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This paper presents a novel slotted array for dual-band and circular-polarized applications. Two different propagation modes within a Substrate Integrated Waveguide (SIW), TE10 and TE20, feed at the same time two pairs of slots, aimed at different frequency bands. The pairs are properly placed to be illuminated by an only propagation mode, whereas the magnetic field of the other propagation mode presents a null. Unlike many dual-band slot arrays, this novel antenna holds the same beam tilt for both frequency bands by a new method, which is only feasible through the use of two propagation modes. A dual-mode transition, based on a double microstrip input, allows to excite both propagation modes within the SIW, and it can be fed by a novel single layer dual-band phase shifter with a different shift at each frequency. A square patch is placed over each pair of slots to increase the coupled energy per element, resulting in a low polarization loss and high performance compact antenna at 3.5GHz and 6GHz for dual-band TX/RX systems at C-Band.

Abstract Background Residency selection is crucial for enhancing the healthcare workforce. Most research on this topic arises from the global north, leaving a gap from the global south perspective. Hence, this study aimed to evaluate factors associated with the Peruvian National Residency Examination (ENARM) in Peruvian applicants. Methods A repeated cross-sectional analytical study was conducted using data from applicants to the Peruvian ENARM from 2019 to 2023. The data were sourced from the National Council of Medical Residency’s webpage and analyzed using descriptive statistics and linear mixed-effect models. Results The final population consisted of 28,872 (95.06%) of applicants between 2019 and 2023. The mean ENARM score was 11.69, with a pass rate of 61.6% if a standard setting was set at 11. The highest scores were seen in those who achieved scores above 13 in the ENAM and received honors in medical school, while the lowest in those who applied in the captive modality and did not take the ENAM. Most applicants were concentrated in Lima and applied to Surgery, Pediatrics, and Obstetric-Gynecology. The ENAM score was positively associated with the ENARM in the mixed model when adjusting for receiving, year, setting of application, modality, and application specialty. Conclusions ENAM scores and honors in medical school were most associated with ENARM; hypothetically, 4 out of 10 applicants would fail the ENARM. Moreover, we portrayed the disparities in Peruvian medical education that point toward the quality of medical education, its centralization in the Peruvian capital, and the power dynamics between specialties.

The contribution of landslides to the Quaternary evolution of relief is poorly documented in arid contexts. In southern Peru and northern Chile, several massive landslides disrupt the arid western Andean front. The Chuquibamba landslide, located in southern Peru, belongs to this set of large landslides. In this area, the Incapuquio fault system captures the intermittent drainage network and localizes rotational landslides. Seismic activity is significant in this region with recurrent Mw 9 subduction earthquakes; however, none of the latest seismic events have triggered a major landslide. New terrestrial cosmogenic dating of the Chuquibamba landslide provides evidence that the last major gravitational mobilization of these rotational landslide deposits occurred at ~ 102 ka, during the Ouki wet climatic event identified on the Altiplano between 120 and 98 ka. Our results suggest that wet events in the arid and fractured context of the Andean forearc induced these giant debris flows. Finally, our study highlights the role of tectonics and climate on (i) the localization of large Andean landslides in the Western Cordillera and on (ii) the long-term mass transfer to the trench along the arid Andean front.

