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Pleural extension of pseudomyxoma peritonei is rare, and treatment demands multidisciplinary care. Perioperative management during cytoreductive surgery and hyperthermic intrathoracic chemotherapy challenges anesthesiology and surgical teams in unique ways. Hemodynamic, arrhythmogenic, ventilatory, fluid balance, acid-base, and nephroprotection issues are important considerations. The use of cytoreductive surgery and hyperthermic intrathoracic chemotherapy for extraperitoneal pseudomyxoma peritonei is an innovative and potentially curative approach. Here, we describe our approach to managing these patients.

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

Background & Aims: Etiologic factor removal (ER) drives recompensation and improves portal hypertension in cirrhosis. Esophageal varices (EV) and portosystemic shunts (PSS) have been found in patients despite hepatic venous pressure gradient (HVPG) dropping below 10 mmHg after ER, questioning HVPG accuracy in reflecting true portal pressure in the setting of ER. We aim to evaluate the correlation of HVPG with direct portal pressure (DPP) in patients with persistence of EV after ER despite HVPG

Purpose: This research examines policies aimed at reducing the environmental impact of the hotel sector in Catalonia, Spain in 2020 and how they are communicated to stakeholders through corporate websites. It applies academic criteria to identify key aspects that are relevant to tourism. Design/Methodology: This study conducts a descriptive analysis of Catalonia's hotel sector in 2020, utilizing SABI (Iberian Balance Sheet Analysis System) data. It selects the top 48 companies in the hotel sector that are legally required to report their annual accounts in the regular format. The study then systematically evaluates their websites to assess the availability and transparency of information on environmental sustainability. Findings: Sustainable tourism, marked by non-financial indicators such as environmental impact, energy/water usage and waste generation, is a very important issue for stakeholders in the hotel industry, including governments, owners, investors, and customers. The sector's reporting methods are crucial for effectively communicating environmental policies to these parties. While many companies have implemented strategies to assess and reduce their environmental impact, there is still considerable room for improvement, particularly in communicating these efforts to the various stakeholders. Research limitations/implications: This research, while rigorous, has certain limitations that suggest directions for future studies. A primary constraint involves data reported at a group level by hotel companies, which complicates obtaining specific data for the Catalonia region, particularly for hotel groups with an international presence. Another significant limitation is the reliance on indirect data collection, based on the companies' self-reported environmental policies posted on their websites. Practical implications: By identifying and knowing the environmental policies of the hotel industry over the analyzed period, we can help the industry itself to improve the sustainability of its environmental efforts and make it more attractive to all stakeholders. Social implications: The study highlights the importance of environmental policies and the achievement of the UN Sustainable Development Goals (SDGs) in the hotel industry. This industry plays an important role in achieving the UN SDGs, which offer significant benefits for business, such as access to new markets, better risk management and long-term sustainability, as well as social benefits. This is increasingly expected by both consumers and investors. Originality/Value: This study examines the commitment and information transparency of the Costa Brava hotel sector in terms of environmental sustainability, as well as its communication strategies. This is achieved primarily through the analysis of corporate websites, comparing the information and indices to those of other entities in the sector. The relevance and value of this analysis stems from the recognition that, despite the efforts made to improve the sector, further progress needs to be made in order to make it more attractive to stakeholders.

