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Background: Measles outbreaks increased worldwide during 2017-19. The largest outbreak in the World Health Organisation Western Pacific region occurred in the Philippines. The aim of this study was to summarise paediatric measles admissions to the national infectious diseases referral hospital in Manila during 2016 to 2019, and consider implications for the Philippines and the wider region. Methods: A retrospective single-centre observational study including 5,562 children aged under five years admitted with measles from January 2016 to December, 2019. We summarised sociodemographic and clinical characteristics, vaccine status, reported exposures and outcomes. Univariable and multivariable logistic regression analyses were undertaken to assess associations between different characteristics of hospitalised children and death. Findings: The median age of children hospitalised with measles was 11 months (interquartile range: 7-28). 84.5% of cases were reported not to have received any measles-containing vaccination (MCV). The case fatality rate was 3.2%, with 30% of deaths occurring among children aged less than 9 months. The following characteristics were associated with increased odds of death: admission during the period of the epidemic (adjusted odds ratio [AOR] 9.40, 95% CI 1.80-49.05), pneumonia (AOR 2.42, 95% CI 1.55-3.78), gastroenteritis (AOR 4.01, 95% CI 2.19-7.35), not receiving vitamin A supplementation (AOR 1.82, 95% CI 1.22-2.72), and not being vaccinated (AOR 2.09, 95% CI 1.07-4.07). Interpretation: No children died who had received two MCVs. MCV1 coverage in the Philippines declined to 72% in 2020. Routine immunization needs to be strengthened and earlier timing of MCV1 requires further evaluation to prevent further outbreaks. Funding Information: This work is in part funded by Nagasaki University (salary support for CS, KA, RN, KA, JS). Declaration of Interests: KM is a member of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization. The other authors declare no conflicting interests Ethics Approval Statement: The study was approved by the SLH research ethics and review unit (Ref: SLH-RERU-2020-010-E Ver 2) and the School of Tropical Medicine and Global Health, Nagasaki University ethical committee (Ref: NU_TMGH_2020-106-0). This was a retrospective analysis of routinely collected anonymised data thus patient or caregiver consent was not required.

espanolEn los ultimos anos, la introduccion de diversos medicamentos biologicos para el tratamiento de la psoriasis ha aumentado considerablemente el arsenal terapeutico del medico, con lo cual se ha logrado un fuerte impacto positivo en el control de la enfermedad. Con el fin de proveer de las mejores recomendaciones para el uso de estos biologicos en los pacientes afectados de psoriasis, el grupo mexicano de expertos en psoriasis PSOMEX ha formulado recomendaciones para mejorar la comprension y el posicionamiento terapeutico de este tipo de medicamentos. EnglishIn recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

KEY FINDINGS• Very low-quality evidence from a single retrospective study suggests that continuous renal replacementtherapy (CRRT) may reduce mortality among COVID-19 patients on invasive mechanical ventilation. Guidelinesrecommend CRRT for critically ill patients to minimize the risk of possible transmission, if this option is available.• Although uncommon, acute kidney injury (AKI) can occur in association with coronavirus disease 2019(COVID-19) and is associated with increased in-hospital mortality.• There are currently no published or ongoing clinical trials directly comparing dialysis modalities for acutekidney injury in COVID-19 patients.• In reducing the risk of transmission during dialysis: currently, there are no studies comparing one dialysismodality to another. The method of dialysis is still primarily determined by the clinical picture of the patient, theexpertise of the center, and the resources available. The American Society of Nephrology (ASN) recommendsCRRT over intermittent hemodialysis (IHD) for critically ill patients with COVID-19 to minimize patient contactwhen it is available, and resources allow. Otherwise, intermittent hemodialysis may be done provided that,infection control measures are strictly followed.• Several international and local guidelines recommend strict adherence to infection prevention and controlmeasures (e.g. hand hygiene, physical distancing, proper use of personal protective equipment (PPE), andcohorting of patients) who are undergoing dialysis.

Psoriasis is a chronic, autoimmune skin disease. In psoriasis, PON1 activity is diminished and peroxidation biomarkers are elevated. The most studied PON1 polymorphisms are rs662 (A G) and rs854560 (A T), which have been associated with the antioxidant activity of PON1, risk of cardiovascular diseases and psoriasis development. The aim of this study, was to determine the association of rs662 (A G) and rs854560 (A T) PON1 polymorphisms with psoriasis susceptibility in Western Mexico population. In this case-control study, we included 104 psoriasis patients and 124 control subjects. The genotyping of polymorphisms rs662 (A G) and rs854560 (A T) of PON1 was carried out by PCR-RFLPs. The lipid profiles were quantified by enzymatic colorimetric method, and PON1 activity was determined by spectrophotometry. The lipid profile levels, except HDL-C and atherogenic index, were higher in patients vs. controls. Patients presented lower paraoxonase and arylesterase activity. The G allele of rs662 (A G) is associated with risk for psoriasis, while the T allele of rs854560 (A T) is associated with low susceptibility to psoriasis. The AG haplotype was more frequent within the patient group (p 0.05). The AA and AG genotypes of rs662 (A G) and TT and AA genotypes of rs854560 (A T) are associated with lower PONase and ARE activity in patients vs. controls. Patients with the G allele of rs662 (G A) and T alleles of rs854560 (A T) show significant differences in the lipid levels in comparison to controls. These results suggest that carriers of G allele of rs662 (A G) present a greater susceptibility to psoriasis.

