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Horses revolutionized human history with fast mobility1. However, the timeline between their domestication and their widespread integration as a means of transport remains contentious2-4. Here we assemble a collection of 475 ancient horse genomes to assess the period when these animals were first reshaped by human agency in Eurasia. We find that reproductive control of the modern domestic lineage emerged around 2200 BCE, through close-kin mating and shortened generation times. Reproductive control emerged following a severe domestication bottleneck starting no earlier than approximately 2700 BCE, and coincided with a sudden expansion across Eurasia that ultimately resulted in the replacement of nearly every local horse lineage. This expansion marked the rise of widespread horse-based mobility in human history, which refutes the commonly held narrative of large horse herds accompanying the massive migration of steppe peoples across Europe around 3000 BCE and earlier3,5. Finally, we detect significantly shortened generation times at Botai around 3500 BCE, a settlement from central Asia associated with corrals and a subsistence economy centred on horses6,7. This supports local horse husbandry before the rise of modern domestic bloodlines.

Background: Postpartum depression is a public health problem that affects a considerable percentage of women. Despite the proliferation of related apps, there are limited data available on the best apps to prevent postpartum depression. We identified which apps available in Spanish could be recommended by midwives based on their content, quality, and behaviour change techniques, as a complementary tool for preventing postpartum depression in women. Methods: A systematic search was performed to identify apps available on iOS App Store and Google Play, which were used to replicate how patients’ access “postpartum depression prevention” apps. Apps’ quality, behaviour change potential, and contents were assessed. Results: A total of 1408 apps were identified, of which 7 were retrieved for assessment (0.5%). The mean objective and subject quality were 3.1 (SD = 1.01) and 2.7 (SD = 1.27), respectively. A total of 24 topics were identified. The mean ABACUS score was 6.6 (SD = 3.64), and the mean number of topics addressed by the apps was 9.9 (SD = 5.90). Conclusion: The results of the present study suggest that a specific free app is not available in Spanish for the prevention of postpartum depression, and only a small percentage of free apps should be recommended based on their quality, BCTs, and contents. The systematic review protocol was not registered.

Abstract Purpose To report the use of Fluocinolone intravitreal implant (Iluvien) for the treatment of persistent cystoid macular edema (CME) due to immune recovery uveitis syndrome in a patient with previous cytomegalovirus retinitis and acute myeloid leukemia. Design Case report. Methods The clinical history of a patient who received an Iluvien implant in one eye for the treatment of cystoid macular edema due to immune recovery uveitis syndrome, previously treated with peribulbar Triamcinolone and intravitreal Dexamethasone injections, was reviewed. Results A 48-year-old woman presented with cystoid macular edema due to immune recovery uveitis syndrome. The patient had a history of cytomegalovirus retinitis 3.5 years prior, secondary to immunosuppressive treatment for an acute myeloid leukemia. Three periocular triamcinolone injections and two dexamethasone intravitreal implants were performed, but the edema recurred, so fluocinolone intravitreal implant was used, achieving a sustained control of the condition at one year of follow-up. Conclusion The Fluocinolone intravitreal implant may be an effective treatment for persistent CME in patients with immune recovery uveitis syndrome.

BackgroundThe coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known.ObjectivesThis study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia.MethodsThe International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison.ResultsProcedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020.ConclusionsThe COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

ObjectivesThis study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic.BackgroundThe COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality.MethodsData were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States.ResultsReductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p

The aim of this study is to discover students' perceptions from the School of Education about the use of the learning platform to improve educational process in distance higher education. To this end, a descriptive study with a mixed approach (quantitative and qualitative) has been applied according to the objectives of the study. An ad-hoc semi-structured questionnaire has been validated by experts, obtaining the response of 111 students of the Spanish National University of Distance Education (UNED), who are conducting social education, pedagogy, and master's degrees in education. The results showed positive values in the different dimensions analyzed: (I) Role of learning platform in distance education, (II) Instructional of the design learning platform, (III) Didactic interaction through the learning platform and (IV) The learning platform and professional practice. The analysis of the open questions, provides guidelines for improving the use of the learning platform in distance higher education regarding strengths (student's exchange, and independent learning) and weaknesses (feedback delay, and content repository).