Introduction: Gaining practical experience in health professions education is a significant challenge. Simulation-based training has emerged as a key solution to this issue, but the high costs associated with advanced equipment and software limit accessibility for many institutions. Hence, to close this gap, this study aims to map the research field of low-cost simulation in health professions education through a bibliometric analysis. Methods: Utilizing a bibliometric study design, we analyzed publications from 2003 to 2022 in the Scopus Database, in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Publications discussing low-cost simulation in English were included. Data points such as research design, study location, and outcomes were extracted. The Scival Platform and VosViewer were used to analyze publication trends, prolific institutions, authors, journals, and conceptual and intellectual structure. Results: The study found an increase in low-cost simulation research from 2003 to 2022, with significant growth after 2015. Observational studies predominated (68.57%), with general surgery being the most studied specialty. Less than half of the studies reported cost details, and only 2 compared the low-cost model with a standard. The United States led in scientific production, with notable collaboration networks. The keyword co-occurrence and co-citation analyses highlighted 4 main clusters in low-cost simulation research, emphasizing surgical training. Conclusions: This investigation highlights the expanding interest in low-cost simulation to enhance access to hands-on training in health professions education, especially under financial constraints. However, the research field requires further development, particularly in validating these models against their more expensive counterparts. Such validation is crucial for ensuring the effectiveness and comparability of low-cost simulation. Resumen: Introducción: Adquirir experiencia práctica en la formación de las profesiones sanitarias es un reto importante. El aprendizaje basado en simulación ha surgido como una solución a este problema, pero los elevados costes asociados a los equipos y programas avanzados limitan la accesibilidad de muchas instituciones. De ahí la necesidad de cerrar esta brecha. Este estudio pretende delimitar el campo de investigación de la simulación de bajo costo en la formación de las profesiones sanitarias mediante un análisis bibliométrico. Métodos: Utilizando un diseño de estudio bibliométrico, analizamos las publicaciones de 2003 a 2022 en la base de datos Scopus, siguiendo las directrices de Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Se incluyeron las publicaciones que discutían la simulación de bajo coste en inglés. Se extrajeron datos como el diseño de la investigación, la ubicación del estudio y los resultados. La plataforma Scival y VosViewer se emplearon para analizar las tendencias de publicación, las instituciones prolíficas, los autores, las revistas y la estructura conceptual e intelectual. Resultados: El estudio encontró un aumento de la investigación con simulación de bajo coste desde 2003 hasta 2022, con un crecimiento significativo después de 2015. Predominaron los estudios observacionales (68,57%), siendo la cirugía general la especialidad más estudiada. Menos de la mitad de los estudios informaron sobre detalles de costes, y solo dos compararon el modelo de bajo coste con uno estándar. Estados Unidos lideró la producción científica, con notables redes de colaboración. Los análisis de co-ocurrencia de palabras clave y co-citación destacaron cuatro clusters principales en la investigación sobre simulación de bajo coste, con énfasis en la formación quirúrgica. Conclusiones: Esta investigación pone de relieve el creciente interés en la simulación de bajo coste para mejorar el acceso a la formación práctica en la educación de las profesiones de la salud, especialmente bajo restricciones financieras. Sin embargo, el se requiere un mayor desarrollo, sobre todo en lo que respecta a la validación de estos modelos económicos frente a sus homólogos más caros. Dicha validación es crucial para garantizar la eficacia y comparabilidad de las simulaciones de bajo coste.

Abstract Background Validation of self-reported tools, such as physical activity (PA) questionnaires, is crucial. The aim of this study was to determine test-retest reliability, internal consistency, and the concurrent, construct, and predictive validity of the short semi-quantitative Physical Activity Unit 7 item Screener (PAU-7S), using accelerometry as the reference measurement. The effect of linear calibration on PAU-7S validity was tested. Methods A randomized sample of 321 healthy children aged 8–16 years (149 boys, 172 girls) from the nationwide representative PASOS study completed the PAU-7S before and after wearing an accelerometer for at least 7 consecutive days. Weight, height, and waist circumference were measured. Cronbach alpha was calculated for internal consistency. Test-retest reliability was determined by intra-class correlation (ICC). Concurrent validity was assessed by ICC and Spearman correlation coefficient between moderate to vigorous PA (MVPA) derived by the PAU-7S and by accelerometer. Concordance between both methods was analyzed by absolute agreement, weighted kappa, and Bland-Altman statistics. Multiple linear regression models were fitted for construct validity and predictive validity was determined by leave-one-out cross-validation. Results The PAU-7S overestimated MVPA by 18%, compared to accelerometers (106.5 ± 77.0 vs 95.2 ± 33.2 min/day, respectively). A Cronbach alpha of 0.76 showed an acceptable internal consistency of the PAU-7S. Test-retest reliability was good (ICC 0.71 p