Making data broadly accessible is essential to creating a medical information commons (MIC). Transparency about data-sharing practices can cultivate trust among prospective and existing MIC participants. We present an analysis of 34 initiatives sharing DNA-derived data based on public information. We describe data-sharing practices captured, including practices related to consent, privacy and security, data access, oversight, and participant engagement. Our results reveal that data-sharing initiatives have some distance to go in achieving transparency.

Meaningful participant engagement has been identified as a key contributor to the success of efforts to share data via a “Medical Information Commons” (MIC). We present findings from expert stakeholder interviews aimed at understanding barriers to engagement and the appropriate role of MIC participants. Although most interviewees supported engagement, they distinguished between individual versus collective forms. They also noted challenges including representation and perceived inefficiency, prompting reflection on political aspects of engagement and efficiency concerns.

Advances in technologies and biomedical informatics have expanded capacity to generate and share biomedical data. With a lens on genomic data, we present a typology characterizing the data-sharing landscape in biomedical research to advance understanding of the key stakeholders and existing data-sharing practices. The typology highlights the diversity of data-sharing efforts and facilitators and reveals how novel data-sharing efforts are challenging existing norms regarding the role of individuals whom the data describe.

Introduction: Pilocytic astrocytomas (PA) are a common, benign childhood tumor known for their slow growth rates and excellent prognosis. The aim of our study was to characterize patient, tumor, and imaging-related risk factors for recurrence and progression of disease. Methods: We identified 116 patients with PA who underwent surgery at our institution between 2000 and 2015. Data were collected retrospectively from the clinical charts. Results: The mean age at resection was 7 ± 5 years (range 0.5–31) and mean follow-up was 6 ± 3 years. Initial resection was complete in 33 patients (29%), subtotal in 78 patients (67%), and biopsy in 5 patients (4%). A total of 45/116 (40%) patients experienced either recurrence or progression after initial resection with a mean time to recurrence or progression of 2.2 years. Bivariate analysis identified subtotal resection, tumor location, age at diagnosis, and imaging features (i.e., T2 invasion, exophytic component, hemorrhage, and solid tumors) as factors significantly associated with recurrence or progression (p < 0.05). Conversely, PAs that were completely resected, predominately cystic, and located in the cerebellum were significantly associated with no recurrence or progression (p < 0.05). Multivariate regression analysis narrowed down 4 robust risk factors: extent of resection, T2 invasion, predominantly solid lesions, and presence of an exophytic component (p < 0.05). Conclusion: Total surgical removal of PA has been the most important prognostic factor for the clinical course of PA. Our study reveals additional risk factors for the recurrence or progression of disease: tumor invasion, solid composition, and tumors with an exophytic component.

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Genomic databases support research intended to advance understanding, diagnosis, and treatment of disease. Utility is linked to diversity, and initiatives are seeking to enroll traditionally underrepresented groups such as people with disabilities. Commentators have called for adoption of a participant-centric approach to build trust and address barriers to inclusion. Complexities emerge, however, when minors are enrolled and whose perspective on their condition may with time diverge from their parents’ perspective. Public response to MSSNG, a genomic database focused on autism, and public discourse regarding neurodiversity reveal division regarding autism as a difference or identity versus a disease. We explore what it means for genomic databases enrolling individuals, particularly minors, with disabilities to be participant-centric when affected individuals disagree about the nature of their condition and research priorities, offering recommendations for participant engagement and measures when enrolling minors with conditions that are the subject of difference-disease debates.

This article is an attempt to answer the question, what are we being called to do as biblical scholars in Asia today? What is our calling? De riving inspiration from the story of the healing of the paralytic in Mark 2, this article critiques the traditional western biblical studies we inherited from the west. This approach sees the task of biblical studies as mere determination of “what the text meant in ancient times.” There is now acknowledgment that biblical studies is contextual. But this realization is also insufficient. There is a need to identify calls for a way of doing biblical studies that goes beyond the modern western approach to the discipline, which confines the text''s meaning to the ancient time. In stead, as reflected in the view of the Bible as Scripture.