Background & Aims: Patients with vascular liver diseases (VLD) are at higher risk of both severe courses of COVID-19 disease and thromboembolic events. The impact of SARS-CoV-2 vaccination in patients with VLD has not been described and represents the aim of our study. Methods: International, multicenter, prospective observational study in patients with VLD analyzing the incidence of COVID-19 infection after vaccination, severity of side effects, occurrence of thromboembolic events and hepatic decompensation. In a subgroup of patients, the humoral and cellular responses to vaccination were also analyzed. Results: A total of 898 patients from 14 European centers – part of the VALDIG network – were included, 872 (97.1%) patients received two vaccine doses (fully vaccinated), and 674 (75.1%) three doses. Of the total cohort, 151/898 had a COVID-19 infection prior to vaccination, of whom 9/151 (5.9%) were re-infected. Of the 747/898 patients who were not previously infected, 11.2% (84/747) were diagnosed with a COVID-19 infection during the study period. Two infected patients required intensive care unit admission and infection was fatal in two fully vaccinated patients. Adverse effects were reported in around 40% of patients, with local side effects being the most frequent. During the study period, 31 (3.5%) patients had thromboembolic events and 21 (2.3%) hepatic decompensations. No cases of vaccine-induced thrombocytopenia were reported. Vaccine immunogenicity was assessed in 36 patients; seroconversion reached 100% and IFNy T-cell responses significantly increased post two mRNA-1273 vaccine doses. Conclusion: Patients with VLD seem to have a preserved immune response to SARS-CoV-2 vaccination, which appears to be safe and effective in preventing severe COVID-19 infection. Our study cannot definitively establish a direct link between vaccination and thrombotic events, though the contribution of vaccination as a cofactor in VLD remains to be elucidated. Impact and implications:: Patients with vascular liver disease (VLD) are at increased risk of both SARS-CoV-2 infection and severe COVID-19 disease. The potential risks associated with vaccination against this infection need thorough investigation. Our research enhances the understanding of the effects of COVID-19 vaccination in patients with VLD, highlighting its good tolerability. Moreover, patients with VLD appear to have a preserved immune response to SARS-CoV-2 vaccination, providing protection against severe COVID-19 infection. Our study cannot definitively establish a direct link between vaccination and thrombotic events, and no cases of vaccine-induced thrombocytopenia were reported.

IntroductionDengue is a significant public health issue in the Urabá region, accounting for 37.5% of morbidity and 41.7% of mortality resulting from dengue in the department of Antioquia (Colombia) in 2018. Clinical Practice Guidelines (CPGs) are tools based on Evidence-Based Medicine, intended for medical personnel to bridge the gap between proven intervention efficacy and clinical decision-making. This study aims to identify barriers and facilitators in the implementation of CPGs for dengue patient care by healthcare officials in the municipalities of the banana axis in the Urabá region.MethodologyFrom a multifaceted approach to implementation research, a mixed method study that combines qualitative and quantitative approaches, was conducted during the years 2020 and 2021, using combined instruments to identify determinants (Guide Indicative Factors, Individual factors of health professionals, Patient factors, Professional interactions, Incentives and resources, Capacity for organizational change, and lastly Social, political, and legal factors) affecting adherence to the Comprehensive Clinical Care Guide for Patients with Dengue (GACIPD). Semi-structured interviews and focus groups with healthcare workers were conducted to assess determinants based on clinical experience. Questionnaires on determinants of GACIPD adherence, using an adapted version of the Chronic Disease Implementation Checklist (TICD), were also employed. Qualitative analysis of the interviews and focus groups used a concept-based coding framework. The questionnaire responses were analyzed using Likert scaling and frequency counts of determinants within and across domains. Participants included general practitioners, other health professionals, researchers, academics, and administrators.ResultsThere was a total of 103 participants in focus groups, 7 in semi-structured interviews, and 136 participants through questionnaires. Among the domains studied, the identification of barriers and facilitators emphasized institutional factors and individual factors. Organizational change capacity was identified as a major barrier, with only 3.6% of respondents indicating that their institution adjusted the prioritization of adequate care according to the guideline. The GACIPD domain received the highest facilitator rating, with 66.7% acceptance due to its practicality, simplicity, clarity, documentation, and ease of implementation, despite this, only 10% of professionals completely agree that their work is in accordance with the GACIPD. The determinant of patient factors was significant in the negative perception of adherence to GACIPD.ConclusionsAlthough barriers outweighed facilitators for GACIPD adherence, determinants for its use were generally positive, as most participants reported it as being a complete, documented, and easy-to-implement guide. The lack of knowledge of the guidelines impacting health professional's decision making was identified as a potentially modifiable barrier, and educational strategies could be implemented to overcome it. The region requires greater emphasis on the management of chronic health conditions, comorbidities, and coinfections of dengue with other endemic diseases.

