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Fuel cell hybrid electric vehicles employ fuel cells along with batteries or ultracapacitors as power sources, and energy management systems can control their power split. This study investigates energy management strategies for lightweight plug-in extended-range fuel cell hybrid electric vehicles to optimise fuel economy, extend component lifespans, and enhance vehicle efficiency. Comparisons between power follower and dynamic programming-based strategies are conducted, focusing on incorporating PEMFC health constraints to prolong stack durability via on-off binary mode operation. Using the New European Driving Cycle, performance evaluation is conducted on a parallel architecture featuring a 16-kW motor, regenerative braking system, eight 420-Wh batteries in series, and six 1-kW fuel cell stacks. Dynamic programming strategies demonstrated potential improvements, with savings in hydrogen consumption of 62–72 L per driving cycle and SOC levels of 3.9%. Moreover, optimised battery lifespan enabled the system to achieve approximately 18,087 -18,745 charge/discharge cycles. Implementing PEMFC health constraints facilitated reductions in average accumulated active time to 205 seconds per driving cycle and startup/shutdown cycle frequency to 36.5 cycles per hour, promoting enhanced system durability and operational efficiency.

The impact of climate change has made weather events more extreme, unpredictable and frequent. In the last 4 years, Mozambique has been devastated by 8 major cyclones, resulting in material and human damage and affecting the functioning of basic local services, such as in the water and health sectors. In this study, we explored the environmental components of the climate–water quality–disease relationship that could drive the dynamics of waterborne diseases. Statistical models and geospatial information technologies (GITs) were used to analyse water quality and the relationship with waterborne diseases between 2016 and 2023. Results indicate that water quality is the main element, between precipitation natural disasters and waterborne diseases, on which a relevant public health intervention can act to ameliorate the future negative impacts of climate change and disease incidence. The results of this study also showed that the quality of water affected mainly by heavy rain events varies in different regions and in different seasons.

BackgroundTuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. ObjectiveThis study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. MethodsThe platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. ResultsThe platform’s usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3%-28.2%) but high specificity (91.1%-98.2%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification (χ21>20.38, P

Characterization of the diameter distribution of forest stands managed for timber production provides accurate estimates of existing wood volume by diameter class and area unit. It provides the basis for determining the stand's ecological and economic value, its structure, the potential for ecosystem services, and appropriate management practices. Patula pine is one of the most important conifers in southern Mexico and requires biometric tools to improve management strategies. This study aimed to use the Bayesian approach to estimate the parameters of Johnson's SB (JSB) and Weibull (W) probability density functions (pdf) and to model the diameter distribution of patula pine stands in southern Mexico. We used data from 462 diameter distributions derived from 66 permanent 400 m2 sampling plots. The results indicated that the Bayesian approach was appropriate for estimating the JSB and W pdf parameters. Due to the similarity between the nonparametric tests and the goodness-of-fit statistics of the functions, the graphical analysis helped to select the W function as the better option to adequately model the diameter distribution of the analyzed stands. The equations developed for parameter prediction of the W function with stand variables allowed us to characterize and project the theoretical distribution of diameter classes in a simple accurate way with variables easily obtained from forest inventories. The Bayesian approach proved to be an effective method for estimating the pdf parameters used. This allowed for the correct characterization of the observed diameter distribution, and its implementation was easy for executing the procedure. Diameter distribution models are a powerful tool for forest inventory and management of patula pine stands analyzed in southern Mexico.

Physical changes in the tumor microenvironment, such as increased stiffness, regulate cancer hallmarks and play an essential role in gene expression, cell morphology, migration, and malignancy. However, the response of cancer cells to stiffness is not homogeneous and varies depending on the cell type and its mechanosensitivity. In this study, we investigated the differential responses of cervical (HeLa) and prostate (PC-3) cancer cell lines, as well as non-tumoral cell lines (HEK293 and HPrEC), to stiffness using polyacrylamide hydrogels mimicking normal and tumoral tissues. We analyzed cell morphology, migration, and the expression of neuropilin 1 (NRP1), a receptor involved in angiogenesis, cell migration, and extracellular matrix remodeling, known to be associated with cancer progression and poor prognosis. Our findings reveal that NRP1 expression increases on substrates mimicking the high stiffness characteristic of tumoral tissue in the non-tumoral cell lines HPrEC and HEK293. Conversely, in tumoral PC-3 cells, stiffness resembling normal prostate tissue induces an earlier and more sustained expression of NRP1. Furthermore, we observed that stiffness influences cell spreading, pseudopodia formation, and the mode of cell protrusion during migration. Soft substrates predominantly trigger bleb cell protrusion, while pseudopodia protrusions increase on substrates mimicking normal and tumor-like stiffnesses in HPrEC cells compared to PC-3 cells. Stiffer substrates also enhance the percentage of migratory cells, as well as their velocity and total displacement, in both non-tumoral and tumoral prostate cells. However, they only improve the persistence of migration in tumoral PC-3 cells. Moreover, we found that NRP1 co-localizes with actin, and its suppression impairs tumoral PC-3 spreading while decreasing pseudopodia protrusion mode. Our results suggest that the modulation of NRP1 expression by the stiffness can be a feedback loop to promote malignancy in non-tumoral and cancer cells, contingent upon the mechanosensitivity of the cells.