Institutions direct the enduring features of political and social life and of all human behavior. While standard institutionalisms explain why these institutions continue to exist, they fall short in providing a coherent explanation for why they change. Similarly, the focus of mainstream theories of institutional change on crises as structures, disregarding agential properties, challenges their explanatory ability. Anchored on the theory of institutional change and through the utilization of archival research and documentary analysis, this paper addresses the transformation of domestic political institutions by determining the nature and direction of institutional change in the Benigno Simeon Aquino III (PNoy) administration's (2010–2016) e-governance agenda. His and the country's resolve to follow daang matuwid (straight and righteous path) saw the transformation of damaged public institutions into more transparent and responsive ones. This would not have been possible, even with the presence of both domestic and international triggers, had the President not used his institutional preferences and capacity to effectuate the change needed. Arguably, while the institutional context creates both opportunities and constraints for policy makers, the purposive actors decide whether to seek change in their structural environments. Keywords: anticorruption, e-governance, human agency, institutional change, institutions

We present the design of a portable version of our miniaturized laser heterodyne radiometer (mini-LHR) that simultaneously measures methane (CH(4)) and carbon dioxide (CO(2)) in the atmospheric column. The mini-LHR fits on a backpack frame, operates autonomously, and requires no infrastructure because it is powered by batteries charged by a folding 30 W solar panel. Similar to our earlier instruments, the mini-LHR is a passive laser heterodyne radiometer that operates by collecting sunlight that has undergone absorption by CH(4) and CO(2). Within the mini-LHR, sunlight is mixed with light from a distributive feedback (DFB) laser centered at approximately 1.64 μm where both gases have absorption features. The laser scans across these absorption features roughly every minute and the resulting beat signal is collected in the radio frequency (RF). Scans are averaged into half hour and hour data products and analyzed using the Planetary Spectrum Generator (PSG) retrieval to extract column mole fractions. Instrument performance is demonstrated through two deployments at significantly different sites in interior Alaska and Hawaii. The resolving power (λ/∆λ) is greater than 500,000 at 1.64 μm with precisions of better than 20 ppb and 1 ppm for CH(4) and CO(2), respectively. Because mini-LHR instruments are portable and can be co-located, they can be used to characterize bias between larger, stationary, column observing instruments. In addition, mini-LHRs can be deployed quickly to respond to transient events such as methane leaks or can be used for field studies targeting geographical regions.

A medical information commons (MIC) is a networked data environment utilized for research and clinical applications. At three deliberations across the U.S., we engaged 75 adults in two-day facilitated discussions on the ethical and social issues inherent to sharing data with an MIC. Deliberants made recommendations regarding opt-in consent, transparent data policies, public representation on MIC governing boards, and strict data security and privacy protection. Community engagement is critical to earning the public's trust.

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.

Objective: We evaluated the consumption of specific medications for treating cognitive symptoms associated with AD and other types of dementia in individuals over 60 years of age between 2006 and 2011 in the Basque Country. Methods: A retrospective descriptive study was conducted. The pharmacy division of the Basque Government Department of Health provided the prescribing data for the following drugs: donepezil, rivastigmine, galantamine, and memantine. The number of defined daily doses (DDDs) and the number of DDDs per 1000 inhabitants per day (DHD) were calculated. Results: Consumption increased by 49.72% between 2006 and 2011. There were marked differences between drugs (13.02% donepezil; 93.18% rivastigmine; 37.79% galantamine; 70.40% memantine) and Basque provinces (16.34% in Álava; 50.49% in Bizkaia; 57.37% in Gipuzkoa). Likewise, expenditure increased from €11.5 million in 2006 to €18.1 million in 2011. Conclusions: This study shows increased consumption of these drugs, although there are also marked differences by province which may be due to differences in prescribing habits. Spending for these drugs rose parallel to this increase in consumption; drug prices remained stable throughout the study period. Resumen: Objetivo: Este estudio evalúa el consumo de medicamentos para el tratamiento cognitivo de la EA y otras demencias en personas mayores de 60 años entre los años 2006 y 2011 en el País Vasco. Métodos: Se realizó un estudio descriptivo retrospectivo. La Dirección de Farmacia del Departamento de Salud del Gobierno Vasco facilitó los datos de prescripción de donepezilo, rivastigmina, galantamina y memantina. Se obtuvieron el número de dosis diarias definidas (DDD) y el número de DDD por 1.000 habitantes/día (DHD). Resultados: El consumo se incrementó un 49,72% durante el periodo 2006-2011, aumento que varió en función del medicamento (donepezilo 13,02%; rivastigmina 93,18%; galantamina 37,79%; memantina 70,40%) y del TTHH (Álava 16,34%; Bizkaia 50,49%; Gipuzkoa 57,37%). El gasto aumentó de 11,5 millones de euros en 2006 a 18,1 millones en 2011. Conclusiones: Se observó un aumento en el consumo aunque existen diferencias entre TTHH que pueden deberse a hábitos de prescripción diferentes. El gasto farmacéutico se incrementó paralelamente al aumento en el consumo, ya que el precio de los medicamentos permaneció estable en ese periodo. Keywords: Alzheimer disease, Dementia, Cholinesterase inhibitors, Memantine, Palabras clave: Enfermedad de Alzheimer, Demencia, Inhibidores de la colinesterasa, Memantina