The growing prevalence of cybersecurity threats is a significant concern for railway systems, which rely on an extensive network of onboard and trackside sensors. These threats have the potential to compromise the safety of railway operations and the integrity of the railway infrastructure itself. This paper aims to examine the current cybersecurity measures in use, identify the key vulnerabilities that they address, and propose solutions for enhancing the security of railway infrastructures. The report evaluates the effectiveness of existing security protocols by reviewing current standards, including IEC62443 and NIST, as well as case histories of recent rail cyberattacks. Significant gaps have been identified, especially where modern and legacy systems need to be integrated. Weaknesses in communication protocols such as MVB, CAN and TCP/IP are identified. To address these challenges, the paper proposes a layered security framework specific to railways that incorporate continuous monitoring, risk-based cybersecurity modeling, AI-assisted threat detection, and stronger authentication methodologies. The aim of these recommendations is to improve the resilience of railway networks and ensure a safer, more secure infrastructure for future operations.

A systematic review and meta-analysis were conducted focused on the impact of specific methodological prescription variables in resistance training (R T ) programming on muscle strength under hypoxic conditions. Searches of Pubmed-Medline, Web of Science, Sport Discuss and the Cochrane Library compared the effect of R T on strength development under hypoxic (RTH) vs. normoxic (RTN) conditions through the 1-repetition maximum (1RM) test. Apart from the overall meta-analysis, several R T methodological prescription variables available in the included studies (set end point, total weekly training volume, type of exercise, region of the body measured or type of routine) were analysed. Thirteen studies met the inclusion criteria. The overall analyses showed trivial differences in 1RM favouring RTH over RTN (SMD = 0.18 [CI: 0.04; 0.31]; p  = 0.030). Sub-analyses revealed that a R T programme of a non-full-body routine, including 9 or more sets per exercise/week of multi-joint exercises performed to non-failure, favoured RTH for enhancing 1RM ( p  < 0.10). In conclusion, the evidence ratified a trivial benefit of RTH over RTN for muscle strength gains after a R T period. However, the handling of specific R T methodological prescription variables can slightly improve strength development outcomes in hypoxia.

Hypobaric hypoxia (HH) limits oxygen supply to tissues and increases metabolic demands, especially during exercise. We studied the influence of HH exposure on the subcutaneous adipose tissue (SAT) thickness and circulating metabolic-related cytokines levels after a resistance training (R T ) program. Twenty trained men participated in a traditional hypertrophy R T for 8 weeks (three sessions/week) under intermittent terrestrial HH (2320 m) or normoxia (N, 690 m) conditions. Before, at week 6, and after the R T , SAT, and vastus lateralis (VL) muscle thickness were measured by ultrasound. Blood samples were taken to analyse serum cytokines (IL-6, IL-15, irisin, and myostatin) by multiplex immunoassay. Our findings revealed a moderate reduction in IL-6 and irisin in HH following the R T (ES < -0.64; p < 0.05). Additionally, R T in HH promoted serum IL-15 release (ES = 0.890; p = 0.062), which exhibited a trivial inverse association with the reductions observed on SAT (-17.69%; p < 0.001) compared with N. R T in HH explained ~50% of SAT variance ( p < 0.001). These results highlight the benefit of stressor factors linked to R T in HH on SAT through the modulation of serum metabolic cytokine profiles, suggesting a potential effect on overall body composition.

