activity (PA), including the variability of effects by socioeconomic strata (SES), and the trade-offs that may need to be considered in the implementation of these policies in a context with high levels of necessity-based physical activity. Methods The ABM design was informed by local stakeholder engagement. The demographic and spatial characteristics of the in-silico city, and its residents, were informed by local surveys and empirical studies. We used ridership and travel time data from the 2019 Bogotá Household Travel Survey to calibrate and validate the model by SES. We then explored the impacts of fare subsidy and congestion tax policy scenarios. Results Our model reproduced commuting patterns observed in Bogotá, including substantial necessity-based walking for transportation. At the city-level, congestion taxes fractionally reduced car use, including among mid-to-high SES groups but not among low SES commuters. Neither travel times nor physical activity levels were impacted at the city level or by SES. Comparatively, fare subsidies promoted city-level public transportation (PT) ridership, particularly under a ‘free-fare’ scenario, largely through reductions in walking trips. ‘Free fare’ policies also led to a large reduction in very long walking times and an overall reduction in the commuting-based attainment of physical activity guidelines. Differential effects were observed by SES, with free fares promoting PT ridership primarily among low-and-middle SES groups. These shifts to PT reduced median walking times among all SES groups, particularly low-SES groups. Moreover, the proportion of low-to-mid SES commuters meeting weekly physical activity recommendations decreased under the 'freefare' policy, with no change observed among high-SES groups. Conclusions Transport policies can differentially impact SES-level disparities in necessity-based walking and travel times. Understanding these impacts is critical in shaping transportation policies that balance the dual aims of reducing SES-level disparities in travel time (and time poverty) and the promotion of choice-based physical activity.

This paper presents the results of a study on the formation of nanostructures of electrochemical titanium oxide for neuromorphic applications. Three anodization synthesis techniques were considered to allow the formation of structures with different sizes and productivity: nanodot, lateral, and imprint. The mathematical model allowed us to calculate the processes of oxygen ion transfer to the reaction zone; the growth of the nanostructure due to the oxidation of the titanium film; and the formation of TiO, Ti2O3, and TiO2 oxides in the volume of the growing nanostructure and the redistribution of oxygen vacancies and conduction channel. Modeling of the nanodot structure synthesis process showed that at the initial stages of growth, a conductivity channel was formed, connecting the top and bottom of the nanostructure, which became thinner over time; at approximately 640 ms, this channel broke into upper and lower nuclei, after which the upper part disappeared. Modeling of the lateral nanostructure synthesis process showed that at the initial stages of growth, a conductivity channel was also formed, which quickly disappeared and left a nucleus that moved after the moving AFM tip. The simulation of the imprint nanostructure synthesis process showed the formation of two conductivity channels at a distance corresponding to the dimensions of the template tip. After about 460 ms, both channels broke, leaving behind embryos. The nanodot, lateral, and imprint nanostructure XPS spectra confirmed the theoretical calculations presented earlier: in the near-surface layers, the TiO2 oxide was observed, with the subsequent titanium oxide nanostructure surface etching proportion of TiO2 decreasing, and proportions of Ti2O3 and TiO oxides increasing. All nanodot, lateral, and imprint nanostructures showed reproducible resistive switching over 1000 switching cycles and holding their state for 10,000 s at read operation.

This paper proposes a matheuristic approach for the location-routing of industrial platforms of the pineapple supply chain problem. We have proposed a three-phase methodology to solve the considered problem. The first phase consists of obtaining the potential supply in terms of suitability and productivity, the potential location of platforms, and the times of the value chain echelons. In the second phase, a mathematical optimization model for the location problem of platforms considering the coverage in terms of timing is proposed. Finally, the final phase proposes a cluster-routing and a granular reactive tabu search approach for the routing phase. The proposed methodology uses official information on production times, speed, and capacity and georeferenced aptitude, spatial, economic, and land yield information for the first time. The proposed approach has been validated through scenarios, particularly pineapple exports for the Colombian country. The obtained results show the efficiency of the proposed approach.