Resumen: Objetivo: Este estudio evalúa el consumo de medicamentos para el tratamiento cognitivo de la EA y otras demencias en personas mayores de 60 años entre los años 2006 y 2011 en el País Vasco. Métodos: Se realizó un estudio descriptivo retrospectivo. La Dirección de Farmacia del Departamento de Salud del Gobierno Vasco facilitó los datos de prescripción de donepezilo, rivastigmina, galantamina y memantina. Se obtuvieron el número de dosis diarias definidas (DDD) y el número de DDD por 1.000 habitantes/día (DHD). Resultados: El consumo se incrementó un 49,72% durante el periodo 2006-2011, aumento que varió en función del medicamento (donepezilo 13,02%; rivastigmina 93,18%; galantamina 37,79%; memantina 70,40%) y del TTHH (Álava 16,34%; Bizkaia 50,49%; Gipuzkoa 57,37%). El gasto aumentó de 11,5 millones de euros en 2006 a 18,1 millones en 2011. Conclusiones: Se observó un aumento en el consumo aunque existen diferencias entre TTHH que pueden deberse a hábitos de prescripción diferentes. El gasto farmacéutico se incrementó paralelamente al aumento en el consumo, ya que el precio de los medicamentos permaneció estable en ese periodo. Abstract: Objective: We evaluated the consumption of specific medications for treating cognitive symptoms associated with AD and other types of dementia in individuals over 60 years of age between 2006 and 2011 in the Basque Country. Methods: A retrospective descriptive study was conducted. The pharmacy division of the Basque Government Department of Health provided the prescribing data for the following drugs: donepezil, rivastigmine, galantamine, and memantine. The number of defined daily doses (DDDs) and the number of DDDs per 1000 inhabitants/day (DHD) were calculated. Results: Consumption increased by 49.72% between 2006 and 2011. There were marked differences between drugs (13.02% donepezil; 93.18% rivastigmine; 37.79% galantamine; 70.40% memantine) and Basque provinces (16.34% in Áraba; 50.49% in Bizkaia; 57.37% in Gipuzkoa). Likewise, expenditure increased from €11.5 million in 2006 to € 18.1 million in 2011. Conclusions: This study shows increased consumption of these drugs, although there are also marked differences by province which may be due to differences in prescribing habits. Spending for these drugs rose parallel to this increase in consumption; drug prices remained stable throughout the study period. Palabras clave: Enfermedad de Alzheimer, Demencia, Inhibidores de la colinesterasa, Memantina, Keywords: Alzheimer disease, Dementia, Cholinesterase inhibitors, Memantine

The Kalipunan ng mga Katutubong Mamamayan ng Pilipinas (KAMP) or the National Alliance of Indigenous Peoples’ Organization in the Philippines is al- most in their 30 years of existence and yet, like in most cases of indigenous peoples’ issues, there is still no significant number of studies about their role in campaigning for the betterment of the Indigenous Cultural Communities. Anchored on political opportunity structures theory as a guide, the basic motiva- tion of the paper is to illustrate how the KAMP fights and survives through resource mobilization and how the government represented by National Commission on Indigenous Peoples (NCIP) and Department of Environment and Natural Resources (DENR) accommodate their interests. Using archival research, secondary data analysis, elite interview and participant observation, the paper asserts that KAMP’s use of their organizational structure, advocacy campaigns and political assaults as their basic resources to fight for the Nueva Vizcaya Mining issue are relatively insufficient to a centralist and relatively closed government, despite the presence of democratic institutions. The ability of the Philippine government to strike the balance between development and indigenous peoples’ rights pro- tection shall remain to be a defining feature if not a challenge to the quality of democracy and governance in our land

Background: Coronavirus disease 2019 (COVID-19) has spread to almost every region and country in the world, leading to widespread travel restrictions and national lockdowns. Currently, there are limited epidemiological and clinical data on COVID-19 patients from low and middle-income countries. We conducted a retrospective single-center study of the first 100 individuals with suspected COVID-19 (between Jan. 25 and Mar. 29, 2020) admitted to San Lazaro Hospital (SLH), the national infectious diseases referral hospital in Manila, Philippines. Results: Demographic data, travel history, clinical features, and outcomes were summarized and compared between COVID-19 confirmed and non-confirmed cases. The first two confirmed cases were Chinese nationals, admitted on Jan. 25. The third confirmed case was a Filipino, admitted on Mar. 8. Trends toward confirmed COVID-19 cases not reporting international travel and being admitted to SLH from the densely populated area of Manila city were observed during Mar. 8-29. All 42 of the 100 confirmed COVID-19 cases were adults, 40% were aged 60 years and above and 55% were male. Three were health workers. Among individuals with suspected COVID-19, confirmed cases were more likely to be older, Filipino, not report international travel history and have at least one underlying disease,particularly diabetes, report difficulty in breathing, and a longer duration of symptoms. In over 90% of non-COVID-19 cases, the alternative diagnosis was respiratory. Nine (21%) confirmed cases died. The median duration from symptoms onset to death was 11.5 (range: 8-18) days. Conclusions: Imported COVID-19 cases have reduced but local transmission persists and there is a trend toward cases being admitted to SLH from densely populated areas. This study highlights the difficulty in diagnosing COVID-19 on clinical grounds and the importance of diagnostic capacity in all settings. Difficulty of breathing was the only symptom associated with COVID-19 infection and should alert clinicians to the possibility of COVID-19. Clinical characteristics of confirmed COVID-19 cases and a hospital case fatality rate of 21% are comparable with other settings., Tropical Medicine and Health, 48(1), art.no.51; 2020

