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Background Anti‐SARS‐CoV‐2 S antibodies prevent viral replication. Critically ill COVID‐19 patients show viral material in plasma, associated with a dysregulated host response. If these antibodies influence survival and viral dissemination in ICU‐COVID patients is unknown. Patients/Methods We studied the impact of anti‐SARS‐CoV‐2 S antibodies levels on survival, viral RNA‐load in plasma, and N‐antigenaemia in 92 COVID‐19 patients over ICU admission. Results Frequency of N‐antigenaemia was >2.5‐fold higher in absence of antibodies. Antibodies correlated inversely with viral RNA‐load in plasma, representing a protective factor against mortality (Adjusted HR [CI 95%], p): (S IgM [AUC ≥ 60]: 0.44 [0.22; 0.88], 0.020); (S IgG [AUC ≥ 237]: 0.31 [0.16; 0.61]

Scientific evidence has demonstrated that deterioration of ambient air quality has increased the number of deaths worldwide by appointing air pollution among the most pressing sustainability concerns. In this context, the continuous monitoring of air quality and the modelling of complex air pollution patterns is critical to protect population and ecosystems health. Availability of air quality observations has terrifically improved in the last decades allowing – nowadays – for extensive spatial and temporal resolved analysis at both global and local scale. Satellite remote sensing is mostly accountable for this data availability and is promising to foster air quality monitoring in support of traditional ground sensors measurements. In view of the above, this study compares observations from the Sentinel-5P mission of the European Copernicus Programme (the most recent Earth Observation platform providing open measurements of atmospheric constituents) with traditional ground measurements to investigate their space and time correlations across the Lombardy region (Northern Italy). The correlation analysis focused on nitrogen dioxide. The use of data collected during the COVID-19 pandemic allowed for a parallel exploration of the lockdown effects on nitrogen dioxide emissions. Results show a marked decrease in nitrogen dioxide concentrations during the lockdown and an overall strong positive correlation between satellite and ground sensors observations. These experiments are preparatory for future activities that will focus on the development of satellite-based air quality local prediction models, aiming at improving the granularity of the ground-based information available for air quality monitoring and exposure modelling.

Resumen Antecedentes y objetivos Existen multiples escalas para la deteccion de fragilidad en ancianos, pero no especificamente para poblacion institucionalizada. El objetivo fue comprobar tras 3 anos de seguimiento que escala predice con mayor precision el declive funcional y la mortalidad. Metodos Estudio longitudinal de cohortes con 110 pacientes mayores de 65 anos institucionalizados en Pamplona (Navarra). Se aplicaron 4 escalas de fragilidad (Fried, Fried Imputada, Rockwood y FRAIL NH). El poder de la asociacion entre las escalas y los resultados se comprobo mediante analisis de regresion lineal y de Cox. Resultados El 46,5% de la muestra fallecio durante el seguimiento, el 68% de ellos en su residencia, con 43 meses de media de supervivencia. El 71,3% de los ancianos estudiados presento discapacidad a los 3 anos, especialmente los fragiles. Los pacientes robustos experimentaron hospitalizaciones mas prolongadas (m = 3,4 dias) que los fragiles. Las escalas Fried Imputada y la FRAIL NH encontraron diferencias estadisticamente significativas entre grupos para las variables estudiadas; Fried Imputada mostro un HR significativo de muerte para sujetos fragiles (HR = 3,3). Conclusiones Las escalas Fried Imputada y FRAIL NH mostraron una mayor capacidad predictiva para declive funcional y cognitivo, siendo la escala Fried Imputada la unica que relaciona la mortalidad con la fragilidad.

Background and objectives There are multiple frailty detection tools, but they have not been specifically developed for the institutionalized population. The aim of this study is to ascertain at 3-year follow-up which tool predicts functional impairment and mortality most precisely. Methods Longitudinal cohort study with 110 patients in Pamplona (Navarra) >65 years. Four frailty tools were applied (Fried Criteria, Rockwood Frailty Scale, FRAIL-NH and Imputed Fried Frailty Criteria). The power of the association between the scales and the results was assessed by linear regression and Cox's analyses. Results 46.5% of the sample died during time to follow-up, 68% of whom died in their nursing home, with 43-month mean survival. Of the studied population, 71.3% showed disability at 3 years, especially the frail subjects. The robust patients had longer hospitalizations (m = 3.4 days) than the frail. Imputed Fried and FRAIL-NH found statistically significant differences between groups for the variables studied. Imputed Fried Frailty Criteria showed a significant HR of death for the frail subjects (HR = 3.3). Conclusions The Imputed Fried and FRAIL-NH tools showed a higher predictive capability for functional and cognitive decline, but only the Imputed Fried Frailty Criteria found a significant relationship between frailty and mortality.

Repair of the deltoid ligaments is suggested in patients with medial ankle instability after a ligamentous injury or lateral malleolar fracture fixation. Arthroscopy can be a definitive mode of determining whether there is medial instability and, therefore, help to determine whether there is a need to repair the deltoid ligaments. The authors describe a technique for the arthroscopic repair of the deltoid ligaments, using a suture passer and suture anchors. Cadaveric analysis was utilized to establish safe zones and indicate that there is a relatively wide safe zone between the posterior tibialis tendon and the saphenous vein when performing the technique. The authors have performed more than 87 arthroscopic deltoid repairs, with a greater than 90% satisfaction rate among patients. However, future studies with validated outcome measures are needed. Level of Evidence: Level V, expert opinion.

