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International audience; Background: Streptococcus equi subspecies equi (S.equi) is the cause of the highly contagious equine respiratory disease ‘strangles’. Approximately 10% of recovered animals can persistently carry the bacteria and transmit it to naïve animals. The global movement of horses is an ideal mechanism for widespread transmission to geographically distant locations.Objectives: Utilise whole-genome sequence data to disentangle the transmission of S. equi and subsequent outbreaks of strangles.Study design: In vitro analysis of micro-organisms.Methods: Isolates (n = 670) of S. equi were recovered from clinical samples submitted to multiple collaborating clinics and institutions globally. Following species confirmation, isolates underwent whole-genome sequencing using Illumina technology. Sequence reads passing quality control measures were assembled and uploaded to Pathogenwatch, which assigned a phylogeny based upon sequences of core genome alleles. Population structure was inferred using the population mixture analysis in BAPS.Results: BAPS clustered the isolates into six different clusters (BAPS 1-6) and showed dominant lineages in different geographical areas but also global transmission within the clusters. Sub-groups within the clusters highlighted multiple outbreaks at local, national and international scales and highlighted population structures and transmission dynamics within single locations. For example, four different strains collected over just seven months were identified in a single location. Sequence data also identified a statistically significant decline in BAPS-5 since 2010.Main limitations: Pathogenwatch has shown its utility in investigating S. equi transmission and population structure. However, it is based upon a curated set of 1286 core genome loci. Further investigations will need to be conducted using the full spectrum of data available from whole-genome sequencing.Conclusions: Pathogenwatch was used as a tool to rapidly identify and visualise the whole-genome sequence data of a large S. equi dataset. The data demonstrate widespread transmission of multiple S. equi lineages and provide strong evidence that asymptomatic carrier horses are perpetuating this dissemination.

Sustainability is becoming of vital importance in project management, and a life cycle assessment (LCA) can ensure a body of knowledge to bear in mind the environmental burdens the project involves. In this study, two different ways of supplying energy to a sensor network are analyzed. Firstly, we analyze the environmental impact of the devices connected to the public grid. Secondly, we analyze the completely full off-grid system, with the sensor connected to a photovoltaic (PV) panel. Our findings show that the off-grid option has a greater number of benefits than the grid-connected option in terms of environmental impacts, although it is less economically advantageous. In a detailed analysis of the off-grid scenario, it can be observed that the battery is the component with the highest impact, so actions to try to reduce consumption, and, therefore, the battery size and its negative impact are taken. After reducing the battery size, the break-even point was reached, providing a net economic benefit of EUR 0.23 sensor/year. However, this analysis refers to a single sensor, and although the environmental and economic benefits seem low, in an economy of scale, this could result in large savings if these types of sensors are massively installed.

The equine disease strangles, which is characterized by the formation of abscesses in the lymph nodes of the head and neck, is one of the most frequently diagnosed infectious diseases of horses around the world. The causal agent, Streptococcus equi subspecies equi , establishes a persistent infection in approximately 10 % of animals that recover from the acute disease. Such ‘carrier’ animals appear healthy and are rarely identified during routine veterinary examinations pre-purchase or transit, but can transmit S. equi to naïve animals initiating new episodes of disease. Here, we report the analysis and visualization of phylogenomic and epidemiological data for 670 isolates of S. equi recovered from 19 different countries using a new core-genome multilocus sequence typing (cgMLST) web bioresource. Genetic relationships among all 670 S. equi isolates were determined at high resolution, revealing national and international transmission events that drive this endemic disease in horse populations throughout the world. Our data argue for the recognition of the international importance of strangles by the Office International des Épizooties to highlight the health, welfare and economic cost of this disease. The Pathogenwatch cgMLST web bioresource described herein is available for tailored genomic analysis of populations of S. equi and its close relative S. equi subspecies zooepidemicus that are recovered from horses and other animals, including humans, throughout the world. This article contains data hosted by Microreact.