[EN] Different dopant strategies are currently under investigation in order to overcome the many problems that limit the commercial viability of BiFeO-based ceramic devices. Neodymium substitution onto the A site of the perovskite lattice provokes significant changes in the crystal structure of the parent material which can derive in enhanced multiferroic properties, but the conductivity in the bulk system is still too high. Titanium doping on the other hand generates a distinctive micro-nanostructure in the consolidated ceramics which can largely increase the dc resistivity of the whole material. A combination of these two effects is here attempted in a co-doping approach which evidences that the microstructural effect caused upon Ti-doping, provoking a reduction of the leakage currents, eventually allows the co-doped material to capitalize on the unique piezoelectric and magnetic properties structurally triggered by the Nd-doping., This work has been conducted in the frame of MAT2016-80182-R and MAT2014-59210-JIN research projects.

[EN] The conventional solid state processing of bulk Ti,Sm co-doped BiFeO ceramics typically produces a complex micro-nanostructure which exhibits an effective decrease of the leakage conductivity. This same nanostructured configuration however confines the mobility of the ferroelectric domains and in this way the potential piezoelectric response of the formulated composition remains restrained. Hereby, a two-step doping strategy based on a simple surface modification approach is proposed which eventually allows for suitably engineering the microstructural development of the material, leading to a coarsened configuration where the conductivity is kept in low levels while the piezoelectric response is satisfactorily released for practical purposes., [ES] El procesamiento convencional en estado sólido de materiales cerámicos en volumen deBiFeO3co-dopado con Ti y Sm, típicamente produce una compleja micro-nanoestructuraque permite una reducción efectiva de la conductividad eléctrica del material (corrientesde fuga). Sin embargo, esta misma configuración nano-estructurada también reduce lamovilidad de los dominios ferroeléctricos y por ello, la potencial respuesta piezoeléctricade la composición formulada permanece confinada. En este trabajo se propone el empleo de una estrategia de dopado en dos etapas, basada en una sencilla aproximación de modi-ficación superficial, con la cual es posible dise ̃nar y controlar adecuadamente el desarrollomicroestructural del sistema, dando lugar a un engrosamiento de la microestructura quepermite mantener la conductividad del material en bajos niveles al tiempo que libera sat-isfactoriamente su respuesta piezoeléctrica., This work was supported by the Spanish Ministry of Economyand Competitiveness (MINECO) through MAT2016-80182-Rand MAT2014-59210-JIN projects. Dr. T. Jardiel acknowledgesthe European Science Foundation (ESF) and the Ramon y Cajal Program of MINECO for the financial support. Dr. D.G.Calatayud also acknowledges the Fundación General CSIC(ComFuturo Program) for the financial support.

Primary hyperparathyroidism is one of the most frequent endocrine disorders. Its diagnosis is biochemical. Imaging techniques are not useful for the diagnosis of this pathology; they are just tools for pre-surgical localization. In this continuing education, we will analyze the different imaging modalities used in this indication, focusing on Nuclear Medicine. The most commonly used imaging technique in this context is the parathyroid scintigraphy, nowadays double phase protocol with

We hypothesized that total body strength (S) and hypertrophic (H) resistance training (RT) protocols using relatively short rest interval (RI) lengths between sets will elicit significant acute increases in total testosterone (TT) and cortisol (C) in healthy young men. Six men, 26 (±2.4) years, completed 4 randomized RT sessions, after a control session (R). The S and H protocols were equated for volume load (sets × repetitions × load); S: 8 sets × 3 repetitions at 85% 1RM, H: 3 sets × 10 repetitions at 70% 1RM, for all exercises. The RI used 60 seconds (S60, H60) and 90 seconds (S90, H90). Blood was drawn preexercise (PRE), immediately postexercise (POST), 15 minutes postexercise (15 MIN), and 30 minutes postexercise (30 MIN). The H60 elicited significant increases in TT from PRE (7.32 ± 1.85 ng·ml) to POST (8.87 ± 1.83 ng·ml(-1)) (p0.01), 15 MIN (8.58 ± 2.15 ng·ml(-1)) (p0.01), and 30 MIN (8.28 ± 2.16 ng·ml(-1)) (p0.05). The H90 also elicited significant increases in TT from PRE (8.37 ± 1.93 ng·ml(-1)) to POST (9.90 ± 1.25 ng·ml(-1)) (p0.01) and 15 MIN (9.46 ± 1.27 ng·ml(-1)) (p0.05). The S60 elicited significant increases in TT from PRE (7.73 ± 1.88 ng·ml(-1)) to 15 MIN (8.35 ± 1.64 ng·ml(-1)) (p0.05), and S90 showed a notable (p0.10) difference in TT from PRE (7.96 ± 2.29 ng·ml(-1)) to POST (8.75 ± 2.45 ng·ml(-1)). All the protocols did not significantly increase C (p0.05). Using relatively short RI between RT sets augments the acute TT response to hypertrophic and strength schemes. Shortening RI within high-intensity strength RT may lead to concomitant enhancements in muscle strength and size over a longer period of training.