Patients with limited English proficiency (LEP) have disproportionately lower rates of cancer screening than English-proficient patients. Given the multifactorial nature of screening disparities, strategies to improve screening rates must address barriers within and outside of the clinic setting. The objectives of this study were to understand local barriers from multiple stakeholder perspectives, to identify potential multilevel intervention approaches, and to mobilize community-engaged intervention decision making and planning. This participatory formative evaluation approach employed needs assessment and user engagement in order to enhance intervention usefulness and relevance. The study took place in several stages and involved clinic and community partners in a small metropolitan area of the Midwest USA. Interviews were conducted with LEP patients (n = 9) who had not completed three recommended screenings (breast, cervical, and colorectal), primary care providers (n = 5), medical interpreter (n = 5), and community members (n = 3). These highlighted multilevel barriers including limited patient understanding of preventive health, time and cost constraints, and variable roles of language interpreters. The literature was also reviewed to identify interventions used with similar populations. Findings from this review suggest that interventions are largely focused on single population groups or address single screening barriers. Finally, a community-academic summit (n = 48 participants) was held to review results and develop recommendations for community and clinic interventions. Findings from this study indicate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds.

Metal-organic frameworks (MOFs) have been a promising material for many applications, e.g., photocatalysis, luminescence-based sensing, optoelectronics, and electrochemical devices, due to their tunable electronic properties through linker functionalization. In this work, we investigate the effect of mixed organic linkers on the bandgap modulation of polymorphic zirconium-based MOFs, UiO-66 and MIL-140A using density functional theory (DFT) calculations. We show that the electronic properties of both MOFs are in contrast to Vegard's law for semiconductors, that is, mixed-linker systems exhibit bandgaps not intermediate within the range of single-linker systems. Calculations of the total and partial density of states revealed the formation of mid-gap states in mixed-linker MOFs, causing the bandgap reduction. Interestingly, although both MOFs have similar composition, the effect is more significant in MIL-140A than in UiO-66. This is due to the presence of π-π stacking interactions in MIL-140A, which does not occur in UiO-66. The simulation results reveal a direct relationship between the strength of π-π interactions and the bandgap. This illustrates that distinct structural features, particularly the orientation of organic linkers can give rise to different consequences in bandgap modulation. Moreover, this computational work highlights the possibility to engineer the electronic properties of MOFs through a mixed-linker approach.

Moderate indoor relative humidity (RH) levels (i.e., 40%-60%) may minimize transmission and viability of some viruses, maximize human immune function, and minimize health risks from mold, yet uncertainties exist about typical RH levels in offices globally and about the potential independent impacts of RH levels on workers' health. To examine this, we leveraged one year of indoor RH measurements (which study participants could view in real time) in 43 office buildings in China, India, Mexico, Thailand, the United Kingdom, and the United States, and corresponding self-report symptom data from 227 office workers in a subset of 32 buildings. In the buildings in this study, 42% of measurements during 9:00 - 17:00 on weekdays were less than 40% RH and 7% exceeded 60% RH. Indoor RH levels tended to be lower in less tropical regions, in winter months, when outdoor RH or temperature was low, and late in the workday. Furthermore, we also found statistically significant evidence that higher indoor RH levels across the range of 14%-70% RH were associated with lower odds of reporting dryness or irritation of the throat and skin among females and unusual fatigue among males in models adjusted for indoor temperature, country, and day of year.

Multiple chemical sensitivity (MCS) is a multisystem syndrome, and limited knowledge of its pathophysiology exists. Based on the population-based Danish cohort DanFunD, this study investigated metabolic health in people with MCS compared to individuals who did not have MCS. From 9656 cohort participants aged 18–76 years old, 1.95% were categorized as MCS individuals with comorbid functional somatic disorders (MCS +FSD, n = 188), and 1.13% were categorized as MCS without functional somatic disorders (MCS ÷FSD, n = 109). MCS was characterized based on three criteria: the experience of symptoms upon exposure to common odors and airborne chemicals, symptoms related the central nervous systems and others organ symptoms, and significant impact on every day, social, and occupational life. The remaining study population without MCS or any other functional somatic disorders were regarded as controls. We used adjusted multiple linear regression with link-function to evaluate the associations between lipid and glucose metabolism markers and MCS. We also tested the odds ratio of metabolic syndrome in MCS. Results did not point to statistically significant associations between lipid biomarkers or metabolic syndrome and both MCS groups compared to the controls. We found that MCS individuals may be more insulin resistant and that MCS ÷ FSD may have an impaired glucose metabolism when compared to controls.

Background An emergent group of studies have examined the extent under which ridesharing may decrease alcohol-related crashes in countries such as United States, United Kingdom, Brazil, and Chile. Virtually all existent studies have assumed that ridesharing is equally distributed across socioeconomic groups, potentially masking differences across them. We contribute to this literature by studying how socioeconomic status at the municipal level impacts Uber’s effect on alcohol-related crashes. Methods We use data provided by Chile’s Road Safety Commission considering all alcohol-related crashes, and fatal and severe alcohol-related injuries that occurred between January 2013 and September 2013 (before Uber) and January and September 2014 (with Uber) in Santiago. We first apply spatial autocorrelation techniques to examine the level of spatial dependence between the location of alcohol-related crashes with and without Uber. We then apply random-effects meta-analysis to obtain risk ratios of alcohol-related crashes by considering socioeconomic municipality differences before and after the introduction of Uber. Results In both analyses, we find that the first 9 months of Uber in Santiago is associated with significant rate ratio decreases (RR = 0.71 [95% Confidence Interval (C.I.) 0.56, 0.89]) in high socioeconomic municipalities in all alcohol-related crashes and null (RR = 1.10 [95% C.I. 0.97, 1.23]) increases in low socioeconomic municipalities. No concomitant associations were observed in fatal alcohol-related crashes regardless of the socioeconomic municipality group. Conclusions One interpretation for the decline in alcohol-related crashes in high socioeconomic municipalities is that Uber may be a substitute form of transport for those individuals who have access to credit cards, and thus, could afford to pay for this service at the time they have consumed alcohol. Slight increases of alcohol-related crashes in low socioeconomic municipalities should be studied further since this could be related to different phenomena such as increases in alcohol sales and consumption, less access to the provision of public transport services in these jurisdictions, or biases in police reports.