Background: We examined the frequency and risk factors associated with readmission after left atrial appendage closure (LAAC) in patients with and without previous ischemic stroke and/or transient ischemic attack (TIA). Methods: Hospitalizations for LAAC were identified from the US National Readmission Database, 2016-2018. The primary outcome was the first unplanned readmission after LAAC, with readmission times stratified into those occurring within 0 to 30 days vs within 31 to 180 days. Patients were stratified based on the history of previous stroke and/or TIA. Results: Of 12,901 discharges after LAAC, 28% had previous stroke and/or TIA, and 8.2% had a readmission within 30 days while 18% had a readmission within 31 to 180 days. The rates of in-hospital complications and readmissions at both periods were not significantly different between individuals with vs without previous stroke and/or TIA. Cardiac causes accounted for 28% of readmissions within 30 days and 32% of those within 31 to 180 days, and congestive failure, bleeding, and infections were the most common readmission diagnoses. New stroke and/or TIA accounted for 4% and 6% of the total noncardiac readmissions within 30 days and 31 to 180 days, respectively, and the incidence was higher among those with previous stroke and/or TIA. Female sex and index hospitalization length of stay (LOS) > 1 day were factors independently associated with readmission within 30 days, whereas LOS, diabetes, renal disease, chronic obstructive pulmonary disease, and anemia were among the factors associated with readmissions within 31 to 180 days. Conclusions: Unplanned rehospitalizations were common after LAAC and had similar frequency for patients with vs without previous ischemic stroke and/or TIA. Female sex and index hospitalization LOS > 1 day were among the strongest factors that were independently associated with readmission within 30 days. Résumé: Contexte: Nous avons examiné la fréquence et les facteurs de risque des réadmissions consécutives à une fermeture de l'appendice auriculaire gauche (FAOG) chez les patients ayant ou non subi un accident vasculaire cérébral (AVC) ischémique et/ou un accident ischémique transitoire (AIT). Méthodologie: Les hospitalisations pour une FAOG ont été recensées au moyen de la US National Readmission Database (base de données nationale des réadmissions aux États-Unis) pour la période 2016-2018. Le critère d’évaluation principal était la première réadmission non prévue après une FAOG, avec stratification du moment de la réadmission selon que celle-ci était survenue de 0 à 30 jours ou de 31 à 180 jours après l’intervention. Les patients ont été stratifiés en fonction des antécédents d’AVC et/ou d’AIT. Résultats: Parmi les 12 901 patients ayant reçu leur congé de l’hôpital après une FAOG, 28 % avaient des antécédents d’AVC et/ou d’AIT; 8,2 % des patients admissibles ont été réadmis dans les 30 jours et 18 %, entre le 31e et le 180e jour suivant l’intervention. Aucune différence significative n’a été observée entre les patients ayant subi un AVC et/ou un AIT et les patients qui n’en avaient pas subi en ce qui concerne les taux de complications hospitalières et de réadmission durant ces deux périodes. Les causes cardiaques représentaient 28 % des réadmissions dans les 30 jours et 32 % des réadmissions entre le 31e et le 180e jour. L’insuffisance cardiaque congestive, les hémorragies et les infections ont été les causes les plus fréquentes de réadmission. Les nouveaux cas d’AVC et/ou d’AIT ont respectivement été à l’origine de 4 % et de 6 % de l’ensemble des réadmissions de cause non cardiaque dans les 30 jours, et entre le 31e et le 180e jour, et leur fréquence a été plus élevée chez les patients ayant des antécédents d’AVC et/ou d’AIT. Le sexe féminin et une durée d’hospitalisation initiale > 1 jour ont été des facteurs indépendants associés aux réadmissions dans les 30 jours, tandis que la durée de l’hospitalisation, un diabète, une néphropathie, une maladie pulmonaire obstructive chronique et une anémie faisaient partie des facteurs associés aux réadmissions entre le 31e et le 180e jour. Conclusions: Les réhospitalisations non prévues ont été courantes après une FAOG, et leur fréquence a été similaire en présence ou en l’absence d’antécédents d’AVC ischémique et/ou d’AIT. Le sexe féminin et une durée d’hospitalisation initiale > 1 jour ont été les facteurs les plus importants associés aux réadmissions dans les 30 jours.

