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Background: The epidemiological evidence on the interaction between heat and ambient air pollution on mortality is still inconsistent. Objectives: To investigate the interaction between heat and ambient air pollution on daily mortality in a large dataset of 620 cities from 36 countries. Methods: We used daily data on all-cause mortality, air temperature, particulate matter ≤ 10 μm (PM10), PM ≤ 2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) from 620 cities in 36 countries in the period 1995–2020. We restricted the analysis to the six consecutive warmest months in each city. City-specific data were analysed with over-dispersed Poisson regression models, followed by a multilevel random-effects meta-analysis. The joint association between air temperature and air pollutants was modelled with product terms between non-linear functions for air temperature and linear functions for air pollutants. Results: We analyzed 22,630,598 deaths. An increase in mean temperature from the 75th to the 99th percentile of city-specific distributions was associated with an average 8.9 % (95 % confidence interval: 7.1 %, 10.7 %) mortality increment, ranging between 5.3 % (3.8 %, 6.9 %) and 12.8 % (8.7 %, 17.0 %), when daily PM10 was equal to 10 or 90 μg/m3, respectively. Corresponding estimates when daily O3 concentrations were 40 or 160 μg/m3 were 2.9 % (1.1 %, 4.7 %) and 12.5 % (6.9 %, 18.5 %), respectively. Similarly, a 10 μg/m3 increment in PM10 was associated with a 0.54 % (0.10 %, 0.98 %) and 1.21 % (0.69 %, 1.72 %) increase in mortality when daily air temperature was set to the 1st and 99th city-specific percentiles, respectively. Corresponding mortality estimate for O3 across these temperature percentiles were 0.00 % (-0.44 %, 0.44 %) and 0.53 % (0.38 %, 0.68 %). Similar effect modification results, although slightly weaker, were found for PM2.5 and NO2. Conclusions: Suggestive evidence of effect modification between air temperature and air pollutants on mortality during the warm period was found in a global dataset of 620 cities.

Metal pollution and distribution in marine surface (0-5 cm) sediments of the Baja California border region were characterized during 1989. The total organic carbon, clay, silt and sand contents in the sediments and their correlation with the metals examined were also analysed. The results show higher concentrations (µg g–1 dry weight) of Al (7493), Mn (78.8) Cr (24.2) Zn (16.5) Cu (6.2) Cd (0.29) and Ag (0.30) in sediments of the 60-m isobath, with a gradient in their concentrations toward the shoreline. Analyses of simple correlation, principal components and similarity indicate that this behaviour is explained by the association of the elements with grain size and with silicoaluminate and organic matter contents. The possible influence of pollution and productivity phenomena as other processes that may control the distribution and origin of the metals in the study area, particularly Cd and Ag, is also noted. The results obtained show a decrease in Zn (15%), Cu (16%) Ag (20%) and Cd (22%) with respect to the values measured in coastal sediments of San Diego, California, in 1979.

Min oscillations are a fascinating mechanism used by Escherichia coli to find their middle. Beyond their biological role, they provide a convenient and relatively unexplored method to monitor the effect of sublethal environmental challenges on bacterial physiology in real-time and at the single-cell level. In this review, we discuss the original papers that put forward the idea of using Min oscillations as a reporting tool to monitor the effect of extracellular cationic compounds, including antibiotics. More recent work from our laboratory explores this tool to follow bacterial response to other challenges such as weak mechanical interactions with nanomaterials or photodynamic treatment. We discuss the physiological meaning of the changes in Min oscillation period, likely related to membrane potential dynamics, as well as the benefits and limitations of using oscillations as a reporter in fluorescence microscopy. Overall, Min oscillations are a useful addition to the fluorescence microscopy toolbox in order to visualize stress responses in E. coli, and have the potential to provide full mechanistic understanding of the events that lead to bacterial cell death in different contexts.

BackgroundEstimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance.MethodsUsing estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region.ResultsThe Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8–70.3) to 80.3 (77.2–83.2) years. This increase was driven by the decline in under-5 mortality (−80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region.ConclusionIn the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Mechanobactericidal nanomaterials, such as low‐dimensional nanoparticles in suspension or high‐aspect‐ratio nanofabricated topographies, rely on their mechanical or physical interactions with bacteria and are promising antimicrobial strategies that overcome bacterial resistance to classical antibiotics. However, the underlying killing mechanisms are poorly understood, given the challenges associated with the real‐time characterization of the mechanical interaction in a biologically relevant environment. Indeed, different death mechanisms have been proposed depending on the magnitude of the interaction forces. Herein, the real‐time and single‐cell response of bacteria to weak mechanical interactions with nanostructured topographies and “nanodarts,” exemplified by flowing single‐walled carbon nanotubes, is investigated. To that end, an advanced reporting strategy is used to follow sublethal physiological effects on bacteria upon contact with these materials. With this method, it is estimated that the contact time at which the initial stages of bacterial death occur is in the order of a few tens of minutes. This information contributes to a full understanding of the complex mechanisms of mechanically induced bacterial death.