Inverter-based distributed energy resources (DERs) are characterized with low fault current and negligible amount of negative and zero sequence currents. Understanding DER's fault characteristics is critical for fault analysis and protective relay setting. Despite the abundant work on DER modeling, few research studies have been done to analyze DER's fault behaviors during actual fault events. This paper explores recorded fault events collected by Dominion Energy. Fault magnitude, angle, and sequence components are analyzed to show that actual DER fault response may differ from previous understandings.

Background and objective To estimate the prevalence of polypharmacy and hyperpolypharmacy in non-institutionalised older adults in Spain and assess the associated factors. Material and methods A cross-sectional study based on data from the National Health Survey of Spain 2017, with participants aged 65 and over. The prevalence of polypharmacy (≥5 medications) and hyperpolypharmacy (≥10) were estimated, as well as the association with several factors through multivariate logistic regression. A sensitivity analysis was carried out considering the possible consumption of more than one drug for the same indication (polytherapy). Results 7023 participants were included, with a mean age of 76.0 (SD 7.6), 59.4% female and average consumption of 3.3 (SD 2.2) drugs per person. The prevalence of polypharmacy was 27.3% (95% C I 26.2–28.3) and of hyperpolypharmacy 0.9% (95% CI 0.7–1.1). The sensitivity analysis showed that the prevalence could be at least 37.5% and the average 3.9 (SD 2.5) when considering polytherapy. The factors most associated with polypharmacy were the number of chronic diseases, degree of dependence for the basic activities of daily living, self-perceived health or contacts with the health system; and negatively, sensory deficits and incontinence. Conclusions The prevalence of polypharmacy in the elderly in primary care continues to increase and could be widely underestimated. In addition to multimorbidity, factors such as functional capacity or geriatric syndromes, fundamental in elderly people, modulate the habits of consumption and prescription of drugs in this population.

Resumen Fundamento y objetivo Estimar la prevalencia de polifarmacia e hiperpolifarmacia en adultos mayores no institucionalizados en Espana y analizar los factores asociados. Material y metodos Estudio transversal a partir de datos de la Encuesta Nacional de Salud de Espana 2017, con participantes de 65 anos o mas. Se estimo la prevalencia de polifarmacia (≥ 5 medicamentos) e hiperpolifarmacia (≥ 10), y la asociacion con diversos factores mediante regresion logistica multivariante. Se realizo un analisis de sensibilidad considerando el posible consumo de mas de un farmaco para la misma indicacion (politerapia). Resultados Se incluyeron 7.023 participantes, con edad media de 76,0 (desviacion estandar [DE] 7,6) anos, 59,4% mujeres y consumo medio de 3,3 (DE 2,2) medicamentos por persona. La prevalencia de polifarmacia fue de 27,3% (intervalo de confianza del 95%: 26,2-28,3) y la de hiperpolifarmacia de 0,9% (intervalo de confianza del 95%: 0,7-1,1). El analisis de sensibilidad estimo que la prevalencia podria ascender al menos a un 37,5% y la media a 3,9 (DE 2,5) al considerar la politerapia. Los factores que mas se asocian a la polifarmacia fueron el numero de enfermedades cronicas, el grado de dependencia para las actividades basicas de la vida diaria, el estado de salud percibido o los contactos con el sistema sanitario; y de forma inversa los deficits sensoriales y la incontinencia. Conclusiones La prevalencia de polifarmacia en adultos mayores en atencion primaria continua aumentando, y podria estar ampliamente infraestimada. Ademas de la pluripatologia, factores como la capacidad funcional o los sindromes geriatricos, fundamentales en personas mayores, modulan los habitos de consumo y prescripcion de medicamentos en esta poblacion.

Pancreatic adenosquamous carcinoma (PASC) is a rare, aggressive subtype of pancreatic tumor with a poor prognostic outlook compared to the much more common pancreatic adenocarcinoma. Here we present two cases of the rare PASC and analyze the radiologic findings on computed tomography (CT) and 18F- fluorodeoxyglucose positron emission tomography (FDG-PET).Both cases involve 62-year-old women presenting with abdominal pain, nausea, and vomiting who on imaging were found to have infiltrating lobular pancreatic masses with ring enhancement on CT and peripheral hypermetabolism with central necrosis on FDG-PET. Location in the pancreas and involvement of adjacent structures differed in the two cases, resulting in varying progressive clinical manifestations.PASC is a rare subtype of pancreatic cancer with nonspecific imaging findings. Here we presented two cases of PASC supporting previously reported imaging findings suggestive of PASC with additional FDG-PET manifestations and SUV levels, which only few reports have previously described. Keywords: Pancreatic adenosquamous carcinoma, CT, FDG-PET

Patient: Male, 37 Final Diagnosis: Acute myocardial infarction Symptoms: Retrosternal chest pain Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual setting of medical care Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate, despite prompt revascularization, advanced medical therapy and the use of mechanical circulatory support devices. Therapeutic hypothermia is associated with physiological cellular changes in the ischemic myocardium, and a trend towards improved hemodynamics in patients with AMI and cardiogenic shock, but is currently not considered to be a therapeutic modality. A case is presented that supports the role of therapeutic hypothermia as salvage therapy in patients with cardiogenic shock following AMI. Case Report: A 37-year-old man who presented with cardiac arrest following an anterior wall AMI due to occlusion of the left anterior descending coronary artery complicated by cardiogenic shock, underwent emergent percutaneous revascularization with placement of a stent, a percutaneous left ventricular-assist device (LVAD), and a pulmonary artery catheter. Therapeutic hypothermia was initiated to achieve a target core body temperature of between 32–34°C for 24 hours, followed by slow re-warming. However, after rewarming, the patient developed refractory cardiogenic shock, despite revascularization, pharmacological and mechanical circulatory support. A second cycle of therapeutic hypothermia was initiated as salvage therapy, leading to clinical improvement. The patient had a favorable outcome, was discharged from hospital and was able to return to work. Conclusions: The first successful case is described in which therapeutic hypothermia was re-initiated as salvage therapy for cardiogenic shock where no other hemodynamic support resources were available.