Acetone-Butanol-Ethanol (ABE) fermentation has regained interest due to the environmental problems generated by fossil fuels and the need to modify production chains including considerations of sustainability and circular economy. This work focuses on the modelling of ABE fermentation, with a Clostridium acetobutylicum mutated strain, to support the synthesis and improvement of butanol and acetone production process. To reach this objective, bioreactor fermentations with different glucose concentrations were developed. Results show that a two phases model (with a set of equations for the acidogenesis and another for the solventogenesis) generates satisfactory process predictions. In acidogenesis, the main effect on growth and acid production is due to the inhibition by acids, which can be quantified as a function of the total concentration of acids. While in the solventogenesis, inhibition must be quantified as a function of the total concentration of solvents. This model agrees with metabolic analysis that considers solvents generation being produced, simultaneously, from acids and sugars. For the studied system, acetone and butanol production is based on re-assimilated acids and pyruvate from glycolysis, with a distribution that changes with glucose availability.

Leptospirosis is a global zoonotic disease caused by spirochete bacteria of the genus Leptospira. The disease exhibits a notable incidence in tropical and developing countries, and in Colombia, environmental, economic, social, and cultural conditions favor disease transmission, directly impacting both mortality and morbidity rates. Our objective was to establish the pooled lagged effect of runoff on leptospirosis cases in Colombia. For our study, we included the top 20 Colombian municipalities with the highest number of leptospirosis cases. Monthly cases of leptospirosis, confirmed by laboratory tests and spanning from 2007 to 2022, were obtained from the National Public Health Surveillance System. Additionally, we collected monthly runoff and atmospheric and oceanic data from remote sensors. Multidimensional poverty index values for each municipality were sourced from the Terridata repository. We employed causal inference and distributed lag nonlinear models to estimate the lagged effect of runoff on leptospirosis cases. Municipality-specific estimates were combined through meta-analysis to derive a single estimate for all municipalities under study. The pooled results for the 20 municipalities suggest a lagged effect for the 0 to 2, and 0–3 months of runoff on leptospirosis when the runoff is

Introducción: una buena salud mental es primordial en el desarrollo del individuo, tener un manejo apropiado de las capacidades, habilidades y herramientas personales les permite adaptarse a las necesidades del mundo actual; son muchos los factores asociados a salud mental post COVID-19; después del confinamiento se dieron situaciones de perturbación psicosocial en la población estudiantil de educación superior. Objetivo: determinar los factores asociados a la salud mental pos confinamiento por COVID-19 en estudiantes universitarios en Barranquilla, Colombia. Método: estudio cuantitativo correlacional, la muestra fueron 212 estudiantes de enfermería, utilizando la calculadora de Epi Info. Resultados: el 50% de la población tiene entre 20 y 24 años, solteros, de estrato socioeconómico bajo-bajo, pertenecientes al régimen de salud subsidiado, se encontró una relación significativa entre la edad y la ansiedad, entre el género y las ideas suicidas, las variables psicosociales y familiares de interés explican de manera significativa la ocurrencia de ideas suicidas en la población estudiada. Conclusiones: existen diversos factores que influyen en la salud mental pos confinamiento por COVID-19, por ello, urge la necesidad de potenciar la resiliencia, el crecimiento personal, las relaciones intrafamiliares y particularmente a los grupos vulnerables que permitan minimizar el impacto psicosocial en la población.