Could the connectivity of a global railway network increase through small changes in the timetable services? When designing railway schedules, transfer connections to intermediate stations may not be the primary focus considered. However, they may have an important influence on connectivity. In this paper, we study the potential improvement in connections by introducing small changes to the current schedules, using real timetables from all international railway services in Europe. The modelling was completed using the Complex Networks methodology and performance was measured based on total closeness centrality. Various factors are considered to calibrate the necessary amendments to provide a better traveller service, including connection times at stations and different allowed levels of schedule changes. The results indicate that by changing the schedule of only 1% of the services by at most 10 min, the connectivity improvement is remarkable. Railway companies should consider this result in order to expand the potential use of the international railway service at a time when public transportation must be encouraged.

We analyzed 136 children with tuberculosis disease or infection and a positive QuantiFERON-TB (QFT) assay, followed-up for a median of 21 months (0.4-11years). QFT reversed in 16.9% of cases, with significant decreases in TB1 (-1.72 vs. -0.03 IU/ml, p=0.001) and TB2 (-1.65 vs. -0.43 IU/ml, p=0.005) levels compared to non-reverters. We found a higher QFT reversion rate among children under 5 years (25.0% vs 11.9%, p=0.042), and those with TST induration

Colonial imperialism tends to appear in Spanish Compulsory Secondary Education (ESO) very subordinated to other historical processes, without paying enough attention to it as an autonomous phenomenon. The subject of 1st year of Spanish upper secondary education (Baccalaureate) Contemporary World History is obliged to provide a broader and more monographic approach that allows a critical analysis of concepts such as “domination” or “racism”, usually condemned in ESO classrooms without further justification. To achieve our objective, we propose a didactic proposal centered on viewing a series of fragments from The Man Who Would Be King (John Huston, 1975), which will be preceded by the teacher’s explanations and followed by a series of activities designed to encourage debate and responsible skepticism.

Abstract Background It is known that SARS-CoV-2 antibodies from pregnant women with SARS-CoV-2 infection during pregnancy cross the placenta but the duration and the protective effect of these antibodies in infants is scarce. Methods This prospective study included mothers with SARS-COV-2 infection during pregnancy and their infants from April 2020 to March 2021. IgG antibodies to SARS-CoV-2 spike protein were performed on women and infants at birth and at two and six months during follow-up. Anthropometrical measures and physical and neurological examinations and a clinical history of symptoms and COVID-19 diagnosis were collected. Simple linear regression was performed to compare categorical and continuous variables. To compare the mother’s and infant’s antibody titers evolution, a mixed linear regression model was used. A predictive model of newborn antibody titers at birth has been established by means of simple stepwise linear regression. Results 51 mother-infant couples were included. 45 (90%) of the mothers and 44 (86.3%) of the newborns had a positive serology al birth. These antibodies were progressively decreasing and were positive in 34 (66.7%) and 7 (13.7%) of infants at 2 and 6 months, respectively. IgG titers of newborns at birth were related to mothers’ titers, with a positive moderate correlation (Pearson’s correlation coefficient: 0.82, p

Tomato (Solanum lycopersicum L.) is a crop that is affected by more than a hundred viral species. De la pera is a local varietal type of tomato that is very popular in southeastern Spain. However, it is highly susceptible to several viruses, such as Tomato yellow leaf curl virus (TYLCV), which is considered one of the most important diseases of tomato crops and is a limiting factor for production in both outdoor and protected crops, making it difficult to eradicate. This study shows the effect of gene introgression on the performance of traditional lines of De la pera by combining two genes that offer tolerance to TYLCV, Ty-1 and ty-5, on some yield and quality traits and on the antioxidant capacity of tomato fruits. Two pear tomato breeding families, UMH175 and UMH220, were evaluated. Four lines from each of the families with all homozygous combinations of the Ty-1 and ty-5 genes were studied. The results showed that the introgression of the ty-5 allele produced a slight negative effect on yield, mean fruit weight, total soluble solids, and titratable acidity, in contrast to Ty-1, which produced a large negative effect. None of the introgressions showed a negative effect on the antioxidant compounds. ty-5 is a promising gene for use in breeding programs.

Different levels of metabolizable energy (ME) and the inclusion of guanidinoacetic acid (GAA) in the diet of 53-week-old Lohmann LSL-CLASSIC hens were used to evaluate its effect on reproductive parameters, egg quality, intestinal morphology, and the immune response. Six diets were used in a 3 × 2 factorial design, with three levels of ME (2850, 2800, and 2750 kcal/kg), and with (0.08%) or without the inclusion of GAA. The addition of GAA to diets with low levels of ME increased (p < 0.05) egg production and egg mass. Moreover, hens fed with 2800 kcal/g without GAA had the highest concentration (p < 0.05) of serum interleukin IL-2, while those fed diets with the same amount of ME but supplemented with 0.08% GAA had the lowest concentration. Finally, the inclusion of 0.08% GAA increased (p < 0.05) the concentration of vascular endothelial growth factor (VEGF), regardless of the ME level in the diet. This study highlights the potential role of GAA in decreasing the energy level of ME (50–100 kcal/g) in the feeding of hens and in the modulation of specific immune responses. Further research is recommended to fully understand the mechanisms of action of GAA on the mechanism target of rapamycin and its relationship with the immune response.

Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn’s disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment.

According to World Health Organization estimates, more than 1 million patients aged less than 15 years develop tuberculosis (TB) each year worldwide. In some regions, up to 25% of new TB cases are caused by drug-resistant strains. Although Spain is considered a low-incidence country, several hundred children and adolescents develop TB each year. The importance of paediatric TB has been minimized for years due to the lack of microbiological confirmation in many patients and because these patients are not usually contagious. Nevertheless, in the past 15 years there have been major improvements in the epidemiological reporting of TB in children and adolescents, new immunodiagnostic tests have been developed, molecular methods that allow rapid microbiological diagnosis and detection of variants associated with drug resistance have become available, novel second-line antituberculosis drugs have been discovered, including for paediatric use, and the results of clinical trials have validated shorter courses of treatment for some patients. This document, developed by a group of experts from the Sociedad Española de Infectología Pediátrica and the Sociedad Española de Neumología Pediátrica, updates and complements the previous guidelines for the diagnostic and therapeutic management of children with TB in Spain based on the newly available scientific evidence. Resumen: Más de un millón de pacientes menores de 15 años desarrollan tuberculosis (TB) anualmente en el Mundo, según estimaciones de la Organización Mundial de Salud. La TB por cepas resistentes a los fármacos de primera línea alcanza al 25% de los nuevos casos en algunas regiones. Aunque España es considerada un país de baja incidencia, varios centenares de niños y adolescentes enferman de TB cada año. La importancia de la TB pediátrica ha sido minimizada durante años por la dificultad en confirmar el diagnóstico microbiológico y la escasa contagiosidad que asocia. Sin embargo, en los últimos 15 años, se han reportado mejoras relevantes en los informes epidemiológicos de la TB en niños y adolescentes, han surgido nuevos tests inmunodiagnósticos, se dispone de estudios de biología molecular que permiten un diagnóstico microbiológico y una identificación de mutaciones asociadas a resistencia rápidos, han surgido nuevos fármacos antituberculosos de segunda línea, también en pediatría, y se han publicado ensayos clínicos que validan tratamientos acortados en algunos pacientes. Este documento, realizado por un grupo de expertos de la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica, actualiza y complementa las recomendaciones previas para el manejo diagnóstico y terapéutico del niño con TB en España, en base a las nuevas evidencias científicas disponibles.

Abstract Background Invasive fungal disease (IFD) is a significant cause of morbimortality in children under chemotherapy or hematopoietic stem cell transplant (HSCT). The purpose of this study is to describe the changes in the IFD epidemiology that occurred in a Pediatric Hematology-Oncology Unit (PHOU) with an increasing activity over time. Methods Retrospective revision of the medical records of children (from 6 months to 18 years old) diagnosed with IFD in the PHOU of a tertiary hospital in Madrid (Spain), between 2006 and 2019. IFD definitions were performed according to the EORTC revised criteria. Prevalence, epidemiological, diagnostic and therapeutic parameters were described. Comparative analyses were conducted using Chi-square, Mann-Whitney and Kruskal-Wallis tests, according to three time periods, the type of infection (yeast vs mold infections) and the outcome. Results Twenty-eight episodes of IFD occurred in 27 out of 471 children at risk (50% males; median age of 9.8 years old, [IQR 4.9-15.1]), resulting in an overall global prevalence of 5.9%. Five episodes of candidemia and 23 bronchopulmonary mold diseases were registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met criteria for proven, probable and possible IFD, respectively. 71.4% of patients had a breakthrough infection, 28.6% required intensive care and 21.4% died during treatment. Over time, bronchopulmonary mold infections and breakthrough IFD increased (p=0.002 and p=0.012, respectively), occurring in children with more IFD host factors (p=0.028) and high-risk underlying disorders (p=0.012). A 64% increase in the number of admissions in the PHOU (p