Osteosarcopenia is a phenotype resulting from the combination of sarcopenia and low bone mineral density. Based on the relationship between bone and muscle, this phenotype is associated with a higher risk of falls, fractures, dependence, and health care costs than its individual components. Given its characteristics, it can be considered as a new geriatric syndrome. Therefore, understanding its pathophysiology and diagnosis, as well as its non-pharmacological and pharmacological management is a task of great importance. The problem in addressing this phenotype arises from the tradition of managing sarcopenia and osteoporosis separately. There is also a lack of consensus on what to call it (sarco-osteopenia, sarco-osteoporosis, osteosarcopenia). The aim of this review is to outline the epidemiology, pathophysiology, diagnoses, adverse events, and management of osteosarcopenia.

Nowadays, most optical network planning strategies route the users by the shortest paths. However, balancing the network paths may achieve remarkable savings by using network resources as even as possible. In this work, we propose a balancing routing strategy for elastic optical networks (EON) architectures with static network operation, called Bandwidth-Balanced (BB). We compute the connection paths balancing the number of FSUs demanded in all network links, contrary to the users balancing strategies found in the literature. To evaluate our proposal, we perform the Routing, Modulation Level, and Spectrum Assignment problems (RMLSA), taking into account physical-layer impairments (PLI) found in optical communications. Experimental results show that the BB strategy outperforms commonly used strategies in capacity savings and spectral fragmentation.

Objectives:The aim of this study was to provide insights learned from disaster research response (DR2) efforts following Hurricane Harvey in 2017 to launch DR2 activities following the Intercontinental Terminals Company (ITC) fire in Deer Park, Texas, in 2019.Methods:A multidisciplinary group of academic, community, and government partners launched a myriad of DR2 activities.Results:The DR2 response to Hurricane Harvey focused on enhancing environmental health literacy around clean-up efforts, measuring environmental contaminants in soil and water in impacted neighborhoods, and launching studies to evaluate the health impact of the disaster. The lessons learned after Harvey enabled rapid DR2 activities following the ITC fire, including air monitoring and administering surveys and in-depth interviews with affected residents.Conclusions:Embedding DR2 activities at academic institutions can enable rapid deployment of lessons learned from one disaster to enhance the response to subsequent disasters, even when those disasters are different. Our experience demonstrates the importance of academic institutions working with governmental and community partners to support timely disaster response efforts. Efforts enabled by such experience include providing health and safety training and consistent and reliable messaging, collecting time-sensitive and critical data in the wake of the event, and launching research to understand health impacts and improve resiliency.

Purposeto evaluate the association between anti-SARS-CoV-2 S IgM and IgG antibodies with viral RNA load in plasma, the frequency of antigenemia and with the risk of mortality in critically ill patients with COVID-19.Methodsanti-SARS-CoV-2 S antibodies levels, viral RNA load and antigenemia were profiled in plasma of 92 adult patients in the first 24 hours following ICU admission. The impact of these variables on 30-day mortality was assessed by using Kaplan-Meier curves and multivariate Cox regression analysis.Resultsnon survivors showed more frequently absence of anti-SARS-CoV-2 S IgG and IgM antibodies than survivors (26.3% vs 5.6% for IgM and 18.4% vs 5.6% for IgG), and a higher frequency of antigenemia (47.4% vs 22.2%) (p p]: [S IgM (AUC ≥60): 0.48 (0.24; 0.97), 0.040]; [S IgG (AUC ≥237): 0.47 (0.23; 0.97), 0.042]; [Antigenemia (+): 2.45 (1.27; 4.71), 0.007]; [N1 viral load (≥ 2.156 copies/mL): 2.21 (1.11; 4.39),0.024]; [N2 viral load (≥ 3.035 copies/mL): 2.32 (1.16; 4.63), 0.017]. Frequency of antigenemia was >2.5-fold higher in patients with absence of antibodies. Levels of anti-SARS-CoV-2 S antibodies correlated inversely with viral RNA load.Conclusionabsence / insufficient levels of anti-SARS-CoV-2 S antibodies following ICU admission is associated to poor viral control, evidenced by increased viral RNA loads in plasma, higher frequency of antigenemia, and also to increased 30-day mortality.Take-home messageabsent or low levels of antibodies against the S protein of SARS-CoV- 2 at ICU admission is associated to an increased risk of mortality, higher frequency of antigenemia and higher viral RNA loads in plasma. Profiling anti-SARS-CoV-2 s antibodies at ICU admission could help to predict outcome and to better identify those patients potentially deserving replacement treatment with monoclonal or polyclonal antibodies.

Background Service-learning experiences, informed by the realities of poverty and marginalization, are important for the education of future health professionals in order to commit them to tackling health inequalities and working with underserved populations. At the Caritas Medical Centre for undocumented migrants and homeless in Rome, students obtain an educational experience of service. The aim of this study is to try to measure the long-term impact of this experience on the professional and life choices of the student participants. Methods A questionnaire was designed and distributed by email to all 19–29 years old participants in the experience. Responses were collected and analysed in a quantitative descriptive way and in a qualitative way using the knowledge, skills and attitudes model. Results One hundred and seven students responded from the total 763 questionnaires distributed. Ninety-five percent of participants expressed a very high overall satisfaction, 93% declared that the experience influenced his/her future personal choices, and 84% found that the experience influenced their professional choices. Results were arranged into 6 categories of comments: knowledge about the realities of migration, poverty, and marginalization; relational skills; collaborative skills; attitudes towards migrants, poor people and others; Attitudes towards future professions; Attitudes towards life. A final category was listed with self-reflective questions related to the experience. Conclusion This research shows the importance of service-learning experiences made during academic studies from young students of medicine and other faculties. Developing a relationship with marginalized and homeless people, within a voluntary service setting, can influence the future professional and personal choices of students. Universities should recognize the value of such experiences and establish partnerships with non-profit organizations to allow future health professionals to confront health inequities and commit themselves to their reduction.

