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Gustavo F Gonzales,1–2 Vilma L Tapia,2 Alfredo L Fort,3 Ana Pilar Betran31Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, 2Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; 3Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandAbstract: A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01). The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01). On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01). More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes.Keywords: elective cesarean, emergency cesarean, geographical regions, cesarean rates over time, adverse outcomes, developing country

Summary: Exogenous opsins allow for in vivo interrogation of brain circuits at unprecedented temporal and spatial precision. Here, we found that optical fiber laser stimulation at wavelengths of 637, 594, or 473 nm within the cortex of mice lacking expression of exogenous opsins resulted in a strong neuronal response in the contralateral visual cortex. Evoked responses were observed even at low laser intensities (fiber tip power 1 mW) and most pronounced at 637 nm. We took advantage of retinal light adaptation by using a dim external light source (20 lux) that abolished the 594 and 473 nm-evoked neuronal responses even at high laser intensities (15 mW). The prevention of 637 nm-evoked responses, however, could only be achieved for stimulation intensities ≤ 2.5 mW. This highlights the need for careful selection of light wavelengths and intensities for optogenetic experiments. Additionally, retinal light adaptation offers an effective solution to minimize unintended activation.

Introdução: A tomografia computadorizada de tórax é muito útil na avaliação do comprometimento pulmonar nos pacientes com SARS-CoV-2 (COVID-19), pois fornece informações sobre a natureza, extensão e progressão do dano tecidual, porém, atualmente essa análise é subjetiva. Propôs-se uma análise computacional detalhada de regiões pulmonares específicas em pacientes com COVID-19 para melhorar a compreensão geral dos danos pulmonares e prognóstico do indivíduo. Objetivo: Realizar estudo de comprometimento pulmonar computadorizado através de subsegmetação, em hospitalizados pela COVID-19 comparado à outras infecções pulmonares COVID-19 negativas. Método: Foram selecionados 333 indivíduos adultos com síndrome respiratória aguda, em um hospital universitário, em 2020-2021 e TC à admissão. 190 possuíam diagnóstico molecular positivo para COVID-19 e 143 eram negativos. Usou-se software de segmentação 3D Slice. As quantificações foram extraídas como o volume percentual do volume total de ambos os pulmões e classificadas usando as unidades Hounsfield (HU): enfisema (−1050 HU a −950 HU); pulmão inflado (−950 HU a −750 HU); opacidade (−750 HU a −400 HU); e colapso (−400 HU a 0 HU). A quantificação por Python foi desenvolvida pelos próprios autores. As comparações entre grupos foram feitas por teste t de Student e Teste t de Welch; o teste de Tukey foi usado para determinar diferença entre grupos. Considerado p ≤ 0,05. Resultados: Indivíduos COVID-19 positivos apresentaram alterações significativas nas regiões posteriores mediais direita e esquerda de ambos os pulmões. As porcentagens foram mais elevadas em volume de acometimento, opacidade, colapso e áreas afetadas, o que indica piores condições pulmonares nesses pacientes. Já o grupo negativo, apresentou porcentagens mais elevadas de pulmão inflado e enfisema, especialmente nas regiões posterior e anterior medial esquerda. Não foram observadas diferenças entre o pulmão direito e esquerdo. Conclusão: Através da segmentação computacional avançada e análise quantitativa foram fornecidos detalhes do impacto da COVID-19 na estrutura e função pulmonar, apresentando diferenciação clara entre grupos, sendo a região medial posterior de ambos os pulmões a mais danificada nos casos positivos. Os volumes pulmonares colapsados ??são mais intensos nos que não sobreviveram, especialmente, nas regiões pulmonares do pulmão direito. Isto indica uma forte associação entre volume pulmonar direito colapsados ??e mortalidade à TC na admissão, indicando necessidade de ventilação mecânica precoce.