Distinguishing between primary (PID) and secondary (SID) immunodeficiencies, particularly in relation to hematological B-cell lymphoproliferative disorders (B-CLPD), poses a major clinical challenge. We aimed to analyze and define the clinical and laboratory variables in SID patients associated with B-CLPD, identifying overlaps with late-onset PIDs, which could potentially improve diagnostic precision and prognostic assessment. We studied 37 clinical/laboratory variables in 151 SID patients with B-CLPD. Patients were classified as "Suspected PID Group" when having recurrent-severe infections prior to the B-CLPD and/or hypogammaglobulinemia according to key ESID criteria for PID. Bivariate association analyses showed significant statistical differences between "Suspected PID"- and "SID"-groups in 10 out of 37 variables analyzed, with "Suspected PID" showing higher frequencies of childhood recurrent-severe infections, family history of B-CLPD, significantly lower serum Free Light Chain (sFLC), immunoglobulin concentrations, lower total leukocyte, and switch-memory B-cell counts at baseline. Rpart machine learning algorithm was performed to potentially create a model to differentiate both groups. The model developed a decision tree with two major variables in order of relevance: sum κ + λ and history of severe-recurrent infections in childhood, with high sensitivity 89.5%, specificity 100%, and accuracy 91.8% for PID prediction. Identifying significant clinical and immunological variables can aid in the difficult task of recognizing late-onset PIDs among SID patients, emphasizing the value of a comprehensive immunological evaluation. The differences between "Suspected PID" and SID groups, highlight the need of early, tailored diagnostic and treatment strategies for personalized patient management and follow up., (© 2024. The Author(s).)

This study investigated the effect of a resistance training (R T ) period at terrestrial (HH) and normobaric hypoxia (NH) on both muscle hypertrophy and maximal strength development with respect to the same training in normoxia (N). Thirty-three strength-trained males were assigned to N (FiO 2  = 20.9%), HH (2,320 m asl) or NH (FiO 2  = 15.9%). The participants completed an 8-week R T program (3 sessions/week) of a full body routine. Muscle thickness of the lower limb and 1RM in back squat were assessed before and after the training program. Blood markers of stress, inflammation (IL-6) and muscle growth (% active mTOR, myostatin and miRNA-206) were measured before and after the first and last session of the program. Findings revealed all groups improved 1RM, though this was most enhanced by R T in NH (p = 0.026). According to the moderate to large excess of the exercise-induced stress response (lactate and Ca 2+ ) in HH and N, results only displayed increases in muscle thickness in these two conditions over NH (ES > 1.22). Compared with the rest of the environmental conditions, small to large increments in % active mTOR were only found in HH, and IL-6, myostatin and miR-206 in NH throughout the training period. In conclusion, the results do not support the expected additional benefit of R T under hypoxia compared to N on muscle growth, although it seems to favour gains in strength. The greater muscle growth achieved in HH over NH confirms the impact of the type of hypoxia on the outcomes., (© 2024. The Author(s).)

Purpose: To compare external and internal training load markers during resistance training (R T ) in normoxia (N), intermittent hypobaric hypoxia (HH), and intermittent normobaric hypoxia (NH)., Methods: Thirty-three volunteers were assigned an 8-week R T program in either N (690 m, n = 10), HH (2320 m, n = 10), or NH (inspired fraction of oxygen = 15.9%; ~ 2320 m, n = 13). The R T program (3x/week) consisted of six exercises, with three sets of six to 12 repetitions at ~ 70% of one repetition maximum (1RM) with the first session of each week used for analysis. 1RM in back squat and bench press was used to evaluate muscle strength before and after the program. External load was assessed by the volume load relative to body mass (RVL, kg·kg -1 ). Internal load was assessed by the ratings of perceived exertion (RPE) and heart rate (HR)., Results: Smaller relative improvements were found for the back squat in the N group (11.5 ± 8.8%) when compared to the NH group (22.2 ± 8.2%, P = 0.01) and the HH group (22 ± 8.1%, P = 0.02). All groups showed similar RVL, HR responses and RPE across the program (P˃0.05). However, reduced HR recovery values, calculated as the difference between the highest HR value (HR peak ) and the resting heart rate after a two min rest, were seen in the N and NH groups across the program (P < 0.05)., Conclusion: It seems that 8 weeks of intermittent R T in hypoxic environments could maximize time-efficiency when aiming to improve strength levels in back squat without evoking higher levels of physiological stress. Performing R T at hypobaric hypoxia may improve the cardiorespiratory response, which in turn could speed recovery., (© 2024. The Author(s).)