The world cocoa market has a significant demand, foreseeing an increase of 30% by 2020, which creates opportunities. Panama has been a cocoa producer since 1900, with a low profile, but the quality of the grain competes worldwide. Cocoa cultivation is mostly developed by family of indigenous origin, mainly by women; directly affecting the reduction of rural poverty. Despite this, between 2017 and 2018 there was a 23% reduction in national production. In this sense, from a literature review a conceptualization on the sustainability of the food supply chain is presented. Based on the results, a theoretical model is proposed to measure the relationship between Cocoa Supply Chain Management and its relationship in Sustainable Development, which constitutes a roadmap for future research.

Objectives To determine the impact of anticoagulation on inhospital mortality among coronavirus disease 2019-positive patients with the a priori hypothesis that there would be a lower risk of inhospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin. Design setting Retrospective cohort study from April 1, 2020, to April 25, 2020. The date of final follow-up was June 12, 2020 Two large, acute-care hospitals in Western Connecticut. Patients Five hundred and one inpatients were identified after discharge as 18 years or older and positive for severe acute respiratory syndrome coronavirus 2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, whereas the clinical variables were abstracted from patients' medical records. Exposure Preemptive enoxaparin or heparin at a therapeutic or prophylactic dose. Main results When comparing treatments through multivariable analysis, risk of inhospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0-4.9; p = 0.04). Additionally, the average treatment effects were higher (β = 0.11, p = 0.01) in the therapeutic group. Conclusions An increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation. Thus, in the management of coronavirus disease 2019 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.

A joint work of all areas of the plant is manifested in the design, manufacture and assembly of the fuel mixer, that will improve the quality of the fuel that is received in the plant, this device automatically doses the injection of diesel to the main line of HFO, depending on the viscosity that has the mentioned fuel, this innovation leads to obtain a better fuel for the engines, improving the overall efficiency of the plant, prolonging the useful life of the generators and also decreases NOx emissions.

Background A dispensing error can be defined as an inconsistency between the drug prescribed and drug dispensed to a patient. These errors can lead to ineffective and sometimes unwanted pharmaceutical outcomes. Dispensing errors can be harmful or even fatal to patients. Case presentation The objective to this study was (a) to determine the types and frequency of dispensing errors at the Eric Williams Medical Sciences Complex (EWMSC), (b) to explore the reasons for the occurrence of dispensing errors, and (c) to make suitable recommendations for their prevention. An observational study for a period of 2 weeks was carried out at various in- and outpatient departments of the EWMSC. The observations were carried out during 7:00 am to 3:00 pm. Dispensing errors identified during this period were recorded and analyzed. Results Sixty-eight errors were identified in the adult outpatient pharmacy of the EWMSC; 19 errors in the pediatric outpatient pharmacy, whereas 22 errors were found in inpatient pharmacy. The most common plausible causes for the dispensing errors include high workload, failure to verify patient information, incorrect data in the pharmacy’s record system, inadequate notes made by pharmacists during prior patient visit, and in a few cases, uncomfortable working conditions. Conclusion Dispensing errors were encountered in 2.1% of all the prescriptions filled at the EWMSC pharmacies. The factors which influenced these dispensing errors include but are not limited to a heavy workload, distractions, failure to verify patient information, and uncomfortable working conditions.

Load forecasting provides essential information for engineers and operators of an electric system. Using the forecast information, an electric utility company’s engineers make informed decisions in critical scenarios. The deregulation of energy industries makes load forecasting even more critical. In this article, the work we present, called Nearest Neighbors Load Forecasting (NNLF), was applied to very short-term load forecasting of electricity consumption at the national level in Mexico. The Energy Control National Center (CENACE—Spanish acronym) manages the National Interconnected System, working in a Real-Time Market system. The forecasting methodology we propose provides the information needed to solve the problem known as Economic Dispatch with Security Constraints for Multiple Intervals (MISCED). NNLF produces forecasts with a 15-min horizon to support decisions in the following four electric dispatch intervals. The hyperparameters used by Nearest Neighbors are tuned using Differential Evolution (DE), and the forecaster model inputs are determined using phase-space reconstruction. The developed models also use exogenous variables; we append a timestamp to each input (i.e., delay vector). The article presents a comparison between NNLF and other Machine Learning techniques: Artificial Neural Networks and Support Vector Regressors. NNLF outperformed those other techniques and the forecasting system they currently use.

Introduction: Lack of health equity ultimately leads to unequal treatment of diverse patients and contributes to the growing disparities seen in national health. Academic medical centers should consider providing health care providers and biomedical researchers training on how to identify and address health disparities. Methods: The authors led an introductory health disparities course for graduate students and research and clinical fellows at an academic medical center in the Midwest. We compared pre/postcourse assessments to determine changes in learners’ perceptions and knowledge of health disparities using an unpaired analysis to permit inclusion of responses provided only at baseline. Results: Sixty-two learners completed preassessment, with 56 completing the postassessment (90%). In the postcourse assessment, learners reported an increase in knowledge of disparities and had changes in their perceptions of health disparities linked to treatment of different patient groups based on demographic characteristics. There was a statistically significant difference in learners’ perceptions of how patients are treated based on gender identity (P=0.02) and sexual orientation (P=0.04). Conclusions: The results detail how an academic medical center can provide training on health disparities for diverse learners. This study underscores the influence of health disparities from the perspective of learners who conduct biomedical research and patient care. This course serves a model for introductory-level health disparities courses.