Por un lado, en México, el estado de Oaxaca ha ocupado en años consecutivos los primeros lugares a nivel nacional en la producción de papaya (Carica papaya L.). Por otro lado, las plantaciones son altamente susceptibles al ataque de tipo viral, uno de los más devastadores es la papaya ringspot virus (PRSV). Debido a lo anterior se diseñaron tres oligonucleótidos específicos que permiten la identificación del PRSV mediante la reacción en cadena de la polimerasa acoplada a una transcriptasa reversa (RT-PCR). Los oligonucleótidos fueron diseñados por el software Vector NTI Advance ® V11.5 que amplificaron tres fragmentos de 857 pares de bases (pb), 583 pb y 213 pb de regiones conservadas del genoma viral. Para comprobar el desempeño de los oligonuceótidos se realizaron extracciones de ácido ribonucleico (ARN) de tejido foliar de papaya con signos del PRSV utilizando TRIzolTM y el Kit SuperScriptTM III One-Step RT-PCR System para la técnica de RT-PCR. Los resultados de la amplificación fueron analizados en un gel de agarosa donde los amplicones coincidieron con el tamaño esperado al diseño preliminar.

Summary: Background: Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods: A global dataset of georeferenced surveyed locations was used to model annual 2000–18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000–18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. Findings: We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174–234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6–5·7 million) in the region of the Americas to 107 million (91–134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43–63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation: Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease. Funding: Bill & Melinda Gates Foundation.

Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.

Gastric cancer (GC) is one of the leading causes of cancer-related death. The combination of new molecular classifications with clinicopathological data could contribute to the individualization of patients and to the development of new therapeutic strategies. We examined the various associations in two molecular types of GC: HER2-positive (human epidermal growth factor receptor 2) and microsatellite instability (MSI), assessing their influence on treatment and prognosis. A retrospective study of 142 GC patients was performed with molecular characterization through HER2 overexpression and DNA repair protein expression for MSI. The percentage of HER2-positive tumors was 13.4%, predominantly in men. Correlations were found with intestinal type, metastases, advanced stages and chemotherapy. Almost 75% of HER2-positive patients died. MSI occurred in 16.2%, associated with advanced age, female sex, distal location and intestinal type. These patients had few metastases and low stages. The percentage of deaths was higher among MSI patients who received perioperative chemotherapy. The determination of HER2 and MSI status in GC is important for their association with specific clinicopathological features and for their prognostic and predictive value.

INTRODUCCIÓN Los sistemas de producción de leche en el Ecuador varían desde intensivos a extensivos, estos dependen directamente del manejo reproductivo, sanitario y nutricional, elementos fundamentales para una producción óptima de la explotación ganadera (Chilpe, 2015). La provincia del Azuay, por su ubicación geográfica, posee 3 pisos altitudinales: zona sierra, estribación y costanera; en cada una de estas, el propósito de las ganaderías difiere. Además, estas zonas se caracterizan por la presencia de ganaderías pequeñas (50 ha) (SINAGAP, 2012). Un elevado porcentaje de ganaderías en la zona en estudio, es manejada de forma tradicional, estas no cuentan con registros, lo que impide un manejo adecuado de los parámetros productivos y reproductivos, lo cual afecta la rentabilidad del productor (Dávalos, 2005). El objetivo de la presente investigación fue determinar las características productivas de las ganaderías pertenecientes a los Cantones occidentales de la provincia del Azuay.

INTRODUCCIÓN La zoometría permite cuantificar rasgos corporales, determinar medidas concretas y sus variaciones normales en una población. Además, ayuda a establecer relaciones y diferencias en una determinada raza, cuyos caracteres pueden ser influenciados por el medio ambiente (Contreras, Chirinos, Sambrano, Molero, & Paez, 2011); sin embargo, el tamaño y peso corporal de la vaca lechera son factores fundamentales para dilucidar en qué dirección debe seleccionarse los animales para obtener mayor eficiencia, rentabilidad y longevidad en una determinada explotación. La vaca Holstein americana adulta, pesa entre 600 y 700 kg, el tamaño de los animales de esta raza es superior a 150 cm. En nuestro país, especialmente en la provincia del Azuay, la información de los parámetros productivos, reproductivos y morfológicos del genotipo Holstein Friesian mestizo, adaptado a nuestro medio, es escasa, lo que impide la comparación de estos parámetros con otros han sido obtenido a nivel internacional (Harris & Kolver, 2001). El objetivo de la presente investigación fue determinar la relación entre el número de partos, edad y morfoestructura del genotipo Holstein mestizo; alimentado bajo un sistema de pastoreo, en la región centro sur del Ecuador, Provincia del Azuay.