Abstract Rationale Short‐term weight loss is possible in a variety of settings. However, long‐term, free‐living weight loss maintenance following structured weight loss interventions remains elusive. Objective The purpose was to study body weight trajectories over 2 years of intensive lifestyle intervention (ILI) and up to 4 years of follow‐up versus usual care (UC). Methods Data were obtained from electronic medical records (EMRs) from participating clinics. Baseline (Day 0) was established as the EMR data point closest but prior to the baseline date of the trial. The sample included 111 ILI and 196 UC patients. The primary statistical analysis focused on differentiating weight loss trajectories between ILI and UC. Results The ILI group experienced significantly greater weight loss compared with the UC group from Day 100 to Day 700, beyond which there were no significant differences. Intensive lifestyle intervention patients who maintained ≥5% and ≥10% weight loss at 24 months demonstrated significantly greater weight loss (p

A gravidez envolve alterações metabólicas em que a mulher precisa adaptar-se para manutenção e boa evolução do estado gravídico, sabe-se que inúmeros riscos especialmente os associados a descompensação de alguma doença crônica como hipertensão, obesidade e diabetes são potencializados durante a gravidez. Além de que as influências ambientais são capazes de gerar gatilhos para estresses e interferir no desenvolvimento do feto isso inclui a pandemia do novo coronavírus. Objetivo: Conhecer as principais indicações de interrupções da gravidez antes e durante a pandemia da Covid-19. Procedimentos metodológicos: Trata-se de estudo de caráter observacional realizado numa maternidade universitária de complexidade terciária no município de São Luís, durante o ano de 2018 e 2020, foram analisados os hemogramas, o perfil sociodemográficos e obstétricos de 133 mulheres. Resultados: Foi identificado correlação dos valores de hemoglobina com o peso do recém-nascido e os valores das plaquetas com idade gestacional e tempo de internação, além de que a principal causa de interrupção foi associada a descompensação de fatores pressóricos, especialmente a pré-eclampsia. Conclusão: Por ser a pré-eclampsia a principal causa de óbito materno sugere-se observação rigorosa dos resultados previstos no hemograma que se associam com o desenvolvimento de complicações cardiovasculares como as concentrações de hemoglobina e plaquetas, sobretudo pelos profissionais de atuação na atenção primária por ser principal porta de acesso às gestantes, afim de identificar os fatores de riscos precocemente e minimize os impactos pelas morbidades associadas ao período reprodutivo.

El artículo 220 del Código Civil permite al juez declarar de oficio la nulidad de un acto jurídico, pero solo si es ‘manifiesta’. Esta capacidad del juez ha generado dos interrogantes importantes: ¿qué pasos debe seguir el juez para declarar la nulidad de oficio? y ¿cómo se distingue una nulidad manifiesta de una no manifiesta? En esa línea, el autor del presente trabajo aborda la primera interrogante haciendo un análisis extenso de lo expuesto en distinta jurisprudencia (expedientes del Tribunal Constitucional y plenos casatorios). Sin embargo, hay un gran trabajo por delante en cuanto a la uniformización de la jurisprudencia, así como para alcanzar una correcta articulación entre esta y la doctrina. Así, el autor resalta la idea y la necesidad de encontrar un mecanismo de pasos para la declaración de nulidad que contemple los principios del debido proceso y a la vez sea restrictivo y eficiente frente a los usos de las partes.

IntroductionRacial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States.Methods and analysisThis study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States’ vulnerable communities.DiscussionFindings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

This experiment (N = 1,019) examined how a state of processing fluency, induced through either an easy or difficult task (reading a simple vs. complex message or recalling few vs. many examples) impacted participants’ ability to subsequently detect misinformation. The results revealed that, as intended, easier tasks led to higher reports of processing fluency. In turn, increased processing fluency was positively associated with internal efficacy. Finally, internal efficacy was positively related to misinformation detection using a signal detection task. This work suggests that feelings of ease while processing information can promote confidence and a more discerning style of information processing. Given the proliferation of misinformation online, an understanding of how metacognitions – like processing fluency – can disrupt the tacit acceptance of information carries important democratic and normative implications.