BackgroundThis study is the first of its kind to assess the impact of preemptive therapeutic dose anticoagulation on mortality compared to prophylactic anticoagulation among COVID-19 patients. Its findings provide insight to clinicians regarding the management of COVID-19, particularly with the known prothrombotic state.Research QuestionTo determine the impact of anticoagulation on in-hospital mortality among COVID-19 positive patients with the a priori hypothesis that there would be a lower risk of in-hospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin.Study Design and MethodsStudy DesignRetrospective cohort study from April 1 - April 25, 2020. The date of final follow-up was June 12, 2020.SettingTwo large, acute care hospitals in Western Connecticut.ParticipantFive hundred and one inpatients were identified after discharge as 18 years or older and positive for SARS-CoV-2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, while the clinical variables were abstracted from patients’ medical records.ExposurePreemptive enoxaparin or heparin at a therapeutic or prophylactic dose.Main OutcomIn-hospital mortality.ResultsWhen comparing preemptive therapeutic to prophylactic anticoagulation through multi-variable analysis, risk of in-hospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0, 4.9; p = 0.04).InterpretationAn increase in in-hospital mortality was observed with preemptive therapeutic anticoagulation. Thus, in the management of COVID-19 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.

Background The spread of airborne infectious diseases such as measles is a critical public health concern. The U.S. was certified measles-free in 2000, but the number of measles cases has increased in recent years breaking the record of the nationwide annual number of cases since 1992. Although the characteristics of schools have made them one of the most vulnerable environments during infection outbreaks, the transmission risk of measles among students is not completely understood. We aimed to evaluate how three factors influence measles transmission in schools: personal (vaccination), social (compartmentalizing), and building systems (ventilation, purification, and filtration). Methods We used a combination of a newly developed multi-zone transient Wells-Riley approach, a nationwide representative School Building Archetype (SBA) model, and a Monte-Carlo simulation to estimate measles risk among U.S. students. We compared our risk results with the range of reported transmission rates of measles in school outbreaks to validate the risk model. We also investigated the effectiveness of vaccination and ten supplemental infection control scenarios for reducing the risk of measles transmission among students. Results Our best nationwide estimate of measles transmission risk in U.S. schools were 3.5 and 32% among all (both unvaccinated and immunized) and unvaccinated students, respectively. The results showed the transmission risk of measles among unvaccinated students is > 70 times higher than properly immunized ones. We also demonstrated that the transmission risk of measles in primary schools (assuming teacher self-contained classrooms) is less than secondary schools (assuming departmentalized systems). For building-level interventions, schools with ductless-with-air-filter and ductless-without-air-filter systems have the lowest and highest transmission risks of measles, respectively. Finally, our simulation showed that infection control strategies could cut the average number of infected cases among all students in half when a combination of advanced air filtration, ventilation, and purification was adopted in the modeled schools. Conclusions Our results highlight the primary importance of vaccination for reducing the risk of measles transmission among students. Yet, additional and significant risk reduction can be achieved through compartmentalizing students and enhancing building ventilation and filtration systems.

Con la evolución del Internet, hay una gran cantidad de información presente en la web como lo son las opiniones de los usuarios o consumidores sobre diversos contextos ya sea para expresar su conformidad o inconformidad sobre un producto o servicio recibido, así como la opinión de un artículo comprado o sobre la gestión que realiza alguna persona. Debido a la gran cantidad de opiniones, comentarios y sugerencias de los usuarios, es muy importante explorar, analizar y organizar sus puntos de vista para tomar mejores decisiones. El análisis de sentimientos es una tarea de procesamiento de lenguaje natural y extracción de información que identifica las opiniones de los usuarios explicadas en forma de comentarios positivos, negativos o neutrales. Varias técnicas pueden ser utilizadas para este fin, por ejemplo el uso de diccionarios léxicos que ha sido muy utilizada y recientemente la utilización de la inteligencia artificial específicamente algoritmos supervisados. En este documento, se propone la utilización de técnicas de algoritmos supervisados para observar su utilización y ver el rendimiento de diferentes modelos de algoritmos supervisados para medir la efectividad en la clasificación de un conjunto de datos.

Families separated by distance face the challenge of limited bonding, affecting their opportunities to connect and sustain their relationships. FamilySong is a domestic Media Space that fosters feelings of togetherness via synchronized music-listening. FamilySong was used in an experiment that ran for six months, with six distributed families. Detailed data collection, e.g. interaction routines and music sharing patterns, was gathered through the system. These data provide interesting insights into the social behavior of families separated by distance and how they connect over those distances. In this work, we built software to analyze the experiment's data. The procedures and insights described in this paper will be useful for other researchers and practitioners involved in Information and Communications Technologies projects, making the FamilySong analysis with this software an exemplar for efficient data analysis.

INTRODUCTION AND OBJECTIVE:Concern for over-treatment of prostate cancer has led to the development of new biomarkers that risk-stratify patients prior to biopsy. ExoDx Prostate IntelliScore (ExoDx...

The Boston Residential Investigation on Green and Healthy Transitions (BRIGHT) Study is focused on quantifying the effects of redeveloping public housing developments into new buildings with improved energy performance and indoor environmental quality. This report presents an analysis of utility consumption and work order requests at Old Colony and Washington-Beech, two redeveloped housing sites in Boston, Massachusetts. We compare the consumption of electricity, natural gas, and water, as well as work order data, from 2012&ndash, 2014 to development-wide baseline data from 2006&ndash, 2009. We found that despite the higher number of electric appliances in the new apartments (e.g., air conditioning and ranges), electricity consumption decreased 46% in Old Colony and nearly 30% in Washington-Beech when compared to the baseline data. Natural gas used for space heating decreased by more than 70% at both sites, and water use decreased by nearly 56% at Old Colony and nearly 30% at Washington-Beech. Work order categories that directly influence the residents&rsquo, quality of life, such as pests, mold, windows and plumbing decreased by more than 50% in both renovated sites. In combination with previous documentation of health improvements in the redeveloped sites, these results provide further evidence of the magnitude of benefits from updating public housing infrastructure using green design principles.