INTRODUCCIÓN La mastitis es una enfermedad de la glándula mamaria que afecta sobre todo a las vacas de alta producción, puede presentarse de forma sintomática (clínica) y asintomática (subclínica) que, al no poder ser identificada pasa desapercibida. Martínez, Cruz-Carrillo, Millán, & Moreno-Figueroa (2015) determinaron que la forma clínica se presenta apenas en un 0.66%, mientras que la subclínica en un 98.6%; además, se caracteriza por disminución del volumen de producción, y el aumento de células somáticas con cambios importantes en la composición de la leche, lo que afecta su calidad y la economía del productor. Manjarrez, Díaz, Salazar, Valladares, Gutiérrez et al. (2012) observaron que en hatos pequeños existía una mayor prevalencia de mastitis subclínica; además, según los mismos autores, el ordeño no higiénico predispone al desarrollo de esta enfermedad. Según Ramírez (2015), las vacas a las cuales no se realiza una correcta rutina de ordeño (lavado, secado, despunte, pre-sellado, sellado) tienen mayor riesgo de contraer mastitis subclínica; así mismo, considera que la higiene de la ubre es el principal factor que predispone la presencia de esta enfermedad. Por lo cual el objetivo del estudio fue determinar la influencia de la rutina de ordeño y tamaño del hato sobre la prevalencia de la mastitis subclínica en la región centro sur del Ecuador.

Se evaluó el pensamiento creativo en mujeres con diferentes orientaciones sexuales, para analizar si hay diferencias entre las puntuaciones del pensamiento creativo. Se evaluaron tres grupos, homosexual, bisexual y heterosexual, con un total de 31 participantes mujeres entre 18 y 30 años, con licenciatura o posgrado, mediante el Test de Torrance de Pensamiento Creativo (TTPC); los puntajes fueron analizados con una prueba Kruskall-Wallis. Se encontraron diferencias significativas para la subescala flexibilidad en creatividad verbal, teniendo las mujeres bisexuales el mejor desempeño. Para la subescala originalidad en creatividad figural se encontraron diferencias significativas entre mujeres heterosexuales y homosexuales, obteniendo estas los mayores puntajes. En la subescala resistencia al cierre de creatividad figural, las mujeres heterosexuales puntearon significativamente por debajo de los otros grupos. Los hallazgos sugieren para esta población características creativas expresadas de manera diferenciada entre diferentes orientaciones sexuales, las mismas que están siendo promovidas por propiedades creativas implicadas en el pensamiento divergente, y que parecieran poseer características particulares entre dichas orientaciones sexuales.

Se describió el proceso y producto creativo, funciones ejecutivas y el procesamiento visoespacial en diferentes orientaciones sexuales. La muestra estuvo compuesta por hombres y mujeres heterosexuales y homosexuales. Se evaluaron con el test de Torrance de pensamiento creativo, las tareas selección de refranes, clasificaciones semánticas, metamemoria, fluidez verbal, clasificación de cartas y memoria de trabajo visoespacial, figura compleja de Rey-Osterreith, escala Klein de orientación sexual, depresión, ansiedad e impulsividad. Los datos fueron analizados con un ANOVA de una vía y análisis de Pearson. Se obtuvieron diferencias significativas en originalidad figural para el grupo de mujeres homosexuales, respecto a las heterosexuales; al igual que un mayor puntaje en flexibilidad verbal para los hombres homosexuales en comparación con los heterosexuales. Los aciertos de los hombres heterosexuales fueron estadísticamente significativos respecto a los puntajes de las mujeres heterosexuales en fluidez figural. Las características creativas expresadas de diferente manera entre orientaciones sexuales son promovidas por propiedades creativas relacionadas al pensamiento divergente. Las diferencias en funciones ejecutivas indican estilos cognitivos eficientes para los grupos.

