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OBJECTIVE: To examine whether exposure to ambient ozone, particulate matter with diameter less than 2.5 microns (PM(2.5)), nitrogen dioxide (NO(2)), and distance to major roadways (DTR) impact ovarian cancer-specific survival, while considering differences by stage, race/ethnicity, and socioeconomic status. METHODS: Women diagnosed with epithelial ovarian cancer from 1996-2014 were identified through the California Cancer Registry and followed through 2016. Women’s geocoded addresses were linked to pollutant exposure data and averaged over the follow-up period. Pollutants were considered independently and in multi-pollutant models. Cox proportional hazards models assessed hazards of disease-specific death due to environmental exposures, controlling for important covariates, with additional models stratified by stage at diagnosis, race/ethnicity and socioeconomic status. RESULTS: PM(2.5) and NO(2), but not ozone or DTR, were significantly associated with survival in univariate models. In a multi-pollutant model for PM(2.5), ozone, and DTR, an interquartile range increase in PM(2.5) (Hazard Ratio [HR], 1.45; 95% Confidence Interval [CI], 1.41-1.49) was associated with worse prognosis. Similarly, in the multi-pollutant model with NO(2), ozone, and DTR, women with higher NO(2) exposures (HR for 20.0-30.0 ppb, 1.30; 95% CI, 1.25-1.36 and HR for >30.0 ppb, 2.48; 95% CI, 2.32-2.66) had greater mortality compared to the lowest exposed (

Background Research suggests that geographic location may affect ovarian cancer (OC) outcomes. Insurance status often remains an important predictor of outcomes. The Affordable Care Act was enacted in 2010 to expand access to affordable health insurance. Our objective was to examine spatiotemporal trends in OC treatment nonadherence and disease-specific mortality in California (USA) among women diagnosed with OC. Methods Newly diagnosed epithelial OC cases between 1996 and 2017 were identified from the California Cancer Registry. Spatiotemporal trends in adherence to treatment guidelines were examined using generalized additive models and OC-specific mortality using Cox proportional hazards additive models. Prediction grids covering California were used to display the odds ratios (ORs) and hazard ratios of location using the median value for the study area as the referent value. Seven overlapping 5-year periods and 2 larger ones (pre- and post-2013) were assessed. Analyses were stratified according to stage (early vs advanced) and used P = .05 to determine statistical significance. Results Statistically significant spatial patterns in treatment nonadherence were observed for every time period examined (P Conclusions Residential location was statistically significantly associated with treatment received in California, with spatial patterns varying over time but not OC-specific mortality. Changes in insurance status over time were accompanied by shifts in population demographics and increased travel distances to receive care.

The protozoan Perkinsus marinus has been associated with high mortality episodes of the eastern oyster Crassostrea virginica in the USA. The presence of P. marinus on the pleasure oyster Crassostrea corteziensis cultivated in two estuaries on the southeast coast of the Gulf of California was evaluated. Oysters were collected monthly (September 2016 to September 2017) and analyzed using Ray's fluid thioglycollate medium (RFTM) and polymerase chain reaction (PCR). Water parameters and oyster biometrics were also recorded. Pathogen prevalence increased over time from 0 to 100% in oysters from La Pitahaya, and from 0 to 83.33% in those from Bacorehuis. At both oyster farms, infection intensity was light (

The shell height-body weight relationship of the black clam Chionista fluctifraga cultivated in the intertidal of the southeastern Gulf of California, was evaluated for the first time, to improve the knowledge in determining its harvesting time. Clam seeds (n=900,000; 6.1±1.9 mm) were produced in the laboratory. The culture was divided into pre-fattening in racks on the bottom (2 months) and fattening directly in the bottom (16 months) from May 2018 to October 2019. Each month, 60 (n=1080) clams were randomly selected to stablish the morphometric relationship between shell height (SH) and body weight (BW). The growth rate (mm/d and g/d) was recorded. The SH-BW Interaction in both cultivation phases showed positive allometry. SH in prefattening and fattening registered a growth rate of 0.072 and 0.058 mm/d, respectively. In fattening, the interaction BW-SH displayed a high coefficient of determination (R2=0.99). A final survival rate of 90% was obtained. The results yielded the equations that describe the relative growth of C. fluctifraga for the fattening stage. A harvesting time after 10 months of fattening in the intertidal zone is stablished to reach the commercial size (35 mm, SH).