The research community has made significant advances towards realizing self-tuning cloud caches, notwithstanding, existing products still require manual expert tuning to maximize performance. Cloud (software) caches are built to swiftly serve requests, thus, avoiding costly functionality additions not directly related to the request-serving control path is critical. We show that serverless computing cloud services can be leveraged to solve the complex optimization problems that arise during self-tuning loops and can be used to optimize cloud caches for free. To illustrate that our approach is feasible and useful, we implement SPREDS (Self-Partitioning REDiS), a modified version of Redis that optimizes memory management in the multi-instance Redis scenario. A cost analysis shows that the serverless computing approach can lead to significant cost savings: The cost of running the controller as a serverless microservice is 0.85% of the cost of the always-on alternative. Through this case study, we make a strong case for implementing the controller of autonomic systems using a serverless computing approach.

Purpose This paper aims to report on a case study concerning the development of sustainable energy partnerships involving engineering faculty and undergraduate students at the University of Girona, Catalonia, Spain. Design/methodology/approach Faculty were motivated to seek partnerships with public and private entities in the local area for the purposes of realising mutually beneficial outcomes. The educational programmes of future engineers, when sustainability is considered, are analysed. Education for sustainable development has to include multidisciplinary active learning as a desirable competence. Active learning can be obtained when problems are based on real life because they are most motivating for students. Constructive alignment component is obtained because learning objectives are linked with learning activities related to the needs of public and private entities. Findings Through the provision of technical expertise, the adoption and success of renewable energy projects was facilitated on the one hand, while final year undergraduate students benefited in terms of hands-on experience in helping to bring these projects to life, drawing on the knowledge and skills they had acquired throughout their degree programmes. These works are addressed to students by faculty members with the aim of developing and promoting renewable energies. Outcomes from partnerships surpassed expectations; not only were different benefits realised as were initially hoped for, but this success led to partnerships being sustained over time. Originality/value Fossil fuel-based energy systems are associated with a myriad of negative environmental and social externalities. It is difficult to overstate the importance of transitioning towards alternative low carbon energy sources for climate change mitigation which are less centralised compared to the status-quo for energy security and energy independence. By actively facilitating the development of decentralised renewable energy sources in Catalonia, the projects reported herein are of significant value in social environmental and educational terms.

There is large interest in networked social science experiments for understanding human behavior at-scale. Significant effort is required to perform data analytics on experimental outputs and for computational modeling of custom experiments. Moreover, experiments and modeling are often performed in a cycle, enabling iterative experimental refinement and data modeling to uncover interesting insights and to generate/refute hypotheses about social behaviors. The current practice for social analysts is to develop tailor-made computer programs and analytical scripts for experiments and modeling. This often leads to inefficiencies and duplication of effort. In this work, we propose a pipeline framework to take a significant step towards overcoming these challenges. Our contribution is to describe the design and implementation of a software system to automate many of the steps involved in analyzing social science experimental data, building models to capture the behavior of human subjects, and providing data to test hypotheses. The proposed pipeline framework consists of formal models, formal algorithms, and theoretical models as the basis for the design and implementation. We propose a formal data model, such that if an experiment can be described in terms of this model, then our pipeline software can be used to analyze data efficiently. The merits of the proposed pipeline framework is elaborated by several case studies of networked social science experiments. Published version

Clinical intervention studies support the efficacy and safety of exercise programs as a treatment modality for non-small-cell lung cancer (NSCLC) during adjuvant/palliative treatment, but the effectiveness of real-world oncogeriatric services is yet to be established. We aimed to examine the effects of a 10-week structured and individualized multicomponent exercise program on physical/cognitive functioning and mental wellness in elderly patients with NSCLC under adjuvant therapy or palliative treatment. A non-randomized, opportunistic control, longitudinal-design trial was conducted on 26 patients with NSCLC stage I&ndash, IV. Of 34 eligible participants, 21 were allocated into two groups: (i) control group (n = 7) received usual medical care, and (ii) intervention group (n =19) received multicomponent program sessions, including endurance, strength, balance, coordination and stretching exercises. Tests included the Short Physical Performance Battery (SPPB), 5-m habitual Gait Velocity Test (GVT), Timed Up &amp, Go Test (TUG), 6-Min Walk Test (6MWT), independence of activities in daily living (IADL), muscular performance, cognitive function, and quality of life, which were measured at baseline and after 10&thinsp, weeks of the program. Results revealed a significant group&times, time interaction for SPPB (p = 0.004), 5-m GVT (p = 0.036), TUG (p = 0.007), and muscular performance (chest and leg power, p &lt, 0.001). Similarly, significant changes were observed between groups for cognitive functioning (p = 0.021) and quality of life for EUROQoL 5D (p = 0.006). Our findings confirm that a multicomponent exercise program improves measures of physical/cognitive functioning and quality of life in the elderly with NSCLC under adjuvant therapy or palliative treatment. This is an interesting and important study that adds to our current body of knowledge on the safety of exercise interventions, especially in the elderly with solid tumors.