Este trabajo se desarrolló en el volcán Ajusco, D. F., en áreas con cuatro tratamientos de quemas prescritas (combinaciones de quemas en marzo y mayo a baja y alta intensidad), así como un testigo no quemado, donde se plantaron árboles de dos calidades (planta grande y planta chica) de Pinus hartwegii Lindl. Éstos fueron evaluados a seis meses de la plantación en supervivencia, diámetro, biomasa y concentración foliar de nitrógeno, fósforo y potasio. Se halló que las quemas prescritas en marzo a baja intensidad, no afectaron negativamente la supervivencia de los árboles, y representaron ventaja en términos de biomasa. La planta grande presentó mayores concentraciones de potasio al cabo de seis meses, lo que aunado a su mayor porte la hace particularmente apta para ambientes con bajas temperaturas y limitaciones de humedad.

Se describe Aristolochia chiapensis, una liana que habita la vegetación secundaria derivada de selva alta perennifolia. Esta planta crece a orillas de ríos o lagos de la parte nororiental del estado de Chiapas, principalmente en la región de la Selva Lacandona. El nuevo taxon pertenece a un grupo de especies estrechamente relacionadas ( Aristolochia asclepiadifolia Brandg., A. paracleta Pfeifer, A. steyermarkii Standl., A. veracruzana Ortega), con las que comparte la presencia de tres lóbulos estigmáticos y seis estambres unidos en un ginostemo. Sin embargo, se diferencia de los demás componentes de este conjunto por la inflorescencia, el cáliz y lóbulo central del limbo de mayor tamaño, así como por la coloración blanquecina y la superficie rugosa en el interior del utrículo del cáliz.

Aristolochia pueblana, se describe como una nueva especie del Valle de Tehuacán, Puebla. Es una hierba procumbente, con un cáliz recto linear de 2-4 cm de largo, estrechamente relacionada con A. islandica Pfeifer y con A. nana Watson.

SARS-CoV-2 disease 2019 (COVID-19) is highly contagious and spreads rapidly. The application of preventive measures has proven to be the best strategy to minimize the number of patients and the dissemination of and deaths from COVID-19. The objective of this study was to determine the risk factors that limit the adherence of asthmatic patients to measures that prevent COVID-19 among residents of a region with a high risk of a COVID-19 outbreak. Through a cross-sectional study, data from 2,372 participants aged 16-24 years were analyzed. To collect their information, a questionnaire was constructed using the Google Forms tool. Due to the prevention measures in place for COVID-19, the home quarantine of many people, and the lack of socialization, the questionnaire was distributed through email (Internet) and WhatsApp. A logistic regression analysis was performed to determine the relationship between the variables. The prevalence of asthma was 12.2%, and non-adherence to the guidelines for the prevention of COVID-19 was 53.1%. Approximately 30.8% of asthma patients did not comply with the basic prevention measures for COVID-19. The results of the logistic regression analysis showed that being male, active smoking, and believing that COVID-19 is not a more severe disease for people suffering from asthma than others were associated with non-adherence to the basic protection measures established in the guidelines for the prevention of COVID-19. It is important for health professionals to advise asthma patients to comply with the basic measures of protection against COVID-19 and timely use medications for asthma control. [ABSTRACT FROM AUTHOR]

The article discusses on the participation of Spanish civil researches and military veterinarians in BIOMEX Space Experiment (Biology and Mars Experiment ILSRA 2009-0834) with the European Space Agency (ESA). Topics discussed including study of the survival and degradation of extremophilic organisms (lichens among others) in space, Circinaria gyrosa's photosynthetic activity and to study of resistance of life to space conditions.

Abstract Oceanic volcanic islands have a complex internal structure due to their geological evolution. La Palma is the second youngest in the Canary Islands. Historical eruptions occurred in the Cumbre Vieja (CV) volcanic system, including the last 2021 Tajogaite eruption. The seismicity before, during, and after the Tajogaite eruption provides valuable information for a better understanding of deep volcanic processes. We applied the receiver function technique to image the crustal and upper mantle structures beneath the CV volcanic complex. We investigated the first 50 km of the lithosphere, identifying various seismic discontinuities. After a thin layer of recent volcanic rocks, we found a layer corresponding to the old oceanic crust. Beneath the Moho, we found a significant decrease in the seismic velocities until about 37 km of depth. This low‐velocity layer corresponds to a zone of partial melting with interconnected magmatic chambers that feed the volcanic activity in CV.