Background: Appropriate programming of cardiovascular implantable electronic devices (CIED) is essential to ensure adequate function and avoid harmful effects. In underdeveloped countries, CIED monitoring and programming are often performed by physicians involved in their implantation. However, many of them often do not have sufficient training in CIED programming. Objective: We aimed to assess the differences in pacemaker programming between electrophysiology (EP) specialists and other physicians. Methods: We retrospectively reviewed changes in pacemaker programming performed by an EP specialist in patients who attended for pacemaker evaluation and reported previous follow-ups by a non-EP specialist. Results: Among 58 patients (26 males), 41 patients (71%) had programming errors and required setting modifications. The rate adaptative pacing function (R-mode) was incorrectly deactivated in 9 patients (15%) and improperly activated in 2 patients (3%). Unnecessary ventricular stimulation was detected in 23 patients (40%) with a pacing burden of 60% (32–95%). The lower rate limit was unnecessarily high in 12 patients (21%).Atrial or ventricular pacing output was inappropriate in 15 patients (26%) and was consequently modified (4 patients unnecessarily high, 9 patients below requirements). The auto-adapted pacing output was switched off in 17 of 18 patients (16 due to physician's preference, and 1 due to algorithm inaccuracy). The programmed sensitivity was inaccurate in 2 patients (3%). In 2 patients (3%) switching from DDDR to VVIR mode was required. Conclusion: We found a high prevalence of errors in pacemaker programming by non-EP specialists. An EP specialist should always be responsible for CIED follow-up.

Resumo Este artigo propõe uma metodologia de análise das capacidades institucionais de enfrentamento das mudanças climáticas em âmbito municipal e metropolitano. A metodologia foi aplicada na Região Metropolitana de São Paulo (RMSP), utilizando os dados relativos a Meio Ambiente e Gestão de Riscos, da Pesquisa Nacional de Informações Municipais do IBGE (Munic), edições de 2013, 2017 e 2020. Os resultados indicam perda consistente das capacidades institucionais de enfrentamento das mudanças climáticas entre 2013 e 2020. Há uma diferença considerável no padrão dessa perda quando a análise incide separadamente sobre a capacidade institucional para lidar com os temas da gestão ambiental e da gestão de riscos de desastres.

IntroductionMany decarbonization technologies have the added co-benefit of reducing short-lived climate pollutants, such as particulate matter (PM), nitrogen oxides (NOx), and sulfur dioxide (SO2), creating a unique opportunity for identifying strategies that promote both climate change solutions and opportunities for air quality improvement. However, stakeholders and decision-makers may struggle to quantify how these co-benefits will impact public health for the communities most affected by industrial air pollution.MethodsTo address this problem, the LOCal Air Emissions Tracking Atlas (LOCAETA) fills a data availability and analysis gap by providing estimated air quality benefits from industrial decarbonization options, such as carbon capture and storage (CCS). These co-benefits are calculated using an algorithm that connects disparate datasets that separately report greenhouse gas emissions and other pollutants at U.S. industrial facilities.ResultsVersion 1.0 of LOCAETA displays the estimated primary PM2.5 emission reduction co-benefits from additional pretreatment equipment for CCS on industrial and power facilities across the state of Louisiana, as well as the potential for VOC and NH3 generation. The emission reductions are presented in the tool alongside facility pollutant emissions information and relevant air quality, environmental, demographic, and public health datasets, such as air toxics cancer risk, satellite and in situ pollutant measurements, and population vulnerability metrics.DiscussionLOCAETA enables regulators, policymakers, environmental justice communities, and industrial and commercial users to compare and contrast quantifiable public health benefits due to air quality impacts from various climate change mitigation strategies using a free and publicly-available tool. Additional pollutant reductions can be calculated using the same methodology and will be available in future versions of the tool.