Antecedentes La cuarentena y el distanciamiento social como resultado de la pandemia de COVID-19 planteó la necesidad de continuar virtualmente el tratamiento de los pacientes con trastornos alimentarios (TA). Objetivo Evaluar la viabilidad, aceptabilidad y adherencia al tratamiento virtual de los pacientes, las familias y los terapeutas. Métodos: Se aplicaron encuestas en línea a 14 pacientes, 10 familiares y 8 terapeutas de un Programa Ambulatorio Intensivo para TA, y se realizó un análisis DOFA con las respuestas. Resultados El tratamiento virtual durante el confinamiento fue considerado factible y útil por todos los encuestados. El miedo al contagio y la presencia de los padres en el hogar se identificaron como fortalezas. Los padres informaron problemas con el cumplimiento del plan nutricional, especialmente en anorexia. Los terapeutas señalaron la necesidad de adaptaciones metodológicas en las sesiones para mejorar la participación. La adherencia de las familias fue total y la de los pacientes, del 90%. Conclusiones La adaptación virtual del programa es una opción válida y útil durante el confinamiento obligatorio, mejora la participación familiar, pero no reemplaza el tratamiento presencial.

Background. Different species of Perkinsus spp. have been associated to mortality of commercial mollusks. Goals. The prevalence of Perkinsus sp. in the callista clam Megapitaria squalida was evaluated monthly (June 2015 to November 2016) to determine the relationship between the infection and size of clam. Methods. 5,000 clam seeds (5.73 mm height of the shell and 0.03 g of initial weight) were placed in a fishing refuge of Altata, Sinaloa. A total of 60 specimens were collected each month to evaluate their growth and parasite prevalence. The water physicochemical parameters (temperature, salinity, pH, dissolved oxygen, depth, and transparency) and the length, height, and width of the shell and final weight of M. squalida were obtained. Results. Ray’s thioglycollate fluid medium test (MFTR) detected spherical cells (10X) of dark color indicating the presence of presumed hypnospores of Perkinsus sp. during the first 17 months of sampling. The mean infection intensity was grade 2 (mild), while the maximum prevalence was 43.33% in the months of November (2015) and March (2016), with an average of 21.05%. None of the Perkinsus sp sample (n = 112) positively detected by MFTR confirmed the presence of the protozoan. There was no correlation (p >0.05) between the prevalence of the pathogen with all the parameters studied. Conclusions. The results suggest that M. squalida is not susceptible to Perkinsus sp. The present represents the first report of Perkinsus sp. In the callista clam M. squalida.

Introduction Patients with severe COVID-19 develops an acute respiratory distress syndrome (ARDS), requiring admission to the intensive care unit. COVID-19 also reports an increased prevalence of comorbidities, similar to patients with Sleep disorder breathing (SDB). Objectives To evaluate the association between undiagnosed SDB and the risk of ARDS and pulmonary abnormalities in a cohort of patients’ survivors of COVID-19 between 3 and 6 months after diagnosis. Methods Prospective cohort study of patients who developed ARDS during hospitalization due to COVID-19 compared with a control group of patients who had COVID-19 with mild to moderate symptoms. All patients were evaluated between the 12th and 24th week after SARS-CoV-2 infection. The evaluation includes persistent symptoms, lung diffusing capacity of carbon monoxide (DLCO), chest CT scan and home sleep apnea test. SDB was diagnosed by the respiratory disturbance index ≥5 ev/h. The association between SDB and ARDS, the hazards of lung impairment and the hazard ratios (HR) were analyzed. Results A total of 60 patients were included (ARDS: 34 patients, Control: 26 patients). The mean follow-up was 16 weeks (range 12–24). ARDS reported a high prevalence of SDB (79% vs. 38% in control group). A total of 35% reported DLCO impairment, and 67.6% abnormal chest CT. SDB was independently associated to ARDS, OR 6.72 (CI, 1.56–28.93), p, Graphical abstract Image 1