Objective. To evaluate the prevalence of soil-transmitted helminth infections, anemia, and malnutrition among children in the Paucartambo province of Cusco region, Peru, in light of demographic, socio-economic, and epidemiologic contextual factors. Methods. Children from three to twelve years old from six communities in Huancarani district in the highlands of Peru were evaluated for helminth infections, anemia, and nutritional status. Data collected included demographic variables, socioeconomic status, exposures, complete blood counts, and direct and sedimentation stool tests. Results. Of 240 children analyzed, 113 (47%) were infected with one or more parasites. Giardia (27.5%) and Fasciola (9.6%) were the most commonly identified organisms. Eosinophilia was encountered in 21% of the children. Anemia (48.8%) was associated with age (3-4 vs 5-12 years old; odds ratio (OR): 5.86; 95% confidence interval (CI): 2.81-12.21). Underweight (10%) was associated with male sex (OR: 5.97; CI: 1.12-31.72), higher eosinophil count (OR: 4.67; CI: 1.31-16.68) and education of the mother (OR: 0.6; CI: 0.4-0.9). Stunting (31.3%) was associated with education of the mother (OR: 0.83; CI: 0.72-0.95); wasting (2.7%) was associated with higher eosinophil count (OR: 2.75; CI: 1.04-7.25). Conclusions. Anemia and malnutrition remain significant problems in the Peruvian highlands. These findings suggest that demographic factors, socio-economic status, and possibly parasitic infections intertwine to cause these health problems.

Background Travelers receive medical advice from a variety of sources, including travel agencies. The aim of this study is to describe the quality of pre-travel advice provided by travel agencies in Cuzco to travelers interested in visiting malaria and yellow fever endemic areas. Methods Trained medical students posed as tourists and visited travel agencies in Cuzco requesting travel advice for a trip to the southern Amazon of Peru, recording advice regarding risk and prevention of malaria and yellow fever. Results A total of 163 registered travel agencies were included in the study. The mean proposed tour duration was 6.8 days (±1.4 days) with a median time to departure of 3 days and a median tour cost of 805 US dollars (USD) [interquartile range (IQR) 580–1,095]. Overall, 45% employees failed to mention the risk for any illness. Eighteen percent of the employees acknowledged risk of malaria and 53% risk of yellow fever. However, 36% denied malaria risk and 2% denied risk of yellow fever in the region. The price of tours from travel agencies that did not mention any health risk was significantly lower [1,009.6 ± 500.5 vs 783.9 ± 402 USD, t (152) = 3, p

National and international public–private partnerships, consortia, and government initiatives are underway to collect and share genomic, personal, and healthcare data on a massive scale. Ideally, these efforts will contribute to the creation of a medical information commons (MIC), a comprehensive data resource that is widely available for both research and clinical uses. Stakeholder participation is essential in clarifying goals, deepening understanding of areas of complexity, and addressing long-standing policy concerns such as privacy and security and data ownership. This article describes eight core principles proposed by a diverse group of expert stakeholders to guide the formation of a successful, sustainable MIC. These principles promote formation of an ethically sound, inclusive, participant-centric MIC and provide a framework for advancing the policy response to data-sharing opportunities and challenges.