Purpose: To conduct a genome-wide association study (GWAS) of individuals with neuropathic ocular pain (NOP) symptoms to identify genomic variants that may predispose to NOP development. Design: Prospective study of individuals with NOP. Participants: Three hundred twenty-nine patients recruited from the Miami Veterans Affairs eye clinic. Methods: The Neuropathic Pain Symptom Inventory modified for the eye (NPSI-Eye) was completed to calculate a NPSI-Eye-Sub-Score (summed ratings of burning and wind sensitivity) as an indicator of NOP severity. A GWAS was performed for the NPSI-Eye-Sub-Score with a significance threshold of P 0.8) within ENSG00000279046 coding for transcript ENST00000624288.1. The most significant genes from gene-based tests were matrix metalloproteinase-19 (MMP19) (P = 1.12 × 10−5), zinc finger RNA-binding motif and serine/arginine rich-1 (ZRSR1) (P = 1.48 × 10−4), CTC-487M23.8 (P = 1.79 × 10−4), receptor expression-enhancing protein-5 (REEP5) (P = 2.36 × 10−4), and signal recognition particle-19 (SRP19) (P = 2.56 × 10−4). From gene set enrichment analysis, the sensory perception (false discovery rate = 6.57 × 10−3) and olfactory signaling (false discovery rate = 1.63 × 10−2) pathways were enriched with the most significant genes. Conclusions: Our GWAS revealed genes with protein products that may impact sensory perception, lending biological plausibility to a role for SNPs identified by our GWAS in the development of NOP. A better understanding of the biological relevance of these genes and pathways in the pathophysiology associated with NOP may facilitate future novel mechanism-based treatments. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Abstract Background The American Society of Anesthesiologists (ASA) has an impressive array of professional perioperative guidelines but has not issued a guideline specific to perioperative blood glucose management and does not delve into the topic in their other guidelines. Case report We experienced a perioperative case that highlights the potential difficulty of glucose management in this setting. During anesthetic induction for an orthopedic foot surgery, as the medication was infusing, an IDDM 1 (insulin dependent diabetes mellitus type 1) patient expressed feeling that her blood sugar level was low. Her finger stick after induction showed severe hypoglycemia with a blood glucose of 34 mg/dL. The hypoglycemia was treated with intravenous glucose and further closely monitored. Conclusions This case led us to revisit the different perioperative guidelines and recommendations for diabetic patients and this manuscript aims to highlight the similarities and discrepancies among the different published recommendations. This case highlights the value of utilizing insulin pump infusions in the perioperative setting when available.

RESUMO A aplicação do Treinamento de Habilidades Sociais no contexto universitário pode ser eficaz para a redução do estresse percebido pelos estudantes. Assim, o objetivo do presente artigo foi descrever, no formato de um estudo de caso único, o processo terapêutico de um Treinamento de Habilidades Sociais realizado com uma estudante de Psicologia, apresentando dados referentes à eficácia da intervenção. As avaliações pré e pós-teste foram feitas com os seguintes instrumentos: Inventário de Habilidades Sociais 2 (IHS2-Del-Prette), Escala de Estresse Percebido (PSS-14), entrevistas e diário de campo. Contatou-se o aprimoramento de habilidades sociais como recusar e fazer pedidos, lidar com críticas e expor desagrado e solicitar mudança de comportamento do outro, e redução dos níveis de estresse com base em dados qualitativos e quantitativos, com manutenção desses resultados no follow-up de seis semanas. Concluiu-se que o Treinamento de Habilidades Sociais realizado possibilitou a melhora da experiência na universidade para a participante.

Latin America is the world’s most urbanized region and its heterogeneous urban development may impact chronic diseases. In this study, the authors evaluate the association of built environment characteristics with body mass index, obesity, and type 2 diabetes.

Green vegetation may protect against heat-related death by improving thermal comfort. Few studies have investigated associations of green vegetation with heat-related mortality in Latin America or whether associations are modified by the spatial configuration of green vegetation. We used data from 323 Latin American cities and meta-regression models to estimate associations between city-level greenness, quantified using population-weighted normalized difference vegetation index values and modeled as three-level categorical terms, and excess deaths from heat (heat excess death fractions [heat EDFs]). Models were adjusted for city-level fine particulate matter concentration (PM2.5), social environment, and country group. In addition to estimating overall associations, we derived estimates of association stratified by green space clustering by including an interaction term between a green space clustering measure (dichotomized at the median of the distribution) and the three-level greenness variable. We stratified analyses by climate zone (arid vs. temperate and tropical combined). Among the 79 arid climate zone cities, those with moderate and high greenness levels had modestly lower heat EDFs compared to cities with the lowest greenness, although protective associations were more substantial in cities with moderate versus high greenness levels and confidence intervals (CI) crossed the null (Beta: −0.41, 95% CI: −1.06, 0.25; Beta −0.23, 95% CI: −0.95, 0.49, respectively). In 244 non-arid climate zone cities, associations were approximately null. We did not observe evidence of effect modification by green space clustering. Our results suggest that greenness may offer modest protection against heat-related mortality in arid climate zone Latin American cities.