This is the first report of the health economic benefits derived from preventing infections through Immunoglobulin Replacement Therapy (IgRT) in patients with secondary immunodeficiency due to hematological malignancies. We conducted a retrospective population-based cohort study using patient medical history and pharmacy data from the Hospital Clínico San Carlos for 21 patients between 2011 and 2020. The pharmacoeconomic impact of using prophylactic IgRT was assessed by comparing characteristics of the SID patients 1 year before and after initiating IgRT measured by direct medical and tangible indirect costs. Results indicate a marked reduction in hospitalization days following IgRT initiation, decreasing from an average of 13.9 to 6.1 days per patient, with the elimination of ICU admissions. While emergency department visits decreased significantly, the number of routine consultations remained unchanged. Notably, absenteeism from work dropped substantially. The financial analysis revealed significant reductions in medication use and fewer ancillary tests, resulting in considerable cost savings. Specifically, total expenditure dropped from €405,088.18 pre-IgRT to €295,804.42 post-IgRT-including the cost of IgRT itself at €156,309.60. Overall, the annual savings amounted to €109,283.84, validating the cost-effectiveness of IgRT in managing SID in patients with hematological cancers., Competing Interests: SS-R has served on advisory boards and as a speaker for Grifols, CSL Behring, Takeda, Octapharma, Biotest and Biogen. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Guerola, Sacristán, Portolés, Jasso, Guerra-Galán, de la Fuente-Munoz, Palacios-Ortega, Fernández-Arquero, Cuesta-Mínguez, Rodríguez-Sanz, Peña-Cortijo, Polo, Morales, Anguita-Mandly, Benítez Jiménez, Benavente Cuesta and Sánchez-Ramón.)

It has been proposed that the onset of Acquired Thrombotic Thrombocytopenic Purpura (iTTP) is more severe than subsequent relapses; however, existing studies have limitations. We conducted a retrospective observational study to compare analytical and clinical severity of onset and relapse aTTP cases between 2012 and 2023. A total of 370 episodes of aTTP were analyzed, comprising 272 at initial diagnosis and 98 relapses. At onset, analytical parameters indicative of severity (low hemoglobin, low platelet count, and increased LDH) were significantly worse; patients had severe neurological symptoms (p<0.001) and ≥ 3 points in the TMA mortality score (p<0.001). In conclusion, the onset of aTTP is associated with worse analytical parameters and severe neurological involvement., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A greater understanding of clinical trends in COVID-19 outcomes among patients with hematologic malignancies (HM) over the course of the pandemic, particularly the Omicron era, is needed. This ongoing, observational, and registry-based study with prospective data collection evaluated COVID-19 clinical severity and mortality in 1818 adult HM patients diagnosed with COVID-19 between 27 February 2020 and 1 October 2022, at 31 centers in the Madrid region of Spain. Of these, 1281 (70.5%) and 537 (29.5%) were reported in the pre-Omicron and Omicron periods, respectively. Overall, patients aged ≥70 years (odds ratio 2.16, 95% CI 1.64-2.87), with >1 comorbidity (2.44, 1.85-3.21), or with an underlying HM of chronic lymphocytic leukemia (1.64, 1.19-2.27), had greater odds of severe/critical COVID-19; odds were lower during the Omicron BA.1/BA.2 (0.28, 0.2-0.37) or BA.4/BA.5 (0.13, 0.08-0.19) periods and among patients vaccinated with one or two (0.51, 0.34-0.75) or three or four (0.22, 0.16-0.29) doses. The hospitalization rate (75.3% [963/1279], 35.7% [191/535]), rate of intensive care admission (30.0% [289/963], 14.7% [28/191]), and mortality rate overall (31.9% [409/1281], 9.9% [53/536]) and in hospitalized patients (41.3% [398/963], 22.0% [42/191]) decreased from the pre-Omicron to Omicron period. Age ≥70 years was the only factor associated with higher mortality risk in both the pre-Omicron (hazard ratio 2.57, 95% CI 2.03-3.25) and Omicron (3.19, 95% CI 1.59-6.42) periods. Receipt of prior stem cell transplantation, COVID-19 vaccination(s), and treatment with nirmatrelvir/ritonavir or remdesivir were associated with greater survival rates. In conclusion, COVID-19 mortality in HM patients has decreased considerably in the Omicron period; however, mortality in hospitalized HM patients remains high. Specific studies should be undertaken to test new treatments and preventive interventions in HM patients.

