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Introduction and objectives Transcatheter aortic valve implant has become a widely accepted treatment for inoperable patients with aortic stenosis and patients at high surgical risk. Its indications have recently been expanded to include patients at intermediate and low surgical risk. Our aim was to evaluate the efficiency of SAPIEN 3 vs conservative medical treatment (CMT) or surgical aortic valve replacement (SAVR) in symptomatic inoperable patients at high or intermediate risk. Methods We conducted a cost-effectiveness analysis of SAPIEN 3 vs SAVR/CMT, using a Markov model (monthly cycles) with 8 states defined by the New York Heart Association and a time horizon of 15 years, including major complications and management after hospital discharge, from the perspective of the National Health System. Effectiveness parameters were based on the PARTNER trials. Costs related to the procedure, hospitalization, complications, and follow-up were included (euros in 2019). An annual discount rate of 3% was applied to both costs and benefits. Deterministic and probabilistic sensitivity analyses (Monte Carlo) were performed. Results Compared with SAVR (high and intermediate risk) and CMT (inoperable), SAPIEN 3 showed better clinical results in the 3 populations and lower hospital stay. Incremental cost-utility ratios (€/quality-adjusted life years gained) were 5471 (high risk), 8119 (intermediate risk) and 9948 (inoperable), respectively. In the probabilistic analysis, SAPIEN 3 was cost-effective in more than 75% of the simulations in the 3 profiles. Conclusions In our health system, SAPIEN 3 facilitates efficient management of severe aortic stenosis in inoperable and high- and intermediate-risk patients.

Rationale and Aim: Advanced Practice Nurse (APN) is a specialist who has acquired clinical skills to make complex decisions for a better professional practice. In the United States, this figure has been developed in different ways, but in some European countries, it is not yet fully developed, although it may imply a significant advance in terms of continuity and quality of care in patients with chronic or multiple pathologies, including cardiac ones and, more specifically, heart failure (HF). The follow- up of HF patients in many countries has focused on the medical management of the process, neglecting all the other comprehensive health aspects that contribute to decompensation of HF, worsening quality indicators or patient satisfaction, and there are not updated reviews to clarify the relevance of APN in HF, comparing the results of APN interventions with doctors clinical practice, since the complexity of care that HF patients need makes it difficult to control the disease through regular treatment. For this reason, this systematic review was proposed in order to update the available knowledge on the effectiveness of APN interventions in HF patients, analysing four PICO questions (Patients, Interventions, Comparison and Outcomes): whether APN implies a reduction in the number of hospital readmissions, if it reduces mortality, if it has a positive cost- benefit relationship and if it implies any improvement in the quality of life of HF patients. Design and Methods: A systematic review was performed based on the PRISMA statement, searching at four databases: PubMed, CINAHL, Scopus and Cuiden. Articles were selected based on the following criteria: English/Spanish language, up to 6 years since publication, and original quantitative studies of experimental, quasi- experimental or observational character. Papers were excluded if they do not comply with CONSORT or STROBE checklists, and if they had not been published in journals indexed in JCR and/or SJR. For the analysis, two separate researchers used the Cochrane Handbook form for systematic reviews of intervention, collecting authorship variables, study methods, risks of bias, intervention and comparison groups, results obtained, PICO question or questions answered, and the main conclusions. Results: A total of 43,754 patients participated in the 11 included studies for the development of this review, mostly from United States and non- European countries, with a clearly visible lack of European publications. Regarding the results related to first PICO question, researches reviewed proved that APN implied a reduction in the number of hospital readmissions in patients with heart failure (up to 33%). Regarding the second question, mortality was always lower in groups assisted by APN versus in control groups (up to 7.8% vs. 17.7%). Regarding the third question, APN was costeffective in this type of patient as the cost reduction was eventually calculated in 1.9 million euros. Regarding the last question, quality of life of patients who have been cared for by an APN had notoriously improved, although one of the papers concluded that no significant differences were found. All the questions addressed obtained a positive answer; therefore, APN is a practice that reduced hospital readmissions and mortality in HF patients. The cost- effectiveness is much better with APN than with usual care, and although the quality of life of HF patients seems to improve with APN, more studies are needed to support this focused on this.

Background. Overweight and obesity arise from a complex range of genetic, environmental, behavioral, educational, and socioeconomic factors. The present study explored the sedentary practices and some life habits related to health among children from the school population of Uruguaiana (Rio Grande do Sul, Brazil). Methods: A cross-sectional descriptive study was conducted to characterize the life habits of the school boys and girls from fourth grade (9&ndash, 10 years old). Results: A total of 470 fourth-grade boys and girls (9&ndash, 10 years old) participated in the study. As regards the variables linked to habits, 24% of the boys and girls answered they had not had breakfast the day they completed the questionnaire and 51.8% stated they did not have breakfast any given day of the week. Regarding sedentary habits, 25.3% of children watched TV or played video games five or more hours a day and 9% rarely played sports with their parents or caregivers. Statistical significance was recorded between &ldquo, number of hours watching TV and playing video games&rdquo, and &ldquo, playing sports with parents or caregivers&rdquo, (p &lt, 0.05). Conclusions: Association between the times spent watching TV or playing video games and the practice of physical exercise in the family proves once again the importance of the family in education for the health of children. The school provides direct access to schoolchildren and their parents to launch numerous health education programs.

Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical implications. The aim of this article is to analyze the health problems and the functional and social situation of chronic patients after hospital admission in order to determine their care needs and the ethical implications these might have. For this, a cross-sectional descriptive study is being carried out with a sample of 111 chronic pluripathological patients admitted to the internal medicine service and discharged later. Overall, 96.6% of the patients in the sample were dependent, 91.7% had social problems or were at social risk and 36.9% had cognitive impairment. Among dependent patients, 59.4% had social problems (p = 0.029), 19.2% lived alone (p = 0.13), and in 73.3% of cases the housing was inadequate (p = 0.47). Among those with cognitive impairment, 79.5% of patients had social problems (p = 0.001), and 10.3% lived alone (p = 0.038). The results of the study confirm the presence of dependence and social problems at hospital discharge in a high proportion of chronic patients. Planning their care can lead to ethical conflicts related to the use of information technologies, which are destined to promote the patients&rsquo, autonomy, and to the social problems associated with the illness.

Our work describes embryonic, larval, and juvenile development of Euvola vogdesi and shows results of experimental larval culture of this species. Broodstock in the conditioning system reached total maturity of the gonad at 42 ± 5 days. Breeders were induced to spawning with thermal shock methods (18- 28°C/20 min) and with intragonadal serotonin injection (0.3 mL to 0.25 mM). The experiments of temperature effect on larval growth (20, 23, and 25°C) showed that the highest growth in shell length was achieved at 25°C. Larval growth achieved in 1992, 1999, and 2001 showed significant differences. After 9 years of technical improvements to optimize larval production, we have been able to decrease culture time from 25 to 11 days from fertilization to the plantigrade stage. After metamorphosis, postlarvae developed ornamentation in the disoconch, acquiring the species typical morphology. Juveniles from 3.5-4.0 mm in length had a survival of 3- 5%, at 55 ± 5 days in pre-fattening. Juveniles of 6-7 mm in length showed the characteristic valves of adults after 20-25 days of fattening.

A study on the dynamic of transport and occurrence of ozone in the air basin of the Puebla-Tlaxcala Valley (PTV) was performed between March and April 2012. The ozone (O 3 ), nitrogen oxides (NOx) and several meteorological variables were measured at the surface level in the rural sites of Huaquechula (HUAQ), Chipilo (CHIP), and Amozoc (AMOZ). The vertical O 3 profile and the associated meteorological conditions, were measured intermittently in CHIP. The 1 hour Mexican air quality standard of 0.095 ppm for O 3 , was exceeded in five and one days in CHIP and AMOZ, respectively. A rapid increase in the morning for O 3 levels was observed in the three sites and was associated with the mixing of O 3 above the inversion layer once started the growing of the turbulent mixing layer. Unusual O 3 evening events of around 0.080 ppm were recorded for several hours in the three sites that could be associated with the recirculation of air masses with ozone formed within the VPT and O 3 advectively transported from the Cuernavaca-Cuautla Valley. The vertical O 3 profile showed an increase with height at concentrations even higher than those observed at the surface, and the 2-D analysis of backward trajectories suggested favorable conditions for O 3 transported from the free troposphere to the surface. It is concluded that the implementation of control strategies in the VPT should consider the influence of the inter-basin exchange, the meteorological local and synoptic seasonality, and the possible contributions of O 3 from the free troposphere and not be limited to local conditions.

Preventive measures are a priority in those groups that perform intense physical efforts without physical preparation and that can also be overweight or obese. One of the groups that reflect these characteristics is the costaleros of the Holy Week of Andalusia, Spain. This paper aims to describe the effect of obesity on blood pressure. A descriptive cross-sectional study was conducted on 101 costaleros. The anthropometric measures were determined through segmental impedance. Cardiac recovery and anaerobic power were measured through the Ruffier&ndash, Dickson test and the Abalakov test, respectively. Blood pressure was measured when the individuals were at rest. The Kruskal&ndash, Wallis test was applied for of continuous parameters and the X2 test for dichotomous measures. Binary logistic regression models were used for the subsequent analysis with R-square and Receiver Operating Characteristic (ROC) curves. The average population was 28 years of age, 173.7 cm tall, and 82.59 Kg weigh. The excess of body fat was 11.27 Kg and Body Mass Index was 27.33 Kg/m2. 72.3% showed abnormal blood pressure and 68.2% were overweight. 32.7% had a waist-hip ratio higher than 0.94. The probability of presenting abnormal blood pressure was higher among the subjects whose fat content was higher and muscle content was lower.