Background E-cigarette or vaping has become an increasingly popular alternative to smoking tobacco. In September 2019 multiple cases of confirmed E-cigarette or vaping product use associated lung injury were published. However, there is limited knowledge regarding the pathologic mechanism of this condition. Methods We performed a systematic literature review in PubMed and EMBASE aiming to obtain additional clinical data on confirmed E-cigarette or vaping product use associated lung injury cases with lung biopsy results. With this information we hope to determine whether this condition is related to a histopathological pattern of acute lung injury instead of lipid deposits. Results Seven articles were reviewed and a total of 27 cases were included. Imaging findings predominantly showed presence of diffuse bilateral ground glass opacities. A majority of patients had complete resolution of the disease. The most common histopathological pattern was organizing pneumonia present in almost half of the patients. Other frequently occurring patterns included diffuse alveolar damage and acute fibrinous pneumonitis; lipoid pneumonia was found in one case. Conclusion The underlying pathophysiological mechanism in E-cigarette or vaping product use associated lung injury is most likely acute lung injury related to direct inhalant-mediated parenchymal inflammation., Highlights • Majority of cases with confirmed EVALI had diffuse bilateral ground glass opacities pattern. • Diffuse ground glass opacities are more associated with typical patterns (organizing pneumonia and diffuse alveolar damage). • Histological patterns are more consistent with acute lung injury than lipids deposition. • Damage to the lung parenchyma appears to be more related to direct inhaled toxin and/or thermal injury. • Variation of the pathologic findings could be secondary to the different types of possible noxious agents.

Climate policies increasingly focus on the building sector to reduce its energy and emission footprint, since building energy use is a major source of greenhouse gas (GHG) and air pollution emissions. The most ambitious climate policy focusing on the building sector is New York City (NYC)'s local law 97 (LL97). LL97 requires all mid-size and large buildings (>25,000 ft2 (2,323 m2)) to reduce the GHG emissions associated with their energy use, 40% by 2030, and 80% by 2050. This study uses several models and regulatory datasets to build novel NYC building energy use and GHG emission profiles based on LL97 and to investigate the impacts of LL97 on energy, climate, and health. Results show that climate impacts of 2018 energy use in LL97-covered buildings is ∼$3.24 billion USD. The premature mortality due to exposure to 2017 NYC stationary fuel combustion emissions were 1.73–3.42K deaths ($19.9–39.2 billion USD). From this total premature mortality cases in stationary sectors (industry, electricity, and buildings), 0.838–1.87K deaths ($9.62–21.5 billion USD) were from buildings. To achieve emission reduction goals and enable beneficial building electrification, the grid should be decarbonized. Additionally, LL97's apparent exclusion of biomass is a key gap, with potentially adverse effects on health and broad implications for energy/climate policies. Biomass has an outsized adverse health impact; NYC biomass use alone caused 0.707–1.55K deaths ($8.12–17.8 billion USD) in 2017. Yet LL97 does not explicitly mention biomass, and may inadvertently incentivize the use of this fuel, for instance by enabling the use of renewable energy credits from biomass for compliance. This can lead to increased adverse health impacts from biomass combustion. Our findings demonstrate the necessity of including health in energy and climate policy design.

Community health workers (CHWs) bring their unique capacity as liaisons for patients, communities, and health care systems to health care teams. We describe the collaborative development of a community-based CHW program to address the social determinants of health that affect patients. This cosupervisory, generalist CHW model provides an innovative template for cocreation of patient-centered infrastructure and resourcing within an evolving and replicable holistic care continuum across patient ages, diagnoses, health care payers, and communities to promote health equity. The program has been effective in decreasing health care utilization and cost.

Civilizational challenges have questioned the status quo of energy and material consumption by humans. From the built environment perspective, a response to these challenges was the creation of green buildings. Although the revolutionary capacity of the green building movement has elevated the expectations of new commercial construction, its rate of implementation has secluded the majority of the population from its benefits. Beyond reductions in energy usage and increases in market value, the main strength of green buildings may be the procurement of healthier building environments. Further pursuing the right to healthy indoor environments could help the green building movement to attain its full potential as a transformational public health tool. On the basis of 40 years of research on indoor environmental quality, we present a summary of nine environment elements that are foundational to human health. We posit the role of green buildings as a critical research platform within a novel sustainability framework based on social-environmental capital assets.

Introduction: Nowadays in Panama, there is a lot of patient information stored in textual form which cannot be manipulated to manage adequate knowledge. There are multiple resources created to represent knowledge, including specialized glossaries, ontologies, among others. The ontologies are an important part within the scope of the recovery and organization of the information and the semantic web. Also in recent works they are used in applications of natural language processing (NLP), as a knowledge base. Aim: This research was conducted with the aim of creating a methodology that allows from a text written in NL, extract the necessary elements using NLP tools and with them create a knowledge base represented by one domain ontology and extract knowledge to help medical specialists. Material and Methods: In this study we carried out a methodology that allows the extraction of knowledge of patient clinical records, general medicine and palliative care, in order to show relevant knowledge elements to specialists. The methodology was validated with a data corpus of approximately 200 patient records. Conclusion: We have created a knowledge representation methodology, combining NLP techniques and tools and the automatic instantiation of an ontology, which can serve as a software agent for other applications or used to visualize the patientÂ’s clinical information. The study was validated using the traditional metrics of information retrieval systems precision, recall, F-measure obtaining excellent results, and can be used as a software agent or methodology for the development of information extraction software systems in the medical domain.

During the last five decades, the forests and natural resources have been highly disrupted by human activities, causing a significant decrease of the plant coverage, consequently resulting in an increase runoff and soil erosion. Likewise, since 1989 non-basic information related to these topics has been obtained from the field, which does not allow appropriate hydraulic structure design. The purpose of the current paper is to determine the relation between the Curve Number CN and runoff coefficient C, from information of the 34 meteorological stations located in the Manabi Hydrographic Demarcation (MHD), during the period 1963-2013. This work is developed using information provided by several State institutions, and support of Geographic Information System. The information is processed using lineal correlation analysis to find an equation that relates the CN a C values.