Spatial structure refers to the horizontal and vertical arrangement of individual trees, and the most accurate way to describe it within a community is to characterize tree strata in terms of their dimensions. The aim of this study was to determine the horizontal and vertical structure of pure stands of Pinus ayacahuite Ehrenb. ex Schltdl., in forests of southern Mexico. Forest measurement data from 24 sample plots were used. For analysis of the horizontal structure, diameters within a range of 0.20 cm to 77 cm were used, while for the vertical structure, heights were from 0.09 m to 40.9 m. Non-parametric histograms and Kernel density methods were used in the analysis, and Fisher and Marron multimodality tests were performed. The homogeneity of the forest stands was determined by the coefficient of homogeneity, and the vertical and horizontal structures were described using the stratification proposed by Pretzsch. The results indicate that the horizontal structure corresponds to a diameter distribution with a reversed "J" shape in 79.2% of the sample plots, while 91.8% of the sites were classified as irregular with coefficients of homogeneity of 1.0 to 3.0. In the vertical structure, it was observed that the lower stratum predominated in 75% of the plots, while 25% had a higher concentration of individuals in the middle stratum. The upper stratum had accumulation percentages ranging from 1.3% to 33.3% but did not predominate in any of the plots. According to the multimodality tests, 50% of the plots present multimodality in the horizontal structure, while in the vertical structure this condition is present in 38% of the plots. Knowledge of the spatial structure of Pinus ayacahuite forest stands is essential to define silvicultural strategies that ensure the sustainable functioning of the ecosystem in terms of yield continuity and conservation.

Fructosyltransferases (FTs) are an important group of enzymes involved in the biosynthesis of fructans in some plants and in a large number of microorganisms. Several studies have shown that FTs play a key role in regulating the levels of fructan molecules during abiotic stress tolerance of certain plant species. Because of their diverse range of functional characteristics, efforts have increased to improve fructans applications in food quality and in added health benefits of plants. For these reasons, interest on the search for more direct and cost-effective routes to producing fructans have also increased. In this paper, we review recent research on plant FTs and summarize their role in the regulation of fructan biosynthesis and their use in producing fructans at an industrial scale. We also present the challenges and opportunities that FTs will present in the future.

The molecular mechanisms underlying metastasis in pheochromocytoma/paraganglioma (mPPGL) remain to be explored. Here, the authors perform genomic and immunogenomic profiling of mPPGL tumors and suggest potential biomarkers for risk of metastasis and immunotherapy response.

In this work, an exhaustive analysis of the partial discharges that originate in the bubbles present in dielectric mineral oils is carried out. To achieve this, a low-cost, high-resolution CMOS image sensor is used. Partial discharge measurements using that image sensor are validated by a standard electrical detection system that uses a discharge capacitor. In order to accurately identify the images corresponding to partial discharges, a convolutional neural network is trained using a large set of images captured by the image sensor. An image classification model is also developed using deep learning with a convolutional network based on a TensorFlow and Keras model. The classification results of the experiments show that the accuracy achieved by our model is around 95% on the validation set and 82% on the test set. As a result of this work, a non-destructive diagnosis method has been developed that is based on the use of an image sensor and the design of a convolutional neural network. This approach allows us to obtain information about the state of mineral oils before breakdown occurs, providing a valuable tool for the evaluation and maintenance of these dielectric oils.

La prevalencia de obesidad en adultos no es homogénea en el espacio, su concentración se vincula con el acceso de los individuos a un ambiente obesogénico. En el artículo se analiza la relación entre el incremento de obesidad en adultos y el ambiente alimentario no-saludable de los municipios de México. Se evalúa el efecto espacial a través de las condiciones municipales que incentivan este problema de salud. Los resultados indican que el ambiente alimentario no-saludable prevalece en los municipios de Colima, la península de Yucatán y el norte del país, donde se difunde su efecto negativo regionalmente.

Objetivo: Describir las interacciones de algunos estudiantes de dos programas de Medicina en Colombia relacionadas con el currículo oculto. Metodología: Estudio hermenéutico, que utilizó la etnografía y la teoría fundamentada, mediante la aplicación de observación participante en cinco escenarios de práctica y once entrevistas en profundidad. El análisis de los datos se hizo con codificación abierta, axial y selectiva, propias de la teoría fundamentada, lo que generó una matriz del paradigma. Resultados: Estudiar Medicina implica hacer parte de una jerarquía desde inspiradora hasta excesiva. La exigencia de la educación médica por formar un médico incansable e intachable, la competencia para ser admitido a cada rango y el miedo a equivocarse exacerban el funcionamiento negativo de la jerarquía médica. Esta jerarquía se basa en el poder del conocimiento que permite el maltrato. Lo anterior desencadena agotamiento, frustración, desinterés y afecta la ética profesional, aspectos que estropean al médico en formación. Conclusión: El currículo oculto determina la formación del médico más que el currículo formal. Reconocer y reflexionar sobre el currículo oculto desde la comunidad académica permite visibilizar, en futuras reformas curriculares, el papel que este desempeña