The intensification of the stress response during resistance training (R T ) under hypoxia conditions could trigger unwanted effects that compromise muscle health and, therefore, the ability of the muscle to adapt to longer training periods. We examined the effect of acute moderate terrestrial hypoxia on metabolic, inflammation, antioxidant capacity and muscle atrophy biomarkers after a single R T session in a young male population. Twenty healthy volunteers allocated to the normoxia (N < 700 m asl) or moderate altitude (HH = 2320 m asl) group participated in this study. Before and throughout the 30 min following the R T session (3 × 10 reps, 90 s rest, 70% 1RM), venous blood samples were taken and analysed for circulating calcium, inorganic phosphate, cytokines (IL-6, IL-10 and TNF-α), total antioxidant capacity (TAC) and myostatin. Main results displayed a marked metabolic stress response after the R T in both conditions. A large to very large proportional increase in the adjusted to pre-exercise change of inflammatory and anti-inflammatory markers favoured HH (serum TNF-α [ES = 1.10; p = 0.024] and IL-10 [ES = 1.31; p = 0.009]). The exercise produced a similar moderate increment of myostatin in both groups, followed by a moderate non-significant reduction in HH throughout the recovery (ES =  - 0.72; p = 0.21). The R T slightly increased the antioxidant response regardless of the environmental condition. These results revealed no clear impact of R T under acute hypoxia on the metabolic, TAC and muscle atrophy biomarkers. However, a coordinated pro/anti-inflammatory response balances the potentiated effect of R T on systemic inflammation., (© 2023. The Author(s).)

Treatment options for patients with secondary acute myeloid leukemia (sAML) and AML with myeloid-related changes (AMLMRC) aged 60 to 75 years are scarce and unsuitable. A pivotal trial showed that CPX-351 improved complete remission with/without incomplete recovery (CR/CRi) and overall survival (OS) as compared with standard "3+7" regimens. We retrospectively analyze outcomes of 765 patients with sAML and AML-MRC aged 60 to 75 years treated with intensive chemotherapy, reported to the PETHEMA registry before CPX-351 became available. The CR/CRi rate was 48%, median OS was 7.6 months (95% confidence interval [CI]: 6.7-8.5) and event-free survival (EFS) 2.7 months (95% CI: 2-3.3), without differences between intensive chemotherapy regimens and AML type. Multivariate analyses identified age ≥70 years, Eastern Cooperative Oncology Group performance status ≥1 as independent adverse prognostic factors for CR/CRi and OS, while favorable/intermediate cytogenetic risk and NPM1 were favorable prognostic factors. Patients receiving allogeneic stem cell transplant (HSCT), autologous HSCT, and those who completed more consolidation cycles showed improved OS. This large study suggests that classical intensive chemotherapy could lead to similar CR/CRi rates with slightly shorter median OS than CPX-351.

Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists' ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic., Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or .5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth., Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) ( p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry ( p <.001) and at the specialist clinic ( p =.028)., Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.