Intermediate care units (ImCUs) have been shown as appropriate units for the management of selected septic patients. Developing specific protocols for residents in training may be useful for their medical performance. The objective of this study was to analyze whether a simulation-based learning bundle is useful for residents while acquiring competencies in the management of sepsis during their internship in an ImCU. A prospective study, set in a tertiary-care academic medical center was performed enrolling residents who performed their internship in an ImCU from 2014 to 2017. The pillars of the simulation-based learning bundle were sepsis scenario in the simulation center, instructional material, and sepsis lecture, and management of septic patients admitted in the ImCU. Each resident was evaluated in the beginning and at the end of their internship displaying a sepsis-case scenario in the simulation center. The authors developed a sepsis-checklist that residents must fulfill during their performance which included 5 areas: hemodynamics (0–10), oxygenation (0–5), antibiotic therapy (0–9), organic injury (0–5), and miscellaneous (0–4). Thirty-four residents from different years of residency and specialties were evaluated. The total median score (interquartile range) increased significantly after training: 12 (25) vs 23 (16), P = .001. First-year residents scored significantly lower than older residents at baseline: 10 (14) vs 14.5 (19), P = .024. However, the performance at the end of the training period was similar in both groups: 21.5 (11) vs 23 (16), P = 1.000. Internal Medicine residents scored significantly higher than residents from other specialties: 18 (17) vs 10.5 (21), P = .007. Nonetheless, the performance at the end of the training period was similar in both groups: 24.5 (9) vs 22 (13), P = 1.000. Combining medical simulation with didactic lectures and a rotation in an ImCU staffed by hospitalists seems to be useful in acquiring competencies to manage critically ill patients with sepsis. We designed a checklist to assure an objective evaluation of the performance of the residents and to identify those aspects that could be potentially improved.

This paper describes the characteristics of contributions made by researchers worldwide in the field of ELF (extremely low frequency) waves from 1957 to 2019. The data were collected through the Scopus database and processed with analytical and bibliometric techniques. The selection of the keywords is an essential step, because ELF has a very different meaning in some areas of medicine, where it is associated with a gene. A total of 12,436 documents were worked on in 12 thematic communities according to their collaborative relationships between authors and documents. Studies included authors publishing in the different thematic areas and the country where the USA stands first with more researchers in this theme than China and Japan. Documents were analyzed from the temporal perspective, their overall contribution, means of publication, and the language of the publication. Research requires extra effort and multidisciplinary collaboration to improve the knowledge, the application, and influence of these fields

This paper describes the characteristics of contributions made by researchers worldwide in the field of ELF (extremely low frequency) waves from 1957 to 2019. The data were collected through the Scopus database and processed with analytical and bibliometric techniques. The selection of the keywords is an essential step, because ELF has a very different meaning in some areas of medicine, where it is associated with a gene. A total of 12,436 documents were worked on in 12 thematic communities according to their collaborative relationships between authors and documents. Studies included authors publishing in the different thematic areas and the country where the USA stands first with more researchers in this theme than China and Japan. Documents were analyzed from the temporal perspective, their overall contribution, means of publication, and the language of the publication. Research requires extra effort and multidisciplinary collaboration to improve the knowledge, the application, and influence of these fields.

Nowadays, both, the number of observations and the accuracy of satellite-based geodesic measurements, like GNSS, have increased. Therefore, GNSS provides more data as displacement values and velocities. This paper demonstrates that GNSS data analysis is a powerful tool to study geodynamic processes.In this study, the analyzed GNSS data correspond to continuously recorded GPS (CGPS) stations, what we call the SPINA network. These stations are located in a region called Ibero-Maghrebian which includes the southern areas of the Iberian Peninsula and northern Africa.The CGPS stations are included in the following organizations: RENEP (National Network of Permanent Stations), RAP (Andalusian Positioning Network), the Murcia Region CGPS Networks, ERVA (Valencian Reference Stations Network), IGN (National Geographic Institute) and the network TOPOIBERIA. The velocity was obtained in two steps: (1) preprocessing position time-series data of daily GPS measurements and (2) applying a combined model using the weighted least-squares method.The prior knowledge of the crustal strain rate tensor provides a description of geodynamic processes such as the fault strain accumulation.Based on the distribution of the GNSS stations, several grid sizes were tested to identify the best resolution. A Python script was used to compute the full two-dimensional velocity gradient tensor by means of inverting the GNSS velocities. The tensorial analysis provides different aspects of deformation, such as the maximum shear strain rate, including its direction, and the dilatation strain rate. These parameters can be used to characterize the mechanism of the current deformation.Based on the computations from the GNSS-data model of components of horizontal deformations, the rates of both principal, values and axes, of the Earth’s crust deformation were found. Deformations measured in the Ibero-Maghrebian region with GPS could be interpreted in terms of either elastic loading or ductile deformation.