Tumour heterogeneity is one of the main characteristics of cancer and can be categorised into inter‐ or intratumour heterogeneity. This heterogeneity has been revealed as one of the key causes of treatment failure and relapse. Precision oncology is an emerging field that seeks to design tailored treatments for each cancer patient according to epidemiological, clinical and omics data. This discipline relies on bioinformatics tools designed to compute scores to prioritise available drugs, with the aim of helping clinicians in treatment selection. In this review, we describe the current approaches for therapy selection depending on which type of tumour heterogeneity is being targeted and the available next‐generation sequencing data. We cover intertumour heterogeneity studies and individual treatment selection using genomics variants, expression data or multi‐omics strategies. We also describe intratumour dissection through clonal inference and single‐cell transcriptomics, in each case providing bioinformatics tools for tailored treatment selection. Finally, we discuss how these therapy selection workflows could be integrated into the clinical practice.

Hard ticks are a problem of great importance in the national livestock industry due to their capacity to be vectors of diseases that affect the productivity of animals and humans, becoming an arthropod of veterinary-medical importance. The methods used for their control have not been efficient; therefore, different integrated control alternatives have become crucial to mitigate their population growth. Products such as calcium polysulfide have shown to be an effective alternative in controlling mite populations. The present study was carried out at the Center for Research and Breeding of Natural Enemies of the University of Caldas using nymphs of Amblyomma cajennense, arranged in Petri dishes and sprayed with an average volume of calcium polysulfide of 1.3ml. From there, the lethal concentration of calcium polysulfide at 31.5°B, on the individuals of this species was determined. The evaluations were carried out at 24, 48 and 96h after application, finding, by Probit analysis, Cl50 of 1.05% and Cl95 of 1.35% concentration of the product, which indicates that this compound has the potential to be used in the integrated management plan of A. cajennense.

El presente artículo comienza por glosar la importancia que para la historia de la gramaticografía tiene la publicación por vez primera de una gramática hebrea escrita en español. A continuación, se propone aclarar cuándo y dónde fue compuesto el Arte hebraispano. Precisar estos datos importa para valorar adecuadamente la iniciativa de Martín del Castillo de redactar su obra en español. Para cumplir este objetivo, el artículo se sirve de algunos datos biográficos que figuran en las obras impresas de Del Castillo y de los que consigna un manuscrito que se guarda en el Archivo General de Indias que contiene un resumen de su vida académica y en el que hasta ahora no se había reparado.

Background and objectiveDimethyl fumarate (DMF) is an immunomodulatory drug approved for the therapy of multiple sclerosis (MS). The identification of response biomarkers to DMF is a necessity in the clinical practice. With this aim, we studied the immunophenotypic and transcriptomic changes produced by DMF in peripheral blood mononuclear cells (PBMCs) and its association with clinical response.Material and methodsPBMCs were obtained from 22 RRMS patients at baseline and 12 months of DMF treatment. Lymphocyte and monocyte subsets, and gene expression were assessed by flow cytometry and next-generation RNA sequencing, respectively. Clinical response was evaluated using the composite measure “no evidence of disease activity” NEDA-3 or “evidence of disease activity” EDA-3 at 2 years, classifying patients into responders (n=15) or non-responders (n=7), respectively.ResultsIn the whole cohort, DMF produced a decrease in effector (TEM) and central (TCM) memory T cells in both the CD4+ and CD8+ compartments, followed by an increase in CD4+ naïve T cells. Responder patients presented a greater decrease in TEM lymphocytes. In addition, responder patients showed an increase in NK cells and were resistant to the decrease in the intermediate monocytes shown by non-responders. Responder patients also presented differences in 3 subpopulations (NK bright, NK dim and CD8 TCM) at baseline and 4 subpopulations (intermediate monocytes, regulatory T cells, CD4 TCM and CD4 TEMRA) at 12 months. DMF induced a mild transcriptional effect, with only 328 differentially expressed genes (DEGs) after 12 months of treatment. The overall effect was a downregulation of pro-inflammatory genes, chemokines, and activators of the NF-kB pathway. At baseline, no DEGs were found between responders and non-responders. During DMF treatment a differential transcriptomic response was observed, with responders presenting a higher number of DEGs (902 genes) compared to non-responders (189 genes).ConclusionsResponder patients to DMF exhibit differences in monocyte and lymphocyte subpopulations and a distinguishable transcriptomic response compared to non-responders that should be further studied for the validation of biomarkers of treatment response to DMF.

Utilizing JWST MIRI/Medium Resolution Spectrograph integral field unit observations of the kiloparsec-scale central regions, we showcase the diversity of ionized gas distributions and kinematics in six nearby Seyfert galaxies included in the GATOS survey. Specifically, we present spatially resolved flux distribution and velocity field maps of six ionized emission lines covering a large range of ionization potentials (15.8–97.1 eV). Based on these maps, we showcase the evidence of ionized gas outflows in the six targets, and find some highly disturbed regions in NGC 5728, NGC 5506, and ESO137-G034. We propose active galactic nucleus (AGN)-driven radio jets plausibly play an important role in triggering these highly disturbed regions. With the outflow rates estimated based on [Ne V ] emission, we find the six targets tend to have ionized outflow rates converged to a narrower range than the previous finding. These results have an important implication for the outflow properties in AGN of comparable luminosity.