Abstract Infections are a major cause of morbidity and mortality in cirrhosis, especially those caused by multi-drug resistant bacteria. During the COVID-19 pandemic, the incidence and type of infection in these patients may have been influenced by the restrictive measures implemented. We aimed to compare the infections in patients with cirrhosis hospitalized before the COVID-19 pandemic versus those hospitalized during the pandemic. We retrospectively compared infections in patients with cirrhosis hospitalized in the hepatology unit during the pre-pandemic period (3/2019–2/2020) with infections in patients hospitalized during the pandemic (3/2020–2/2021). Baseline characteristics, type of infections, type of bacteria, antimicrobial resistance and mortality were evaluated. There were 251 hospitalizations in 170 patients during the pre-pandemic period and 169 hospitalizations in 114 patients during the pandemic period. One or more infections were identified in 40.6% of hospitalizations during the pre-pandemic period and 43.8% of hospitalizations during the pandemic, P = 0.52. We found 131 infections in the pre-pandemic period and 75 infections during the pandemic. The percentage of nosocomial infections decreased in the pandemic period (25.3% vs. 37.4% in the pre-pandemic period, P = 0.06). We found a non-significant trend to a higher incidence of infections by multi-drug resistant organisms (MDRO) in the pandemic period than in the pre-pandemic period (6.5% vs. 4%). The incidence of infections was similar in both periods. However, during the pandemic, we observed a trend to a lower incidence of nosocomial infections with a higher incidence of MDRO infections.

Objective: In patients undergoing elective thoracic surgery, frailty is associated with worse outcomes. However, the magnitude by which frailty influences outcomes of urgent thoracic surgery (UTS) is unknown. Methods: We identified patients admitted with a UTS condition from January to September 2017 in the National Readmissions Database. UTS conditions were classified as esophageal perforation, hemo/pneumothorax, rib fracture, and obstructed hiatal hernia. Outcome of interest was mortality within 90 days of index admission. Frailty score was calculated using a deficit accumulation method. Cox proportional hazard modeling was used to calculate a hazard ratio for each combination of UTS disease type and frailty score, adjusted for sex, insurance payor, hospital size, and hospital and patient location, and was compared with the effect of frailty on elective lung lobectomy. Results: We identified 107,487 patients with a UTS condition. Among UTS conditions overall, increasing frailty elements were associated with increased mortality (hazard ratio, 2270; 95% CI, 1463-3523; P

Abstract This work employed a two-step biorefining process, consisting of a hemicellulose-rich liquor production through ultrasound-assisted cold alkaline extraction (CAE), followed by thermochemical treatment of the resultant solid phase. The post-CAE solid phase’s pyrolytic potential was assessed by application of thermogravimetric analysis (TGA) and Friedman’s isoconversional method, and also from hydrogen production. The solid phases remaining after the CAE treatment were more reactive than the untreated raw material. Notably, the alkali concentration employed in the first step was the individual variable most pronounced influence on their activation energy (E a). Thus, at a degree of conversion α = 0.50, E a ranged from 109.7 to 254.3 kJ/mol for the solid phases, compared to 177 kJ/mol for the raw material; this value decreased with rising glucan content. At maximal degradation, the post-CAE solid phases produced up to 15.57% v/v more hydrogen than did the untreated raw material.

The paper is about community-based participatory research on environmental conflicts about sand quarries in northern Bogotá. Community-based participatory research is applied to understand the environmental conflicts of mining activities. The approach was suitable for improving the relevance and acceptance of research in the local community. It invited community members to participate and uphold their views about the social conflicts and environmental impacts arising from mining activities. The findings highlight the need for participatory environmental governance, integrating local communities and power relations analysis in environmental decision-making.

IntroductionHepatitis B infection (HBV) is prevalent in China. Due to language barriers and cultural differences, it is not always straightforward to evaluate disease knowledge in liver clinics. We aimed to assess the awareness on HBV and its mechanisms of transmission in HBV-infected Chinese patients and their household contacts.MethodsHBV-infected Chinese patients and their contacts were interviewed by a native Chinese nurse regarding their knowledge on HBV transmission mechanisms, use of preventive measures and vaccination status. Non-Chinese HBV-infected patients and their household contacts served as a control group.ResultsIn total 182 patients and 398 contacts participated with 85 (47%) patients and 240 (60%) contacts being from China. Language barrier was reported in 80% of Chinese patients and 44% of their contacts. Knowledge on parenteral and sexual HBV transmission was high in all patients (~90%) but Chinese were more aware of vertical transmission than controls (94% vs. 68%; p