La prematurez (PM) neonatal es un problema mayor de salud pública en el mundo, debido a su frecuencia de presentación y los años de vida potencialmente perdidos; además, es la principal causa de muerte en menores de cinco años. Entre las consecuencias negativas de la PM están las discapacidades del aprendizaje, visual y auditiva. Múltiples son los factores asociados a la PM; algunos pueden ser detectados y modificados de forma oportuna en las consultas prenatales y también, en las preconcepcionales. Por otro lado, la PM no es solamente responsabilidad del prestador de los servicios de salud, sino también del sistema de salud, el cual, debe otorgar los recursos mínimos necesarios para monitorear y mantener a la embarazada en un estado óptimo de salud para evitarla, y en caso de presentarse, debe contar con la infraestructura hospitalaria básica que permita la viabilidad del producto y evitar su muerte. Aunado a lo anterior, se debe de considerar la responsabilidad de la paciente y su pareja, debido a que en ellos recae la obligación de llevar un estilo de vida saludable y acudir a las consultas preconcepcionales y control prenatal.

Summary: Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Funding: Bill & Melinda Gates Foundation.

Actualmente, en el noreste de la Península Ibérica, se conocen muy pocos restos humanos pertenecientes a las primeras comunidades agricultoras y pastoriles de inicios del neolítico. Buena parte de las evidencias que tenemos provienen de contextos arqueológicos excavados con anterioridad a los años 80, lo que supone que no se dispone del mismo acerbo de análisis que se realizan en la actualidad. La excavación realizada en Ca lEstrada viene a rellenar en parte ese vacío aportando no sólo dos nuevos enterramientos, sino también toda una serie de análisis tanto del continente como del contenido de las sepulturas. Su estudio nos ha permitido conocer biológicamente a dos de los sujetos protagonistas de aquella su historia, cómo fueron inhumados y qué objetos les acompañaban. Estamos, sin duda, ante una de las primeras evidencias funerarias de lo que ha venido a denominarse como la Cultura de los Sepulcros de fosa.

Purpose: Mental fatigue has been shown to impair subsequent physical performance in continuous and discontinuous exercise. However, its influence on subsequent fine-motor performance in an applied setting (e.g., marksmanship for trained soldiers) is relatively unknown. The purpose of this study was to investigate whether prior mental fatigue influences subsequent marksmanship performance as measured by shooting accuracy and judgment of soldiers in a live-fire scenario.Methods: Twenty trained infantry soldiers engaged targets after completing either a mental fatigue or control intervention in a repeated measure design. Heart rate variability and the NASA-TLX were used to gauge physiological and subjective effects of the interventions. Target hit proportion, projectile group accuracy, and precision were used to measure marksmanship accuracy. Marksmanship accuracy was assessed by measuring bullet group accuracy (i.e., how close a group of shots are relative to center of mass) and bullet group precision (i.e., how close are each individual shot to each other). Additionally, marksmanship decision accuracy (correctly shooting vs. correctly withholding shot) when engaging targets was used to examine marksmanship performance.Results: Soldiers rated the mentally fatiguing task (59.88 ± 23.7) as having greater mental workload relative to the control intervention [31.29 ± 12.3, t(19) = 1.72, p < 0.001]. Additionally, soldiers completing the mental fatigue intervention (96.04 ± = 37.1) also had lower time-domain (standard deviation of normal to normal R-R intervals) heart rate variability relative to the control [134.39 ± 47.4, t(18) = 3.59, p < 0.001]. Projectile group accuracy and group precision failed to show differences between interventions [t(19) = 0.98, p = 0.34, t(19) = 0.18, p = 0.87, respectively]. Marksmanship decision errors significantly increased after soldiers completed the mental fatigue intervention (48% ± 22.4) relative to the control intervention [M = 32% ± 79.9, t(19) = 4.39, p < 0.001]. There was a significant negative correlation between shooting response time and errors of commission (r = −0.61; p = 0.004) when preceded by the mental fatigue intervention, but not the control (r = −0.31; p = 0.17).Conclusion: The mental fatigue intervention was successful in eliciting fatigue which was supported subjectively and objectively. Marksmanship judgment performance is significantly reduced when soldiers are mentally fatigued, although shot accuracy is not.

Resumen Los schwannomas o neurilemomas son los tumores benignos más comunes en los nervios periféricos y representan el 5% de todos los tumores de la extremidad superior. Por su parte, el schwannoma del nervio mediano tiene una incidencia de entre el 0.1 al 0.3 % de todos los tumores de la mano. Presentamos el caso de un paciente varón con schwannoma del nervio mediano con compromiso neurológico asociado a masa de crecimiento progresivo en túnel carpiano derecho; mostramos el proceso de diagnóstico clínico, radiológico y el tratamiento quirúrgico instaurado para realizar resección completa y preservación funcional, con diagnóstico anatomopatológico definitivo de schwannoma del nervio mediano. Teniendo en cuenta lo infrecuente de esta patología, realizamos también una revisión de la literatura al respecto.