The northwest of South America is conformed by the territories of Ecuador, Colombia and Venezuela. Great part of these territories make up the Northern Andes Block (BAN). The tectonic and volcanic activity in the northwest of South America is directly related to the interaction of the South American plate, and the Nazca and Caribbean plates, with the Maracaibo and Panama-Chocó micro plates. The high seismic activity and the high magnitude of the recorded earthquakes make any study necessary to define this complex geodynamic region more precisely. This work presents the velocity models obtained through GNSS-GPS observations obtained in public continuous monitoring stations in the region. The observations of the Magna-eco network (Agustín Codazzi Geographic Institute) are integrated with models already obtained by other authors from the observations of the GEORED network (Colombian Geological Service). The observations have been processed using Bernese software v.52 using the PPP technique; obtaining topocentric time series. To obtain the speeds, a process of filtering and adjustment of the topocentric series has been carried out. Based on this velocity model, regional structures have been defined within the Northern Andes Block through a differentiation process based on the corresponding speeds of the South American, Nazca and Caribbean tectonic plates. Local geodynamic structures within the BAN itself have been established through cluster analysis based on both the direction and the magnitude of each of the vectors obtained. Finally, these structures have been correlated with the most significant geodynamic elements (fractures, faults, subduction processes, etc.) and with the associated seismic activity.

Sorafenib is a multi-kinase inhibitor and a vascular endothelial growth factor (VEGF) inhibitor approved to treat patients with advanced hepatocellular carcinoma, renal cell carcinoma and differentiated thyroid carcinoma. Its most common side effects are asthenia/fatigue, skin toxicity, diarrhea and arterial hypertension. Reported respiratory adverse reactions include dyspnea, cough, pleural effusion and hoarseness. The aim of this report is to describe for the first time the occurrence of pneumatocele in two patients treated with Sorafenib. Patients had no respiratory symptoms and alternative diagnoses were ruled out. Primary tumors were different (liver metastases from a pancreatic neuroendocrine tumor and hepatocellular carcinoma) but both patients had been treated with yttrium 90 radioembolization 9 and 17 months before starting on Sorafenib, respectively. No complications occurred and Sorafenib withdrawal was followed by radiologic improvement.

The problem of finding an analytical solution for the circuit formed by a diode with series resistance (D-R circuit) has been investigated for a long time and several authors have proposed approximate solutions. Most solutions use the Lambert function and numerical methods. However, an analytical solution independent of experimental parameters is still missing to replace the D-R circuit with an analytical expression, in which only the diode and circuit parameters appear. In this paper, using a Taylor series expansion of the equation VD = f (VS, R, ID), we propose a new analytical solution that fits the exact solution with more accuracy than all known approximations. The average of the absolute error vector is the best, with an order of magnitude of difference compared to the other 3 approximations studied. This new function can be expressed by voltage analysis, which allows analytical solutions. Our solution may have many applications, such as a simple and accurate way, in circuit simulation programs or numerical calculation programs. In particular, it can be used as well in circuits with D-R branches, exponential amplifiers, logarithmic amplifiers and waveform shapers. On another level, a comparison with other state of the art approximations is presented.

SummaryWhat is known and objective Chylous ascites is a rare condition. The most frequent causes are lymphomas, solid malignancies, abdominal trauma and cirrhosis. Isolated case reports describe the relationship between calcium channel blockers (CCB) and chyloperitoneum. Lercanidipine is a third-generation dihydropyridine with low rate of adverse events. We describe a case of lercanidipine-induced chylous ascites. Case summary An 80-year-old white female with hypertension treated with lercanidipine, developed chylous ascites and abdominal pain after the dosage of the CCB was doubled. The initial suspicion was a hidden neoplasm, but after a thorough research, no apparent cause was detected and the symptoms resolved after the drug was suspended. What is new and conclusion Calcium channel blockers should be considered as possible causes in cases of chyloperitoneum of unknown aetiology.