Vasconcellea, the most abundant genus within the Caricaceae family, encompasses twenty-one out of the 35 species in the family, predominantly found in Peru, Ecuador, and Colombia, where they are utilized for both culinary and medicinal purposes. This study investigates the research trends, patents, and nutritional and functional potential of three native Ecuadorian species in the genus: Vasconcellea stipulata V.M. Badillo (toronche), Vasconcellea pubescens (V.M. Badillo) (chamburo), and their natural hybrid Vasconcellea x pentagona V.M. Badillo (babaco). Utilizing bibliometric analysis via a Scopus dataset of 117 documents and sixteen unique patents through Patentscope. Our findings reveal V. pubescens as the most studied species, followed by V. x pentagona and V. stipulata, with scientific production primarily originating from Chile, Brazil, Ecuador, and the United States. Patents focus on V. pubescens, particularly in cultivation and applications of protease and alcohol acyltransferase enzymes. Gastronomically, these species find common usage in jams, juices, and preserves and ritual beverages, with limited innovation. Food technology uses are mainly meat tenderization and beer clarification. Rich in nutrients, all three species offer health and dietary benefits, accompanied by diverse functional activities including anticancer, anti-inflammatory, antioxidant, antiparasitic, and antiseptic properties. Thirty-seven bioactive compounds, including organic acids, carotenoids, esters, alkaloids, phenolic compounds, amino acids, isothiocyanates, alcohols, tocopherols, and phytosterols, were reported across the species. This study underscores the global and local economic, industrial, and health-related significance of Vasconcellea species, while also indicating directions for further research and exploration to realize their full potential.

Abstract Background Bovine genital campylobacteriosis (BGC) is caused by Campylobacter fetus subsp. venerealis (Cfv) including its biovar intermedius (Cfvi). This sexually transmitted disease induces early reproductive failure causing considerable economic losses in the cattle industry. Using a collection of well-characterized isolates (n = 13), C. fetus field isolates (n = 64) and saprophytic isolates resembling Campylobacter (n = 75) obtained from smegma samples of breeding bulls, this study evaluated the concordance of the most used phenotypic (H2S production in cysteine medium and 1% glycine tolerance) and molecular (PCR) methods for the diagnosis of BGC and assessed possible cross-reactions in the molecular diagnostic methods. Results Characterization at the subspecies level (fetus vs. venerealis) of C. fetus isolated from bull preputial samples using phenotypic and molecular (PCR targeting nahE and ISCfe1) methods showed moderate concordance (κ = 0.462; CI: 0.256–0.669). No cross-reactions were observed with other saprophytic microaerophilic species or with other Campylobacter species that can be present in preputial samples. Whole genome sequencing (WGS) of discrepant isolates showed 100% agreement with PCR identification. For the differentiation of Cfv biovars, comparison of the H2S test (at 72 h and 5 days of incubation) and a PCR targeting the L-cysteine transporter genes showed higher concordance when H2S production was assessed after 5 days (72 h; κ = 0.553, 0.329–0.778 CI vs. 5 days; κ = 0.881, 0.631–1 CI), evidencing the efficacy of a longer incubation time. Conclusions This study confirmed the limitations of biochemical tests to correctly identify C. fetus subspecies and biovars. However, in the case of biovars, when extended incubation times for the H2S test (5 days) were used, phenotypic identification results were significantly improved, although PCR-based methods produced more accurate results. Perfect agreement of WGS with the PCR results and absence of cross-reactions with non-C. fetus saprophytic bacteria from the smegma demonstrated the usefulness of these methods. Nevertheless, the identification of new C. fetus subspecies-specific genes would help to improve BGC diagnosis.

Abstract Background The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala’s public primary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innovative application of systems thinking visuals. Methods Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic’s onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff), we evaluated dimensions of “Reach, Effectiveness, Adoption, Implementation and Maintenance,” RE-AIM (Reach, Implementation delivery + adaptations), and “Practical Robust Implementation and Sustainability Model,” PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representativeness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019–July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/PRISM and health districts to identify equity and sustainability considerations. Results Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, program champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated inequities. However, adaptations that were planned enhanced implementation delivery and may have supported improved equity and sustainability. Conclusions Recognition of an EBI’s benefits and program champions are important for supporting initial uptake. The ability to plan adaptations amid rapid contextual changes has potential advantages for sustainability and equitable delivery. Systems thinking tools and mixed methods approaches may shed light on the relations between context, adaptations, and equitable and sustainable implementation. Trial registration NCT03504124