The TAR DNA Binding Protein 43 (TDP-43) has been implicated in the pathogenesis of human neurodegenerative diseases and exhibits hallmark neuropathology in amyotrophic lateral sclerosis (ALS). Here, we explore its tractability as a plasma biomarker of disease and describe its localization and possible functions in the cytosol of platelets. Novel TDP-43 immunoassays were developed on three different technical platforms and qualified for specificity, signal-to-noise ratio, detection range, variation, spike recovery and dilution linearity in human plasma samples. Surprisingly, implementation of these assays demonstrated that biobank-archived plasma samples yielded considerable heterogeneity in TDP-43 levels. Importantly, subsequent investigation attributed these differences to variable platelet recovery. Fractionations of fresh blood revealed that ≥ 95% of the TDP-43 in platelet-containing plasma was compartmentalized within the platelet cytosol. We reasoned that this highly concentrated source of TDP-43 comprised an interesting substrate for biochemical analyses. Additional characterization of platelets revealed the presence of the disease-associated phosphoserine 409/410 TDP-43 proteoform and many neuron- and astrocyte-expressed TDP-43 mRNA targets. Considering these striking similarities, we propose that TDP-43 may serve analogous functional roles in platelets and synapses, and that the study of platelet TDP-43 might provide a window into disease-related TDP-43 dyshomeostasis in the central nervous system., (© 2024. The Author(s).)

Objective : We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods : In this retrospective single-center case-control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results : We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66-4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32-49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02-8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09-3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions : HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight.

Fat emboli may occur in patients after traumatic fractures or orthopedic procedures; however, their clinical detection is a very rare finding. Here, we describe a 77-year-old female who was admitted to the emergency department with a fracture of the right humerus. We diagnosed fat embolism after an ultrasound of the right subclavian vein. The embolism was detected by high-intensity transient signals present on the spectral Doppler. While these signals are well known for microembolization in transcranial Doppler, to our knowledge this is the first case report in the medical literature to observe and describe high-intensity transient signals seen in the upper extremities by spectral Doppler. Although it is unusual to detect a fat embolism in transit, we believe clinicians should be aware of this finding, particularly when evaluating high-risk patients., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Objective: To assess menopausal symptoms and determine awareness of menopausal related information in mid-aged women., Methods: This was a cross-sectional study in which 140 women aged 40 to 60 years from Guayaquil, Ecuador were surveyed with the short 10-item Cervantes Scale (CS-10) and a questionnaire containing personal data and questions assessing awareness of menopause related information., Results: The mean age of the sample was 48.0 ± 5.6 years. More than half of surveyed women had low education and non-urban residency, none were on menopausal hormone therapy, 33.6% had hypertension, 35% were postmenopausal, 78.6% had an increased body mass index (overweight/obese) and 92.9% had abdominal obesity (waist > 88 cm). The average CS-10 score was 15.3 ± 9.0 with a median of 14.0. The three most frequent menopausal symptoms were muscle-joint pain (75.0%), changes in skin texture (74.3%) and vaginal dryness (71.4%). Regarding awareness of information related to the menopause, it was found that 98.6% of women had no idea about what the menopause is and the average age of its onset. Interestingly, although 61.4% knew that during the menopause there is weight gain, 57.9% were sedentary. Married, postmenopausal, older and less educated women presented higher mean total CS-10 scores. Contrarily, those with less awareness of menopause related information present lower scores., Conclusion: In this low-income mid-aged female sample there was a high rate of non-awareness regarding information related to the menopause, including an unhealthy cardiometabolic profile. There is a need for educational programs aimed to increase awareness in this high-risk population in relation to the surveyed aspects in order to improve their health status and prevent chronic conditions.

Objective: There are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert's consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth., Design: Systematic review and three-stage modified Delphi expert consensus., Setting: International., Population: Panel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance., Outcome Measures: Agreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth., Results: Experts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman's haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman's haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach., Conclusion: These agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step., Competing Interests: Competing interests: Disclosure forms provided by the authors are available with the full text of this article., (© World Health Organization 2024. Licensee BMJ.)