In this paper, a real-time monitoring system is presented to be used for environmental parameters measurement in tourist caves that can be employed for getting a sustainable tourism. The system allows the registration of a lot of metadata (temperature, relative humidity, wind speed and direction, CO2, atmospheric pressure, rain, presence and visitor count) and it shows them via the Internet in real time anywhere. The system reports the data registered and stored as metadata in a database online. In the ”El Soplao” Cave in the North of Spain, this system, permits a high level of control and security of the influence of visitors on a day to day and the temporal evolution to medium and long term. These measurements allow developing a sustainable and profitable system where heritage management and tourism exploitation acquire a subordinate commitment to the welfare of the natural asset (Cave-Mine “El Soplao”); the alteration of the fragile microclimate inside the cave can damage or destroy the specific geologic formations that make the touristic cave. After the visits, the company managing the cave takes in charge monitoring the environmental parameters of the cave to regulate future visits. The temperature in the cave has ranges between 11 and 13.5 °C, a seasonal quasi-periodic maximum variation of ± 0.5 °C and depending on the temperature outside the cave and number of visitors; it is difficult to associate one with another because both happen in the same month. The relative humidity is around 70–95%, it has no correlation with the number of visitors accessing the cavity. The CO2 concentration in air is around 400–1000 ppm; it has a clear correlation with the number of visitors and cave area (the deepest present's higher level CO2). In conclusion, a cave is visited as long as its microclimate is maintained, thus the real-time system developed has been conceptualized for monitoring over time the relationship between the cave environment and a sustainable tourism. Monitoring can help to preserve the specific geologic formation and therefore to keep the touristic interest of the cave.

Deception Island (South Shetland Islands) is one of the most active volcanoes in Antarctica. In the 1988–1989 austral summer, after the most recent eruptive process on the island (1967–1970), monitoring of volcanic activity through geophysical and geodetic techniques was resumed by Spanish and Argentinean scientists. In order to monitor the island's tectonic and volcanic behavior, a geodetic network was deployed. Currently, this network consists of 15 geodetic benchmarks located around Port Foster, Deception's inner bay open to the sea. Two additional geodetic benchmarks were installed outside Deception Island to be used as reference benchmarks for the differential positioning strategy. Since 1991–1992, geodetic ground-displacement velocities between the successive austral summer Antarctic campaigns have been computed and analyzed. The overall geodynamic behavior of Deception Island within the South Shetland Islands, Antarctic Peninsula and Bransfield Basin regional environment has been analyzed from geodetic ground-displacements. Results obtained demonstrate that Deception and Livingston island have a similar behavior derived from the Bransfield Basin extension and the Phoenix micro-plate subsidence processes. However, Deception Island is also highly influenced by its volcanic activity. Deception Island's volcanic behavior between 1991 and 2018 is shown by the velocity field, strain tensors and pressure source evolution obtained from the ground-displacements at the geodetic benchmarks. During this time period, it is possible to identify different inflation and deflation phases separated by transitional (or mixed) stages of extension without uplift and compression without subsidence. The most representative inflation and deflation periods were analyzed in detail, to show how they correlate with high and low seismic activity, respectively. The transitional or mixed stages, seem to be the precursors of the next inflation or deflation phase being the Bransfield basin rifting and NW-SE extension the potential related process. Finally, we have analyzed the processes that occurred prior to the volcanic unrests of 1999–2000 and 2012–2013. In both cases, an increase in detected seismic activity and/or soil and seawater temperature was observed and a mixed phase of extension without uplift seems to be precursory to the volcanic unrest. The correlation between the inflation processes, identified by ground-displacement of the network geodetic benchmarks, the increase in seismicity and the increment of soil and seawater temperature makes these transitional mixed phases potential precursors of Deception Island's volcanic unrest periods. © 2019 Elsevier B.V.