This is the first evaluation of growth and survival of spat of the Cortez oyster Crassostrea corteziensis (Hertlein) produced under controlled conditions in a coastal area in the state of Sonora, Mexico for aquaculture purposes. A suspended culture technique, used for the Pacific oyster C. gigas, was used. The Cortez oyster has an isometric shell growth during the first 13 months, reaching 71.3±1.9 mm length, 52.6±1.3 mm thickness and 25.1±0.8 mm width. Allometric growth was found between total weight and length, thickness and width (survival was 70%). The relationships between particulate organic, inorganic material, chlorophyll a and environmental parameters with growth are described. Growth rates of C. corteziensis were affected by temperature with retardation at less than 18°C. For aquaculture purposes, it is recommended that spat be sowed after winter, and oyster harvest occur at the end of autumn. According to the von Bertalanffy equation, Cortez oysters would reach the traditional exploitation size of 65 mm (mean length) at harvest. Finally, the results of this study have shown that C. corteziensis is a good candidate for aquaculture projects in this region.

Occurrence and level of hydrolytic enzymatic activity (proteases, glycosidases, phosphatases, lipases, and esterases) were studied in oocytes, larvae, juveniles, and adult haemolymph of the Pacific oyster Crassostrea gigas. Samples were obtained as oocyte lysate supernatant, larval homogenate supernatant, juvenile homogenate supernatant, haemocyte lysate supernatant, and plasma. The presence of enzymes was demonstrated by colorimetric and lysoplate assay techniques. Between stages, significant differences in enzymatic activity determined by the colorimetric technique were found. Higher levels of enzymatic activity were found in the adult stage. Lysozyme-like activity was not found in oocytes, but was present in larvae, juveniles, and adults. In larvae, the highest lysozyme-like activity was in 3-d larvae. Juveniles had a 48-fold higher level of lysozyme-like activity, compared with 20-h larvae and was six-fold higher compared with 3-d larvae. In adults, lysozyme-like activity had a five-fold higher level in haemocyte lysate supernatant compared with plasma and was 98-fold higher compared with 20-h larvae. As determined with the API ZYM kit, 19 hydrolytic enzymatic activities were present, in oocytes, larvae, juveniles, and adult haemolymph of C. gigas. The presence of important lysozyme-like activity was confirmed from trochophora larvae (20 h) to adult stages.

Limited empirical evidence exists for how economic conditions affect micronutrient nutrition. We hypothesized that increasing poverty and rising food prices would reduce consumption of high-quality “luxury” foods, leading to an increased probability of inadequacy for several nutrients. The 2006 Guatemala National Living Conditions Survey was analyzed. First, energy and nutrient intakes and adequacy levels were calculated. Second, the income-nutrient relationships were investigated by assessing disparities in intakes, determining income-nutrient elasticities, and modeling nutrient intakes by reductions in income. Third, the food price-nutrient relationships were explored through determination of price-nutrient elasticities and modeling 2 price scenarios: an increase in food prices similar in magnitude to the food price crisis of 2007– 2008 and a standardized 10% increase across all food groups. Disparities in nutrient intakes were greatest for vitamin B-12 (0.38 concentration index) and vitamin A (0.30 concentration index); these nutrients were highly and positively correlated with income (r = 0.22–0.54; P , 0.05). Although the baseline probability of inadequacy was highest for vitamin B-12 (83%), zinc showed the greatest increase in probability of inadequacy as income was reduced, followed by folate and vitamin A. With rising food prices, zinc intake was most acutely affected under both scenarios (P , 0.05) and folate intake in the poorest quintile (+7 percentage points) under the 10% scenario. Price-nutrient elasticities were highest for vitamin B-12 and the meat, poultry, and fish group (20.503) and for folate and the legumes group (20.343). The economic factors of food prices and income differentially influenced micronutrient intakes in Guatemala, notably zinc and folate intakes. J. Nutr. doi: 10.3945/jn.111.157321.

Phenoloxidase (PO) activity was studied in larval and juvenile homogenates and in the plasma and haemocytes of adult Crassostrea gigas, Argopecten ventricosus, Nodipecten subnodosus, and Atrina maura. Samples were tested for the presence of PO activity by incubation with the substrate L-3, 4-dihydroxyphenylalanine using trypsin, alpha-chymotrypsin, laminarin, lipopolysaccharides (LPS), and sodium dodecyl sulphate (SDS) to elicit activation of prophenoloxidase (proPO) system. PO activity was not detected in larval homogenate. In juvenile homogenate, PO activity was found only in C. gigas and N. subnodosus. PO activity was present in adult samples and was enhanced by elicitors in the plasma of all species tested, but in haemocyte lysate supernatant (HLS) of only N. subnodosus. Activation of proPO by laminarin was suppressed by a protease inhibitor cocktail (P-2714) in plasma and HLS of all species tested.