This research investigates instructors' experiences at Agusan del Sur College concerning Flexible Learning in the New Normal. The study adopts a mixed-method approach integrating quantitative and qualitative components. Participants are 30 full-time instructors across nine departments. The findings reveal that instructors need more training and technical competencies to conduct online courses, affecting the effectiveness of hybrid classes. Technical problems, including slow internet connections and unannounced power interruptions, despite these challenges, instructors value the flexibility inherent in Flexible Learning, spanning modalities, assessment methods, and instructional delivery, promoting greater student responsibility and time management, ultimately enhancing engagement and attentiveness. Moreover, smartphones and mobile applications serve as prevalent educational tools and eLearning resources, and there remains a preference for face-to-face classes over online learning. The study also underscores the positive impact of Flexible Learning, encompassing synchronous and asynchronous platforms, in enhancing digital and technological competencies, with 45.4% of students and 48.8% of instructors reporting its benefits. Additionally, instructors with 0-5 years of teaching experience exhibit excellent proficiency in Flexible Learning modalities and assessment methods. In conclusion, this research suggests that Flexible Learning could constitute a sustainable mode of delivery in higher education institutions, contingent on instructors receiving adequate training and support to navigate the challenges the New Normal poses effectively.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.ObjectivesThe study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices.MethodsThe International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained.ResultsSurveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p

Maximising the accuracy and learning of self and peer assessment activities in higher education requires instructors to make several design decisions, including whether the assessment process should be individual or collaborative, and, if collaborative, determining the number of members of each peer assessment team. In order to support this decision, a quasi-experiment was carried out in which 82 first-year students used three peer assessment modalities. A total of 1574 assessments were obtained. The accuracy of both the students' self-assessment and their peer assessment was measured. Results show that students' self-assessment significantly improved when groups of three were used, provided that those with the 20% poorest performances were excluded from the analysis. This suggests that collaborative peer assessment improves learning. Peer assessment scores were more accurate than self-assessment, regardless of the modality, and the accuracy improved with the number of assessments received. Instructors need to consider the trade-off between students' improved understanding, which favours peer assessment using groups of three, and a higher number of assessments, which, under time constraints, favours individual peer assessment.

Background: Improving knowledge of risk factors, signs and symptoms positively influence an individual's intention to acquire healthy lifestyle behaviors to prevent breast cancer, to identify breast cancer risk early and seek health advice early. The aim of the present study was to develop and to assess the usability and quality of a web-app (Breast-4Y) designed specifically for younger women to improve their knowledge about breast cancer risk factors and symptoms as well as protective behaviors to reduce their risk. Methods: The development of the Breast-4Y web-app, based on Health Belief Model and the Behaviour Change Wheel, comprised four steps: i) analysis of scientific literature regarding breast cancer risk factors, symptoms and preventive lifestyle behaviors; ii) design of web-app; iii) content review by experts; iv) quality and usability assessment by the end-users (n = 20). Web-app usability was evaluated using the Spanish version of the System Usability Scale for the Assessment of Electronic Tools and the quality using the Spanish version of uMARS. Results: The contents were rated 4.25 or above, indicating high content quality. The mean usability score was 84.9 (SD 12.4), the mean rating for objective quality and subjective quality dimensions mean were 4.2 (SD 0.4) and 3.4 (0.777) respectively, indicating excellent usability and quality. Positive associations (p

Software engineering has traditionally focused on the semantic and notational aspects of domain model understandability, overlooking the cognitive factors involved in this process. This study addresses this knowledge gap by exploring the role of General Intelligence, a cognitive factor associated with comprehensibility and problem-solving abilities, in the understandability of domain models. Existing literature has shown that understandability is not a one-dimensional concept, but rather involves multiple levels of comprehension, from surface-level understanding to deeper-level problem-solving abilities. However, these studies have often relied on subjective measures of comprehension, highlighting the need for more objective, quantifiable measures. In response to this, we conducted an empirical study with 102 participants from the University of Alicante, measuring their General Intelligence using the D48 test as proposed by Spearman’s Bifactorial Theory. Participants were then tasked with performing a series of understandability tasks on UML domain models. We also examined the impact of model understandability performance on the intention to adopt the model, using the UMAM-Q test. Our research methodology involved a two-way analysis of variance. The results confirmed that higher intelligence leads to better model understandability performance and that those with higher model understandability have a greater intention to adopt the model. This study underscores the need to consider cognitive factors in software engineering and provides a new perspective on improving domain model understandability.