Chagas disease (ChD), caused by Trypanosoma cruzi, is endemic in American countries and an estimated 8 million people worldwide are chronically infected. Currently, only two drugs are available for therapeutic use against T. cruzi and their use is controversial due to several disadvantages associated with side effects and low compliance with treatment. Therefore, there is a need to search for new tripanocidal agents. Natural products have been considered a potential innovative source of effective and selective agents for drug development to treat T. cruzi infection. Recently, our research group showed that hexanic extract from Clethra fimbriata (CFHEX) exhibits anti-parasitic activity against all stages of T. cruzi parasite, being apoptosis the main cell death mechanism in both epimastigotes and trypomastigotes stages. With the aim of deepening the understanding of the mechanisms of death induced by CFHEX, the metabolic alterations elicited after treatment using a multiplatform metabolomics analysis (RP/HILIC-LC-QTOF-MS and GC-QTOF-MS) were performed. A total of 154 altered compounds were found significant in the treated parasites corresponding to amino acids (Arginine, threonine, cysteine, methionine, glycine, valine, proline, isoleucine, alanine, leucine, glutamic acid, and serine), fatty acids (stearic acid), glycerophospholipids (phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine), sulfur compounds (trypanothione) and carboxylic acids (pyruvate and phosphoenolpyruvate). The most affected metabolic pathways were mainly related to energy metabolism, which was found to be decrease during the evaluated treatment time. Further, exogenous compounds of the triterpene type (betulinic, ursolic and pomolic acid) previously described in C. fimbriata were found inside the treated parasites. Our findings suggest that triterpene-type compounds may contribute to the activity of CFHEX by altering essential processes in the parasite.

Abstract Background Transport walking has drawn growing interest due to its potential to increase levels of physical activities and reduce reliance on vehicles. While existing studies have compared built environment-health associations between Euclidean buffers and network buffers, no studies have systematically quantified the extent of bias in health effect estimates when exposures are measured in different buffers. Further, prior studies have done the comparisons focusing on only one or two geographic regions, limiting generalizability and restricting ability to test whether direction or magnitude of bias are different by context. This study aimed to quantify the degree of bias in associations between built environment exposures and transport walking when exposures were operationalized using Euclidean buffers rather than network buffers in diverse contexts. Methods We performed a simulations study to systematically evaluate the degree of bias in associations between built environment exposures in Euclidean buffers and network buffers and transport walking, assuming network buffers more accurately captured true exposures. Additionally, we used empirical data from a multi-ethnic, multi-site cohort to compare associations between built environment amenities and walking for transport where built environment exposures were derived using Euclidean buffers versus network buffers. Results Simulation results found that the bias induced by using Euclidean buffer models was consistently negative across the six study sites (ranging from -80% to -20%), suggesting built environment exposures measured using Euclidean buffers underestimate health effects on transport walking. Percent bias was uniformly smaller for the larger 5 km scale than the 1 km and 0.25 km spatial scales, independent of site or built environment categories. Empirical findings aligned with the simulation results: built environment-health associations were stronger for built environment exposures operationalized using network buffers than using Euclidean buffers. Conclusion This study is the first to quantify the extent of bias in the magnitude of the associations between built environment exposures and transport walking when the former are measured in Euclidean buffers vs. network buffers, informing future research to carefully conceptualize appropriate distance-based buffer metrics in order to better approximate real geographic contexts. It also helps contextualize existing research in the field that used Euclidean buffers when that were the only option. Further, this study provides an example of the uncertain geographic context problem.

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease, marked by an unpredictable course, high morbidity, and increased mortality risk that occurs especially in the diffuse and rapidly progressive forms of the disease, characterized by fibrosis of the skin and internal organs and endothelial dysfunction. Recent studies suggest that the identification of altered metabolic pathways may play a key role in understanding the pathophysiology of the disease. Therefore, metabolomics might be pivotal in a better understanding of these pathogenic mechanisms.Methods: Through a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA), searches were done in the PubMed, EMBASE, Web of Science, and Scopus databases from 2000 to September 2022. Three researchers independently reviewed the literature and extracted the data based on predefined inclusion and exclusion criteria.Results: Of the screened studies, 26 fulfilled the inclusion criteria. A total of 151 metabolites were differentially distributed between SSc patients and healthy controls (HC). The main deregulated metabolites were those derived from amino acids, specifically homocysteine (Hcy), proline, alpha-N-phenylacetyl-L-glutamine, glutamine, asymmetric dimethylarginine (ADMA), citrulline and ornithine, kynurenine (Kyn), and tryptophan (Trp), as well as acylcarnitines associated with long-chain fatty acids and tricarboxylic acids such as citrate and succinate. Additionally, differences in metabolic profiling between SSc subtypes were identified. The diffuse cutaneous systemic sclerosis (dcSSc) subtype showed upregulated amino acid-related pathways involved in fibrosis, endothelial dysfunction, and gut dysbiosis. Lastly, potential biomarkers were evaluated for the diagnosis of SSc, the identification of the dcSSc subtype, pulmonary arterial hypertension, and interstitial lung disease. These potential biomarkers are within amino acids, nucleotides, carboxylic acids, and carbohydrate metabolism.Discussion: The altered metabolite mechanisms identified in this study mostly point to perturbations in amino acid-related pathways, fatty acid beta-oxidation, and in the tricarboxylic acid cycle, possibly associated with inflammation, vascular damage, fibrosis, and gut dysbiosis. Further studies in targeted metabolomics are required to evaluate potential biomarkers for diagnosis, prognosis, and treatment response.