Cardiac surgery requiring cardiopulmonary bypass is associated with postoperative acute kidney injury and neurocognitive disorders, including delirium. Intra-operative inflammation and/or impaired tissue perfusion/oxygenation are thought to be contributors to these outcomes. It has been hypothesised that these problems may be ameliorated by the highly selective α 2 -agonist, dexmedetomidine. We tested the effects of dexmedetomidine on renal and cerebral microcirculatory tissue perfusion, oxygenation and histology in a clinically relevant ovine model. Sixteen sheep were studied while conscious, after induction of anaesthesia and during 2 h of cardiopulmonary bypass. Eight sheep were allocated randomly to receive an intravenous infusion of dexmedetomidine (0.4-0.8 μg.kg -1 .h -1 ) from induction of anaesthesia to the end of cardiopulmonary bypass, and eight to receive an equivalent volume of matched placebo (0.9% sodium chloride). Commencement of cardiopulmonary bypass decreased renal medullary tissue oxygenation in the placebo group (mean (95%CI) 5.96 (4.24-7.23) to 1.56 (0.84-2.09) kPa, p = 0.001), with similar hypoxic levels observed in the dexmedetomidine group (6.33 (5.33-7.07) to 1.51 (0.33-2.39) kPa, p = 0.002). While no differences in kidney function (i.e. reduced creatinine clearance) were evident, a greater incidence of histological renal tubular injury was observed in sheep receiving dexmedetomidine (7/8 sheep) compared with placebo (2/8 sheep), p = 0.041. Graded on a semi-quantitative scale (0-3), median (IQR [range]) severity of histological renal tubular injury was higher in the dexmedetomidine group compared with placebo (1.5 (1-2 [0-3]) vs. 0 (0-0.3 [0-1]) respectively, p = 0.013). There was no difference in cerebral tissue microglial activation (neuroinflammation) between the groups. Dexmedetomidine did not reduce renal medullary hypoxia or cerebral neuroinflammation in sheep undergoing cardiopulmonary bypass., (© 2023 Association of Anaesthetists.)

Rationale: Indoor pollutants have been associated with chronic obstructive pulmonary disease morbidity, but it is unclear whether they contribute to disease progression. Objectives: We aimed to determine whether indoor particulate matter (PM) and nitrogen dioxide (NO 2 ) are associated with lung function decline among current and former smokers. Methods: Of the 2,382 subjects with a history of smoking in SPIROMICS AIR, 1,208 participants had complete information to estimate indoor PM and NO 2 , using individual-based prediction models, in relation to measured spirometry at two or more clinic visits. We used a three-way interaction model between time, pollutant, and smoking status and assessed the indoor pollutant-associated difference in FEV 1 decline separately using a generalized linear mixed model. Measurements and Main Results: Participants had an average rate of FEV 1 decline of 60.3 ml/yr for those currently smoking compared with 35.2 ml/yr for those who quit. The association of indoor PM with FEV 1 decline differed by smoking status. Among former smokers, every 10 μg/m 3 increase in estimated indoor PM was associated with an additional 10 ml/yr decline in FEV 1 ( P  = 0.044). Among current smokers, FEV 1 decline did not differ by indoor PM. The results of indoor NO 2 suggest trends similar to those for PM ⩽2.5 μm in aerodynamic diameter. Conclusions: Former smokers with chronic obstructive pulmonary disease who live in homes with high estimated PM have accelerated lung function loss, and those in homes with low PM have lung function loss similar to normal aging. In-home PM exposure may contribute to variability in lung function decline in people who quit smoking and may be a modifiable exposure.

Introduction: Strokes continue to be considered public health problems due to the great social and health impact they entail. They are the second cause of death in the world, with a high incidence and prevalence. They are time-dependent diseases, and more than 80% of cases could be avoidable with greater management of risk factors., Objective: to analyze the factors that influence prehospital time in a stroke code. Assess the population's knowledge of stroke symptoms and teach them how to act when a case is suspected. Document the continued training of health professionals for the early identification of patients with a suspected stroke. Demonstrate the importance of calling EMS as the first contact to reduce delays in prehospital time in a stroke., Methodology: A bibliographic review was carried out focusing on articles published between December 2014 and August 2023. The following databases were consulted: Pubmed (Medline), Dialnet, Google Scholar, Web of Science (WOS), Scielo, Scopus, and ScienceDirect., Results: After applying the article selection criteria and evaluating the quality of the methodology, a total of 18 articles were obtained. The results affirm that the importance of achieving a reduction in prehospital time is based mainly on knowledge of the symptoms and the use of new technologies., Conclusions: The evidence supports that the prehospital time of action in the stroke code is affected by numerous factors. These factors are determining factors in the time of action to achieve good effectiveness in the treatment of the pathology.