This article presents an analysis of privileges as one of the instruments used for the colonization of the New World. Based on an original dataset comprising more than five hundred prerogatives granted by the Spanish Crown, this article applies network analysis to reconstruct and map the concession of privileges by the Habsburg monarchy during the first half of the 16th century. In a high uncertainty scenario, we depict privileges as a necessary cost assumed by the monarchy to solve the principal-agent problem by building up a structure to facilitate information flow, enabling the remote governance of overseas territories.

Background: Individuals with chronic kidney disease (CKD) can develop metabolic acidosis which, in turn, is associated with faster progression of CKD and an increased need for dialysis. Oral sodium bicarbonate (the current standard of care therapy for metabolic acidosis) is poorly tolerated leading to low adherence. Base-producing or alkalizing Fruit and vegetables have potential as an alternative treatment for metabolic acidosis as they have been shown to reduce acid load arising from the diet. Objective: This trial will evaluate the feasibility of providing base-producing fruit and vegetables as a dietary treatment for metabolic acidosis, compared with oral sodium bicarbonate. Design: A 2-arm, open-label, dual-center, randomized controlled feasibility trial. Setting: Two Canadian sites: a nephrology clinic in Winnipeg, Manitoba, and a nephrology clinic in Halifax, Nova Scotia. Participants: Adult participants with G3-G5 CKD and metabolic acidosis. Measurements: Participants will undergo baseline measurements and attend 5 study visits over 12 months at which they will have a measurement of feasibility criteria as well as blood pressure, blood and urine biochemistry, 5-repetition chair stand test (STS5), and questionnaires to assess quality of life and symptoms. Furthermore, participants fill out Automated Self-Administered 24-hour recalls (ASA-24) in the beginning, middle, and end of trial. Methods: A total of 40 eligible participants will be randomized 1:1 to either base-producing fruit and vegetables (experimental) group or sodium bicarbonate (control) group, beginning from a daily dose of 1500 mg. Limitations: Using self-administered dietary assessments, lack of supervision over the consumption of study treatments and the possible disappointment of the control group for not receiving fruit and vegetables would be considered as limitations for this study. However, we are planning to undertake proper practices to overcome the possible limitations. These practices are discussed throughout the article in detail. Conclusions: This study will generate data on base-producing fruit and vegetables consumption as a dietary treatment for metabolic acidosis in CKD. The data will be used to design a future multi-center trial looking at slowing CKD progression in people with metabolic acidosis. Trial Registration: This study is registered on clinicaltrials.gov with the identifier NCT05113641.

Thyroid involvement in Langerhans Cell Histiocytosis (LCH) is rare. We report a 10-year-old Filipino male who presented with a rapidly enlarging goiter. Computed tomography scan showed thyroid and bilateral submandibular masses with malignant features, pulmonary blebs and hepatic cysts. Ultrasound-guided core needle biopsy findings were consistent with LCH and chemotherapy was initiated. This case demonstrates that LCH should be considered in patients with goiter. Multidisciplinary management is warranted to achieve proper diagnosis and institute timely treatment.

IntroductionWith the prevalence of obesity increasing, many weight-loss programs were created to aid in combating the trend. The Weight Loss Clinic (WLC) was created to provide personalized support for lifestyle changes using a multidisciplinary team with medical oversight. This study evaluated the clinically-managed weight loss program at the Wellness Institute.MethodsThis was a prospective evaluation of a newly established program between January 2019–August 2020. Participants who entered the weight loss program were approached to learn about the evaluation. A total of 41 participants were included. The primary outcomes included changes in body weight and achievement of more than 5% initial body weight loss. Outcome measures were collected pre-and post-program and the data was analyzed through paired t-tests on R studio.ResultsGreater body weight-loss was seen in completers pre-COVID-19 compared to those who completed during the pandemic (Mean, ±SD; 7.51 ± 6.24 kg n = 13 p