Background Clostridium difficile infection (CDI) rates suddenly increased 30%, coincident with adoption of a new electronic medical record (EMR) and a reduction in our Environmental Services (ES) workforce. A Targeted Assessment for Prevention (TAP) report suggested we had the greatest opportunity for improvement among Massachusetts hospitals. Senior leadership identified CDI as an institutional top priority. Methods We prospectively measured CDI rates, using CDC criteria. A multidisciplinary team applied root cause analysis to each case; many represented repetitive testing or did not meet criteria for clinically significant disease. We reviewed, revised, and reinforced already robust efforts regarding hand hygiene, environmental cleaning and disinfection, antimicrobial stewardship, and test ordering behaviors. We revised C. difficile testing guidelines in accord with IDSA/SHEA Guidelines and leveraged EMR orders to help providers test more appropriately. Limit testing to patients with ≥3 unformed stools/day. Exclude testing within 24 hours of laxative use. Lab rejects specimens within 7 days after negative result and within 28 days after positive result; orders expire after 48 hours. We compared monthly ES staffing (FTEs/1,000 patient-days) and CDI rates, using linear regression. Results C. difficile testing decreased 47%, from 358 to 188 tests per month (Figure 1). CDI rates decreased 39% in 1 year (from 141 to 83), reducing the rate of infection below expected (Figure 2). Despite improvement, 40–60% of CDI testing still occurs during laxative use. ES staffing rates were associated with 5.2% of CDI rate changes (P < 0.05); adequate staffing reduced CDI rates 44% (Figure 3). Conclusion Implementation of a new EMR brought to light over-diagnosis of hospital-acquired CDI, resulting in unnecessary isolation and treatment of patients without significant illness. Inadequate ES staffing correlates with increased CDI rates. These factors also contribute to vulnerability to CMS Hospital-Acquired Condition (HAC) penalties. Revising laboratory testing and laxative EMR orders is laborious but significantly reduces inappropriate testing. It is essential to have senior leadership endorsement to marshal quality improvement and EMR resources. Figure 1. Figure 2. Figure 3. Disclosures All authors: No reported disclosures.

Optical detection back-action in cantilever resonant or static detection presents a challenge when striving for state-of-the-art performance. The origin and possible routes for minimizing optical back-action have received little attention in literature. Here, we investigate the position and mode dependent optical back-action on cantilever beam resonators. A high power heating laser (100 mu W) is scanned across a silicon nitride cantilever while its effect on the first three resonance modes is detected via a low-power readout laser (1 mu W) positioned at the cantilever tip. We find that the measured effect of back-action is not only dependent on position but also the shape of the resonance mode. Relevant silicon nitride material parameters are extracted by fitting finite element (FE) simulations to the temperature-dependent frequency response of the first three modes. In a second round of simulations, using the extracted parameters, we successfully fit the FEM results with the measured mode and position dependent back-action. From the simulations, we can conclude that the observed frequency tuning is due to temperature induced changes in stress. Effects of changes in material properties and dimensions are negligible. Finally, different routes for minimizing the effect of this optical detection back-action are described, allowing further improvements of cantilever-based sensing in general.

There are numerous efforts to add value for telehealth applications in the country. In this study, the design of a telepresence doctor to facilitate remote medical consultations in the wards of Philippine General Hospital is proposed. This includes the design of a robot capable of performing a medical consultation with clear audio and video information for both ends. It also provides the operating doctor full control of the telepresence robot and gives a user-friendly interface for the controlling doctor. The results have shown that it provides a stable and reliable mobile medical service through the use of the telepresence robot.

This study presents the development of a system which can automatically recognize home appliances based on a dataset of electric consumption profiles. The authors report the creation of AGILASx, a dataset of 50 common home appliances and devices in the Philippines. The dataset is populated with 100 appliance signatures in .XML format acquired using plug-based sensors. Each appliance signature consists of the following electric characteristics: real power (W), apparent power (VA), reactive power (var), RMS current (A), RMS voltage (V) and Power Factor (PF). A machine learning approach was utilized for the recognition experiment following a set of test protocols — intersession and unseen instances. The baseline recognition algorithm used was the k-Nearest Neighbor (k-NN) for both test protocols and accuracy levels were collected over three different acquisition frequencies. Using results of the confusion matrices, best results were observed at acquisition frequency of 10−1 Hz for intersession (99%) and unseen instance (99%) test protocols. Lastly, to integrate the dataset and the recognition algorithm, a web application was developed adapting a Web-of-Things architecture to present a smart of recognized appliances and their corresponding consumption.

CO2 emissions in the atmosphere are increasing dramatically every year. Some organisms such as Ralstonia eutropha, have the ability to assimilate CO2 and convert it into value-added chemicals. The use of synthetic biology approaches may contribute for the bio-based economy to synthesize products such as bio-plastics. R. eutropha can be used as a cell factory for chemical production due to its diverse biochemical pathways for growth and biosynthesis that can achieve industrial production scale, but synthetic biology approaches still have to be enhanced pursuing the creation of robust industrial strains capable of producing chemicals that can compete with petroleum-derived product prices.

Bacterial diseases are probably the major cause of mortality in aquaculture. The use of probiotics is one of the solutions to manage bacterial infections, by preventing the colonization and exclusion of pathogenic bacteria. The effect of two selected probiotics in turbot (Psetta maxima) larvae was evaluated. Turbot larvae were reared on three different dietary treatments consisting of newly hatched Artemia nauplii from day 16 to 34 post-hatch. Groups A and B were fed with Artemia-containing probiotics FAA and FAB, respectively, and group C was control group. Results indicated that the addition of probiotics increased survival and promoted turbot growth, showing that they were beneficial for the aquaculture of turbot. Moreover, turbot fed with bioencapsulated probiotics attained higher percentages of survival during its development.