Background: Evidence suggests that geographic location may independently contribute to ovarian cancer survival. We aimed to investigate how the association between residential location and ovarian cancer-specific survival in California varies by race/ethnicity and socioeconomic status. Methods: Additive Cox proportional hazard models were used to predict hazard ratios (HRs) and 95% confidence intervals (CI) for the association between geographic location throughout California and survival among 29,844 women diagnosed with epithelial ovarian cancer between 1996 and 2014. We conducted permutation tests to determine a global P-value for significance of location. Adjusted analyses considered distance traveled for care, distance to closest high-quality-of-care hospital, and receipt of National Comprehensive Cancer Network guideline care. Models were also stratified by stage, race/ethnicity, and socioeconomic status. Results: Location was significant in unadjusted models (P = 0.009 among all stages) but not in adjusted models (P = 0.20). HRs ranged from 0.81 (95% CI: 0.70, 0.93) in Southern Central Valley to 1.41 (95% CI: 1.15, 1.73) in Northern California but were attenuated after adjustment (maximum HR = 1.17, 95% CI: 1.08, 1.27). Better survival was generally observed for patients traveling longer distances for care. Associations between survival and proximity to closest high-quality-of-care hospitals were null except for women of lowest socioeconomic status living furthest away (HR = 1.22, 95% CI: 1.03, 1.43). Conclusions:Overall, geographic variations observed in ovarian cancer-specific survival were due to important predictors such as receiving guideline-adherent care. Improving access to expert care and ensuring receipt of guideline-adherent treatment should be priorities in optimizing ovarian cancer survival.

Ovarian cancer care at a high-performing hospital is an independent predictor of improved survival, and barriers to access disproportionately affect patients according to sociodemographic characteristics., OBJECTIVE: To validate the observed/expected ratio for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care, and to identify patient characteristics associated with disparities in access to high-performing hospitals. METHODS: This was a retrospective population-based study of stage I–IV invasive epithelial ovarian cancer reported to the California Cancer Registry between 1996 and 2014. A fit logistic regression model, which was risk-adjusted for patient and disease characteristics, was used to calculate the observed/expected ratio for each hospital, stratified by hospital annual case volume. A Cox proportional hazards model was used for survival analyses, and a multivariable logistic regression model was used to identify independent predictors of access to high-performing hospitals. RESULTS: The study population included 30,051 patients who were treated at 426 hospitals: low observed/expected ratio (n=304) 23.5% of cases; intermediate observed/expected ratio (n=92) 57.8% of cases; and high observed/expected ratio (n=30) 18.7% of cases. Hospitals with high observed/expected ratios were significantly more likely to deliver guideline-adherent care (53.3%), compared with hospitals with intermediate (37.8%) and low (27.5%) observed/expected ratios (P

Palliative care has demonstrated effectiveness in alleviating the biological, emotional, social, and spiritual symptoms that accompany serious illness, and improving quality of life for seriously ill individuals and their family members. Despite increasing availability, there are significant disparities in access to and utilization of palliative care, particularly among diverse, low-income, and community-dwelling older adults with chronic illness. Training frontline service providers is a novel approach to expanding access to palliative care among underserved elders. This article presents a process and outcome evaluation of a palliative care curriculum that was developed and piloted for geriatric case managers in a large urban area. We describe the background, planning, design, implementation, and preliminary outcomes associated with a pilot implementation of the curriculum. We conclude with implications for replicating efforts to enhance frontline providers' knowledge, skills, and self-efficacy in extending palliative care to communities that lack access to critical supports for their burdensome symptoms.

Background: More than 14,000 women in the United States die of ovarian cancer (OC) every year. Disparities in survival have been observed by race and socioeconomic status (SES), and vary spatially even after adjusting for treatment received. This study aimed to determine the impact of geographic location on receiving treatment adherent to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for OC, independent of other predictors. Patients and Methods: Women diagnosed with all stages of epithelial OC (1996–2014) were identified through the California Cancer Registry. Generalized additive models, smoothing for residential location, were used to calculate adjusted odds ratios (ORs) and 95% CIs for receiving nonadherent care throughout California. We assessed the impact of distance traveled for care, distance to closest high-quality hospital, race/ethnicity, and SES on receipt of quality care, adjusting for demographic and cancer characteristics and stratifying by disease stage. Results: Of 29,844 patients with OC, 11,419 (38.3%) received guideline-adherent care. ORs for nonadherent care were lower in northern California and higher in Kern and Los Angeles counties. Magnitudes of associations with location varied by stage (OR range, 0.45–2.19). Living farther from a high-quality hospital increased the odds of receiving nonadherent care (OR, 1.18; 95% CI, 1.07–1.29), but travel >32 km to receive care was associated with decreased odds (OR, 0.76; 95% CI, 0.70–0.84). American Indian/other women were more likely to travel greater distances to receive care. Women in the highest SES quintile, those with Medicare insurance, and women of non-Hispanic black race were less likely to travel far. Patients who were Asian/Pacific Islander lived the closest to a high-quality hospital. Conclusions: Among California women diagnosed with OC, living closer to a high-quality center was associated with receiving adherent care. Non-Hispanic black women were less likely to receive adherent care, and women with lower SES lived farthest from high-quality hospitals. Geographic location in California is an independent predictor of adherence to NCCN Guidelines for OC.