Lattice polarons, quasiparticles arising from the interaction between an impurity and its surrounding bosonic environment confined to a lattice system, have emerged as a platform for generating complex few-body states, probing many-body phenomena, and addressing long-standing problems in physics. In this study, we employ a variational ansatz to investigate the quasiparticle and spectral properties of an impurity coupled to a condensate gas of hard-core bosons in a two-dimensional optical lattice. Our findings demonstrate that the polaron features can be tuned by adjusting the filling factor of the bath, revealing intriguing polaron characteristics in the strongly interacting regime. These results offer valuable insights for lattice polaron experiments with ultracold gases and can serve as a guide for new experiments in emergent quantum devices, such as moiré materials, where optical excitations can be described in terms of hard-core bosons.

Stable water isotopes are widely recognised as essential tools to trace processes within the hydrological cycle and to disentangle complex phenomena, such as regional–local atmospheric patterns, infer water balances or characterise the aquifer recharge. In this work, we characterised two post-summer precipitation events over the western sector of Sierra de Gádor through the analysis of the rainwater δ18O and δ2H ratios, ionic composition and, complementarily, remote sensing products to define the atmospheric circulation during the rainfall episodes. This information enabled us to discern the moisture source, formation conditions and orographic influence on the rain episodes, and to better define the origin of the groundwater recharge and its dynamics in the study area. Although the samples share a common moisture source (W Mediterranean), they display substantial differences in their isotopic compositions. Such differences are attributable to sub-cloud evaporation processes that mask their Mediterranean origin, and to the strong influence of the orography on the hydrochemical and isotopic characteristics of the rainfall at the local level. The groundwater presents a very stable isotopic content and is strongly depleted in heavy isotopes, evidencing that most of the aquifer recharge takes place at very high altitudes and primarily during winter, when the influence of evaporation is attenuated.

Health problems in older adults lead to situations where communication with peers, family and caregivers becomes challenging for seniors; therefore, it is necessary to use alternative methods to facilitate communication. In this context, Augmentative and Alternative Communication (AAC) methods are widely used to support this population segment. Moreover, with Artificial Intelligence (AI), and specifically, machine learning algorithms, AAC can be improved. Although there have been several studies in this field, it is interesting to analyze common phrases used by seniors, depending on their context (i.e., slang and everyday expressions typical of their age). This paper proposes a semantic analysis of the common phrases of older adults and their corresponding meanings through Natural Language Processing (NLP) techniques and a pre-trained language model using semantic textual similarity to represent the older adults’ phrases with their corresponding graphic images (pictograms). The results show good scores achieved in the semantic similarity between the phrases of the older adults and the definitions, so the relationship between the phrase and the pictogram has a high degree of probability.

El juego de ficción, aquel que comporta la creación de una situación imaginaria, ha sido un objeto de estudio privilegiado en la psicología del desarrollo y se ha señalado su rol en el desarrollo de funciones psicológicas complejas. Recientemente, gracias a la utilización de herramientas de análisis de las artes temporales, se ha documentado una nueva forma de juego, el juego con las formas de la vitalidad, cuyo foco es la repetición y variación de motivos sonoro-kinéticos de modo interactivo, en detrimento de cualquier contenido figurativo. Se ha observado que durante el tercer año de vida este tipo de juego se presenta de modo combinado con el juego de ficción y que en esos casos podría ser parte del andamiaje del desarrollo del juego de ficción. El objetivo del presente estudio fue realizar un microanálisis de los sonidos y movimientos de una escena de juego de ficción combinado con juego con las formas de la vitalidad de una niña de 1 año y 11 meses de edad, con el fin de conocer cómo se produce dicho andamiaje. Entre los resultados se destacan la presencia de sincronía interactiva basada en un pulso subyacente, la construcción de una mutualidad entre adulto e infante a partir de la calidad de los motivos compartidos, la ampliación del espacio de juego y el sostenimiento de la atención conjunta y la fluidez interactiva.