Este estudio evaluó el comportamiento mecánico de un modelo físico laboratorial de una vía no pavimentada reforzada con una geomalla biaxial GB. Para tal fin, se compactaron 0.15 m de material de mejoramiento y 0.20 m de subrasante en una caja cuadrada de 0.35 m. Se realizaron ensayos con y sin refuerzo, mediante la aplicación de 10000 ciclos de carga dinámica en una maquina universal. Se utilizo una frecuencia de 2.5 Hz y presión de 560 kPa mediante una placa circular de 0.10 m de diámetro, simulando la circulación de una llanta de un eje rueda simple. La validación numérica vía Métodos de los Elementos Finitos (MEF) definió parámetros usando el modelo Hardening Soil. Como gran conclusión, se pudo evidenciar que el refuerzo con una geomalla reduce aproximadamente 45% la magnitud del ahuellamiento, según el modelo, debido a que la geomalla reduce la concentración de esfuerzos cortantes (τ relativo) disminuyendo la deformación plástica.

Abstract Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing‐induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre‐procedure evaluation and preparation, implant procedure management, follow‐up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

La enfermedad de Alzheimer afecta a millones de personas en el mundo y constituye una problemática de salud pública, debido a que tiene consecuencias no solo para el paciente, sino también para los cuidadores, cuya labor recae mayoritariamente en las mujeres. El presente estudio tuvo como objetivo describir la experiencia psicológica y socioeconómica de cuidadores informales de pacientes con Alzheimer, desde una perspectiva familiar y de género, por medio de una metodología cualitativa de diseño fenomenológico. Se realizaron entrevistas semiestructuradas a 14 cuidadores familiares, con edades comprendidas entre los 33 y 77 años; el 71 % de ellos pertenece al género femenino y el 57 % representa a los solteros. Los datos fueron analizados a través del software Atlas.ti, evidenciando afectaciones psicológicas, emocionales y conductuales, así como limitaciones de salud en los cuidadores. Asimismo, se identifican dificultades económicas y sociales en el cuidador relacionadas con el familismo y la feminización del cuidado. Se concluye la importancia del reconocimiento de la labor de los cuidadores y el desarrollo de intervenciones familiares, con el fin de involucrar a todos los miembros en el cuidado de pacientes con Alzheimer y así evitar la sobrecarga de las mujeres, en quienes suele recaer esta responsabilidad.

Advanced chronic liver disease (ACLD) is associated with a wide spectrum of immune dysfunction. The clinical impact of SARS-CoV-2 on the development of decompensation and immune response in unvaccinated outpatients has not as yet been clearly defined. This study aimed to evaluate the clinical and immunological impact of SARS-CoV-2 on outpatients with ACLD. This is an observational case–control study, in which ACLD outpatients were included prospectively and consecutively and classified into two groups: SARS-CoV-2 infected and non-infected. Patients’ baseline characteristics and infection data were collected and analyzed. Immunoglobulin G (IgG) levels against Spike 1 were evaluated. The primary endpoint was risk of liver decompensation during follow-up, assessed after propensity score matching and adjusted by Cox regression. Between October 2020 and July 2021, ACLD outpatients (n = 580) were identified, and 174 patients with clinical follow-up were included. SARS-CoV-2 infection incidence was 7.6% (n = 44). Risk of liver decompensation was significantly higher after infection (HR = 2.43 [1.01–5.86], p = 0.048) vs. non-infection. The time of IgG evaluation was similar in all patients (n = 74); IgG concentrations were significantly higher in compensated vs. decompensated patients (1.02 ± 0.35 pg/mL vs. 0.34 ± 0.16 pg/mL, p < 0.0001) and correlated with hemoglobin levels. The dysregulation of the innate immune response in patients with decompensated liver disease increased the risk of further decompensation following SARS-CoV-2, mainly due to a worsening of ascites.