The severity of infectious disease outbreaks is governed by patterns of human contact, which vary by geography, social organization, mobility, access to technology and healthcare, economic development, and culture. Whereas globalized societies and urban centers exhibit characteristics that can heighten vulnerability to pandemics, small-scale subsistence societies occupying remote, rural areas may be buffered. Accordingly, voluntary collective isolation has been proposed as one strategy to mitigate the impacts of COVID-19 and other pandemics on small-scale Indigenous populations with minimal access to healthcare infrastructure. To assess the vulnerability of such populations and the viability of interventions such as voluntary collective isolation, we simulate and analyze the dynamics of SARS-CoV-2 infection among Amazonian forager-horticulturalists in Bolivia using a stochastic network metapopulation model parameterized with high-resolution empirical data on population structure, mobility, and contact networks. Our model suggests that relative isolation offers little protection at the population level (expected approximately 80% cumulative incidence), and more remote communities are not conferred protection via greater distance from outside sources of infection, due to common features of small-scale societies that promote rapid disease transmission such as high rates of travel and dense social networks. Neighborhood density, central household location in villages, and household size greatly increase the individual risk of infection. Simulated interventions further demonstrate that without implausibly high levels of centralized control, collective isolation is unlikely to be effective, especially if it is difficult to restrict visitation between communities as well as travel to outside areas. Finally, comparison of model results to empirical COVID-19 outcomes measured via seroassay suggest that our theoretical model is successful at predicting outbreak severity at both the population and community levels. Taken together, these findings suggest that the social organization and relative isolation from urban centers of many rural Indigenous communities offer little protection from pandemics and that standard control measures, including vaccination, are required to counteract effects of tight-knit social structures characteristic of small-scale populations.

IntroductionThis study provides an evaluation of the impacts of classroom-based adult bicycle education on bicycling activity, confidence and competency self-perceptions while bicycling, knowledge of the bicycling rules of the road, and mode choice in a sample of residents of the San Francisco Bay Area in the US.MethodsChanges were measured with self-administered surveys completed before and six weeks after the course intervention. Self-reported data were validated using objective data collected using the Ride Report app. We used multivariable regression analyses to examine changes in self-reported data over time.ResultsParticipants reported statistically significant increases in confidence while bicycling in both traffic and car-free areas, feelings of safety while bicycling in car-free areas, and knowledge of the rules of the road. While there were significant changes in the proportion of trips by foot, transit and TNC, there was no change in the count of trips made by bicycle.DiscussionAlthough overall changes in bicycling activity did not change, participants with initial low confidence increased bicycling activity and feelings of safety in traffic, compared to participants overall. Classroom-based bicycle education courses can improve bicycling confidence self-perception and increase knowledge of the bicycling rules of the road.

Abstract Background It is unclear whether the insertion of an axis-orienting double-pigtail plastic stent (DPS) through biliary lumen-apposing meal stent (LAMS) in EUS-guided choledochoduodenostomy (CDS) improves the stent patency. The aim of this study is to determine whether this technical variant offers a clinical benefit in EUS-guided biliary drainage (BD) for the management of distal malignant biliary obstruction. Methods/design This is a multicenter open-label, randomized controlled trial with two parallel groups. Eighty-four patients with malignant biliary obstruction will undergo EUS-BD (CDS type) using LAMS in 7 tertiary hospitals in Spain and will be randomized to the LAMS and LAMS plus DPS groups. The primary endpoint is the rate of recurrent biliary obstruction, as a stent dysfunction parameter, detected during follow-up. Secondary endpoints: technical and clinical success (reduction in bilirubin > 50% within 14 days of stent placement), safety, and others (number of reinterventions, time to biliary obstruction, prognostic factors, survival rate). Discussion The BAMPI trial has been designed to determine whether the addition of a coaxial axis-orienting DPS through LAMS is superior to LAMS alone to prevent stent dysfunction. Trial registration ClinicalTrials.gov NCT04595058 . Registered on October 14, 2020.