While macrophage phagocytosis is an immune defense mechanism against invading cellular organisms, cancer cells expressing the CD47 ligand send forward signals to repel this engulfment. Here we report that the reverse signaling using CD47 as a receptor additionally enhances a pro-survival function of prostate cancer cells under phagocytic attack. Although low CD47-expressing cancer cells still allow phagocytosis, the reverse signaling delays the process, leading to incomplete digestion of the entrapped cells and subsequent tumor hybrid cell (THC) formation. Viable THCs acquire c-Myc from parental cancer cells to upregulate both M1- and M2-like macrophage polarization genes. Consequently, THCs imitating dual macrophage features can confound immunosurveillance, gaining survival advantage in the host. Furthermore, these cells intrinsically express low levels of androgen receptor and its targets, resembling an adenocarcinoma-immune subtype of metastatic castration-resistant prostate cancer. Therefore, phagocytosis-generated THCs may represent a potential target for treating the disease., (© 2023. Springer Nature Limited.)

Objective: Non-cirrhotic portal vein cavernoma (PVC) is a cause of portal hypertension (PH) frequently affecting women of childbearing age. Cavernous transformation of the portal vein is frequently associated with prothrombotic disorders and often entails multiple hemodynamic changes, porto-collateral shunt development and thrombopenia, all of which can affect the course of pregnancy. Our aim was to evaluate the risk of PH-related complications and pregnancy outcomes in patients with PVC., Methods: Retrospective case series study of patients with PVC undergoing pregnancy in a tertiary care hospital., Results: Eight pregnancies fulfilled the eligibility criteria. All patients had a predisposing factor for PVC. One episode of variceal bleeding was reported at week 28. Six cesarean sections were scheduled to avoid labor while two urgent surgeries were indicated due to fetal distress and intrauterine growth restriction (IUGR). In all but one case, anticoagulation was prescribed after delivery. No hemorrhagic or thrombotic complications were reported. There were four cases of IUGR with no case of miscarriage or stillbirth., Conclusion: Pregnancy in patients with PVC has an overall favorable outcome albeit a higher risk of PH-derived complications, and IUGR may be expected. Hence, PVC must not be considered a contraindication for pregnancy although larger prospective studies are necessary., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

In this paper, the performance of ladle furnace slag (LFS), a by-product of secondary steel refining, is evaluated as a binder to stabilize clayey soils of low bearing capacity. The aim is to define whether additions of this by-product to clayey soil can stabilize the soil in accordance with the technical specifications of Spanish standards. To do so, three different soils stabilized with 5% LFS were compared with the same soils stabilized with 2% lime and with no stabilization, in order to investigate their different behaviors. The chemical and mineralogical characterizations of all the soil mixes were conducted using X-ray fluorescence, X-ray diffraction, and scanning electron microscopy. The Atterberg limit test was used to study the plastic behavior of the soils, and the results of compaction, bearing capacity, unconfined compressive strength, and direct shear strength (cohesion and friction angle) tests defined their strength characteristics. The analysis was completed with the pH monitoring of the mixes along the curing time in order to relate the pH changes with the strength evolution. The addition of LFS to the soils has resulted in an increase in the liquid limit and plastic limit, causing therefore a slight decrease in the plasticity index. All the soils showed increases between 30% and 70% in their California Bearing Ratios immediately after mixing with 5% LFS, and after 90 days of curing, improvements of 30-188% in their unconfined compressive strength were noted in comparison with untreated soil, which were higher than the lime-stabilized soils. The cohesion of soils stabilized with LFS at 28 days of curing obtained improvements ranging from 40 to 300% depending on the type of soil. However, the friction angle showed a slight increase of 10% in two of the soils and zero in another. The high initial pH in LFS-stabilized soils was maintained during the curing time, which favored the development of pozzolanic reactions that improve the soil strength. These results confirmed that the substitution of lime with LFS is a feasible option for soil stabilization., (© 2023. The Author(s).)

On Sept. 19th, 2021, a volcanic eruption began on the island of La Palma (Canary Islands, Spain). The pre-eruptive episode was characterized by seismicity and ground deformation that started only 9.5 days before the eruption. In this study, we applied seismic interferometry to the data recorded by six broadband seismic stations, allowing us to estimate velocity variations during the weeks preceding the eruption. About 9.5 days before the eruption, we observed a reduction in the seismic velocities is registered next to the eruptive centers that opened later. Furthermore, this zone overlaps with the epicenters of a cluster of volcano-tectonic earthquakes located at shallow depth (< 4 km) and detached from the main cluster of deeper seismicity. We interpret the decrease in seismic velocities and the occurrence of such a shallow earthquake cluster as the effect of hydrothermal fluid released by the ascending magma batch and reaching the surface faster than the magma itself., (© 2023. The Author(s).)

Objective: To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses., Methods: A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed., Results: Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05)., Conclusion: The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks., (© 2022 International Federation of Gynecology and Obstetrics.)