A practical and efficient treatment of PCBs (polychlorinated biphenyls) in transformer oil by a chemical dechlorination process has been reported. The transformer oil containing commercial PCB mixtures Sovtol-10 was treated by the required amounts of PEG 400 (polyethylene glycol 400) and powdered potassium hydroxide (KOH), along with different reaction times. The reaction of PEG with PCBs under basic condition produces arylpolyglycols and potassium chlorine. The relative efficiencies of PCB treatment process were assessed in terms of destruction and removal efficiency (DRE, %). Under the experimental conditions of KOH/PEG molar ratio 1.2:1, KPEG/oil 22:1 and three hours of reaction at 90 °C, average DRE of PCBs was approximately 99%, showing completely removal of PCBs containing 5-7 chlorines. In the sample remain the congeners 52 and 44 that are not reported as toxic by the WHO (World Health Organization). With the previously reported conditions the scale up of the process was realized.

Schinus molle L., also known as pepper tree, has been reported to have antimicrobial, antifungal, anti-inflammatory, antispasmodic, antipyretic, antitumoural and cicatrizing properties. This work studies supercritical fluid extraction (SFE) to obtain volatile and non-volatile compounds from the aerial parts of Schinus molle L. and the influence of the process on the composition of the extracts. Experiments were performed in a pilot-scale extractor with a capacity of 1 L at pressures of 9, 10, 12, 15 and 20 MPa at 323.15 K. The volatile compounds were obtained by CO2 supercritical extraction with moderate pressure (9 MPa), whereas the non-volatile compounds were extracted at higher pressure (12 to 20 MPa). The analysis of the essential oil was carried out by GC-MS and the main compounds identified were sabinene, limonene, D-germacrene, bicyclogermacrene, and spathulenol. For the non-volatile extracts, the total phenolic content was determined by the Folin-Ciocalteau method. Moreover, one of the goals of this study was to compare the experimental data with the simulated yields predicted by a mathematical model based on mass transfer. The model used requires three adjustable parameters to predict the experimental extraction yield curves.

Background Thoracoscopic talc insufflation (TTI) has been used to obliterate the pleural space and prevent recurrent pleural effusions or pneumothorax. Reports of acute pneumonitis and ARDS after the use of talc raised concern about its safety. Differences in particle size of various talc preparations may explain the variable occurrence of pneumonitis. We sought to determine the incidence of lung injury after TTI over a 13-year period at our institution. Methods Patients who underwent TTI between January 1994 and July 2007 were identified from a prospectively maintained logbook. The talc used was commercially available sterile talc (Sclerosol). The hospital course was reviewed in detail, and all cases of respiratory insufficiency were examined with regard to onset, suspected cause, and outcome. Talc-related lung injury was defined as the presence of new infiltrates on chest radiograph and increased oxygen requirements, with no other identifiable trigger than talc exposure. Results A total of 138 patients underwent 142 TTIs for recurrent pleural effusions or spontaneous pneumothorax. TTI was performed most frequently for malignant pleural effusions (75.5% of effusions). The median dose of talc was 6 g (range, 2–8 g). Dyspnea with increased oxygen requirements developed within 72 h postprocedure for 12 patients. Four patients (2.8%) had talc-related lung injury, and talc exposure may have contributed to the respiratory deterioration in four additional patients. Conclusions We report the occurrence of lung injury after TTI using the only talc approved by the US Food and Drug Administration. These results reinforce previous concerns regarding the talc used for pleurodesis in North America.

Background Melanoma is a malignant neoplasm with high metastatic disease risk and elevated mortality. Incidence of melanoma varies according to geographic region and genetic background. Epidemiological studies indicate that acral melanoma (AM) is among the most common melanomas in the Mexican population. While extensive studies have identified genes associated with melanoma, little is known about the genes involved in the pathogenesis of AM. Objective To compare the gene expression patterns between primary melanoma and normal skin. Methods We used 10 samples of fresh acral melanomas and normal skin for the study of differential gene expression and 22 samples of melanoma for in situ hybridization. Results We first identified a gene that was present in a sample of AM and absent in normal skin. DNA sequencing of this differentially expressed gene revealed that it corresponded to ABCB5, a gene recently implicated in the regulation of progenitor cell fusion. Furthermore, we detected ABCB5 expression in other melanoma specimens by RT-PCR. We showed that nine out of ten melanomas were positive for ABCB5 while only one melanoma and normal skin samples were negative. All ABCB5 expressing melanomas had variable gene expression according to in situ hybridization studies, suggesting that the ABCB5 gene may be differentially regulated by individual melanomas. Conclusions The ABCB5 gene may be related to the properties of chemoresistance and aggressiveness of melanoma. The high expression found in samples of acral melanoma may provide more insight on the pathogenesis of this common type of melanoma in the Mexican population, frequently associated with poor prognosis.