Objectives: The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods: From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results: In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions: Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

Abstract Background The available literature indicates that there are significant differences in maternal mortality according to maternal origin in high income countries. The aim of this study was to examine the trend in the maternal mortality rate and its most common causes in Spain in recent years and to analyse its relationship with maternal origin. Methods This was a cross-sectional study of all live births as well as those resulting in maternal death in Spain during the period between 2000 and 2018. A descriptive analysis of the maternal mortality rate by cause, region of birth, maternal age, marital status, human development index and continent of maternal origin was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analyses, with adjustment for certain variables included in the descriptive analysis. Results There was a total of 293 maternal deaths and 8,439,324 live births during the study period. The most common cause of maternal death was hypertensive disorders of pregnancy. The average maternal death rate was 3.47 per 100,000 live births. The risk of suffering from this complication was higher for immigrant women from less developed countries. The adjusted effect of maternal HDI score over maternal mortality was OR = 0.976; 95% CI 0.95 – 0.99; p = 0.048; therefore, a decrease of 0.01 in the maternal human development index score significantly increased the risk of this complication by 2.4%. Conclusions The results of this study indicate that there are inequalities in maternal mortality according to maternal origin in Spain. The human development index of the country of maternal origin could be a useful tool when estimating the risk of this complication, taking into account the origin of the pregnant woman.

Could the connectivity of a global railway network increase through small changes in the timetable services? When designing railway schedules, transfer connections to intermediate stations may not be the primary focus considered. However, they may have an important influence on connectivity. In this paper, we study the potential improvement in connections by introducing small changes to the current schedules, using real timetables from all international railway services in Europe. The modelling was completed using the Complex Networks methodology and performance was measured based on total closeness centrality. Various factors are considered to calibrate the necessary amendments to provide a better traveller service, including connection times at stations and different allowed levels of schedule changes. The results indicate that by changing the schedule of only 1% of the services by at most 10 min, the connectivity improvement is remarkable. Railway companies should consider this result in order to expand the potential use of the international railway service at a time when public transportation must be encouraged. [ABSTRACT FROM AUTHOR]

Introduction and objectives: To compare fetal images obtained at the first- and second-trimester ultrasound scan when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). Methods: Using the CASSEAL protocol, nine sequential axial views were acquired in B-mode and color Doppler at the first- and second-trimester ultrasound scans, visualizing the main components of the extended fetal cardiovascular system. Images were compared qualitatively between both trimesters. Results: We obtained comparable images for all the nine axial views described in the CASSEAL protocol, with few differences and limitations. Conclusions: The CASSEAL protocol is reproducible in the first trimester, and could help in the early detection of fetal cardiovascular abnormalities. It represents a promising additional tool in order to increase the CHD detection rate.

The potential use of forest species as fuels depends on their energy quality. However, in rural communities in developing countries, fuelwood is still an energy source without any technical study evaluating its energetic characteristics. Therefore, this study aimed to analyze the energetic characteristics of 22 forest species from four communities in the state of Oaxaca, Mexico. The basic wood density, proximal analysis, and high heating value were evaluated. As a result of the analysis, the fuel number (FN) is proposed as a measure of the energy quality of biomass fuels in the form of firewood. FN considers the basic wood density, the fixed carbon, and the high heating value of each species. Wood basic density ranged from 0.472 g·cm-3 for Pinus pseudostrobus to 0.814 g·cm-3 for Dodonaea viscosa, fixed carbon ranged from 4.74% to 21.27% for Liquidambar styraciflua and Quercus rugosa, respectively, and high heating value from 18.33 MJ·kg-1 to 22.07 MJ·kg-1 for Liquidambar styraciflua and Pinus leiophylla, respectively. Classifying wood according to FN, in decreasing order, Quercus rugosa stands out as the best wood (66.97%), followed by Liquidambar styraciflua (39.52%). Regarding the fuel value index, the nine pine species showed the highest values (27.32 to 77.76). The FN provides a measure of the quality of biomass fuels in the form of firewood, and can be evaluated by easily measured variables.

Fructans are categorized as fructose-based metabolites with no more than one glucose in their structure. Agave species possess a mixture of linear and ramified fructans with different degrees of polymerization. Among them, fructooligosaccharides are fructans with low degree of polymerization which might be approachable by high performance thin layer chromatography (HPTLC). Thus, this study used two emblematic Agave species collected at different ages as models to explore the feasibility of HPTLC-based fingerprinting to characterize fructooligosaccharides (FOS) production, accumulation, and behavior through time. To do so, high performance anion exchange was also used as analytical reference to determine the goodness and robustness of HPTLC data. The multivariate data analysis showed separation of samples dictated by species and age effects detected by both techniques. Moreover, linear correlations between the increase of the age in agave and their carbohydrate fraction was established in both species by both techniques. Oligosaccharides found to be correlated to species and age factors, these suggest changes in specific carbohydrate metabolism enzymes. Thus, HPTLC was proven as a complementary or stand-alone fingerprinting platform for fructooligosaccharides characterization in biological mixtures. However, the type of derivatizing reagent and the extraction color channel determined the goodness of the model used to scrutinize agavin fructooligosaccharides (aFOS).