The implantation of the Implantable Cardioverter Defibrillator (ICD) influences the psychological adjustment and the degree of subjective discomfort. The objective of this work was to analyze differences in psychological adjustment, fear of shocks and the degree of subjective discomfort derived from the illness depending on the reasons for implantation (primary vs secondary).A sample of 82 patients with an ICD, for primary (58.5%) or secondary (41.5%) prevention indications was studied. A sociodemographic and clinical questionnaire and List of Brief Symptoms (LBS-50) was used. Descriptive univariate and bivariate analysis, t-tests on mean differences for independent samples and z-tests on proportion differences were performed.Regarding psychological adjustment, 43.9% of the patients reported to have sleeping disorder, regardless the type of prevention. A greater percentage of patients of primary prevention had scored higher in clinical scales. The 29.4% of patients with secondary prevention reported to be afraid of experiencing some shock. The 25% of patients whose type of prevention was primary showed severe or moderate level of subjective discomfort derived from the illness compared with the 14.7% of the secondary prevention patients (p=0.7).The patients with an ICD show symptoms clinically significant in Psychoactivity, Obsession-Compulsion, Anxiety, Somatization, Sleeping disorders and Psychopathology Risk Index. Both groups, regardless the type of prevention showed a similar psychological adjustment. Regarding the fear of shocks and the degree of subjective discomfort derived from the illness, no statistically significant differences between the groups were found.La implantación del Desfibrilador Automático Implantado (DAI) influye en el ajuste psicológico y en el grado de malestar de los pacientes. El objetivo de este trabajo fue analizar las diferencias en el ajuste psicológico, el miedo a las descargas y el grado de malestar subjetivo derivado de la enfermedad en función del motivo de implantación (primaria frente a secundaria).La muestra fue de 82 pacientes portadores de un DAI, tanto por prevención primaria (58,5%) como secundaria (41,5%). Se utilizó un cuestionario sociodemográfico y clínico, así como el Listado de Síntomas Breves (LSB–50). Se realizaron análisis descriptivos univariados y bivariados, pruebas t de diferencias entre medias y pruebas z de diferencias entre proporciones.Respecto al ajuste psicológico, el 43,9% de los pacientes refirió tener alteraciones del sueño, independientemente del tipo de prevención. Un mayor porcentaje de pacientes de prevención primaria mostraron puntuaciones altas en escalas clínicas. El 29,4% de los pacientes de prevención secundaria mostró miedo a sufrir alguna descarga. El 25% de los pacientes cuyo motivo de implantación fue primario indicó un nivel moderado o intenso en cuanto al malestar subjetivo derivado de la enfermedad, comparado con el 14,7% de los pacientes de prevención secundaria (p=0,7).Los pacientes con DAI presentan síntomas clínicamente relevantes en Psicoreactividad, Obsesión-compulsión, Ansiedad, Somatización, Alteraciones del sueño y el Índice de riesgo psicopatológico. Independientemente del tipo de prevención ambos grupos muestran un ajuste psicológico similar. No se encuentran diferencias entre los grupos ni en el miedo a las descargas ni en el grado de malestar subjetivo.

Deception Island is an active volcano located in Bransfield Strait. Its volcanic activity is linked to the presence of gravity anomalies that influence the definition of the geoid. In this paper, a precise undulation geoid model (GeoiDEC14) has been computed from GPS, gravimetric and levelling measurements. GeoiDEC14 highlights local anomalies of the island that match with hot spots, such as the minimum values shown in Fumarole Bay and Whalers Bay (fumarole areas), or the maximum values found in the remains of lava at Colatinas, Black Glacier and Murature Point. Comparison of GeoiDEC14 with global models always shows negative values due to an average of 18.80 m for our model compared to 19.80–20.60 m for models such as ITSG-Grace2014s, EGM08, AIUG-Grace03s or EGM96. This difference is due to the lack of resolution of global models and to the volcanic activity on the island. To confirm the results, the same measurements were taken on nearby Livingston Island. The values of geoid undulation on this island reaffirm the lack of detail in the global geoid in the area, presenting an average of 18.90 m, similar to the average value of GeoiDEC14.

The frequencies between the ELF, ULF and VLF bands are widely used as indicators of the electrical activity in the atmosphere, as precursors of seismic activity and are of interest in the study of geophysical phenomena. These signal methods of analysis are varied, and among them, we find a method of averaged periodograms, which is based on the Fast Fourier Transform (FFT). In this type of analysis, the optimal number of segments to be averaged must be determined; however, there seems to be no satisfactory method for choosing them. In this paper, we provide a method that will allow us to select the optimal number of segments to be averaged.