Although palliative care (PC) has become increasingly familiar, considerable gaps persist in access to and use of services. Community-based programs remain rare, and low-income, minority communities significantly under-utilize hospice and palliative services. We used community-based participatory research (CBPR) methods to conduct a mixed-methods community needs assessment of seriously-ill older adults (n=100) and providers from community-based programs and churches (n=41) in an urban medically-underserved community in the U.S. to explore: (I) the prevalence and severity of illness-related symptoms and psychosocial-spiritual concerns; (II) the scope and quality of community supports helping older adults manage their symptoms; and (III) the perceptions and utilization of palliative and supportive care services among older adults and community-based service providers. Participants reported high rates of chronic illness-related symptoms (i.e., pain, fatigue, sleeping difficulties, depression, and anxiety), and many described unmet needs around symptom management. Few had ever utilized PC or pain management services, and most relied primarily on family, friends, and faith communities to help them manage burdensome symptoms. Barriers included lack of familiarity with PC, limited access and financial concerns. Older adults were largely unfamiliar with PC, and many described unmet needs and desire for help with symptom burden. Findings support the need to further explore community-level and cultural barriers to PC among diverse, underserved older adults. Development of innovative community partnerships may help raise awareness of PC and address the physical and psychosocial-spiritual challenges facing chronically-ill minority older adults and their families.

Objective. To detect the presence of presumptive hypnospores of the protozoan Perkinsus sp. in a wild population of the Mexican chocolata clam Megapitaria squalida in the southeastern Gulf of California, using Ray´s fluid thioglycollate medium (RFTM). Material and methods. Thirty specimens with size between 56.17 and 69.04 mm were captured each month, during an annual cycle. Infection prevalence and intensity and water parameters were recorded monthly from September 2012 to September 2013. Results. Perkinsus sp. was detected in tissue samples from the Mexican chocolate clam using the RFTM test by the presence of dark round corpuscles that represent parasite´s hypnospores. Monthly samplings revealed a prevalence of 0-43.33% and an infection intensity ranging from 1 to 4 (no infection = 0 hypnospores/entire preparation, to moderate = 34 hypnospores/entire preparation). Conclusions. Perkinsus sp. is reported for the first time in a wild population of M. squalida in the southesternmost Gulf of California. The results indicate that this protozoan is dispersed intraspecifically and would now, potentially, parasiting a new host in the region., Objetivo. Detectar la presencia de presuntas hipnosporas del protozoario Perkinsus sp. en una población silvestre de la almeja chocolata mexicana (Megapitaria squalida) del sureste del Golfo de California, usando el medio fluido de tioglicolato de Ray (RFTM). Materiales y métodos. Cada mes durante un ciclo anual, se capturaron 30 especímenes con una longitud entre 56.17 y 69.04 mm. La prevalencia e intensidad de la infección y los parámetros del agua se registraron mensualmente desde septiembre 2012 a septiembre 2013. Resultados. Se detectó la presencia de presuntas hipnosporas de Perkinsus sp. en muestras de tejido de la almeja chocolata mexicana usando la prueba RFTM, por la presencia de corpúsculos redondos y oscuros que representan hipnosporas del parásito. Los muestreos mensuales revelaron un rango de prevalencia e intensidad de la infección de 0-43.33% y 1-4 (infección negativa = 0 hipnosporas/preparación, a moderada = 34 hipnosporas/preparación), respectivamente. Conclusiones. Perkinsus sp. es reportado por primera vez en una población silvestre de M. squalida en la parte más al sureste del Golfo de California. Los resultados indican que el parásito está disperso intraespecíficamente y, potencialmente, parasitaría un nuevo huésped en la región.

Ovarian cancer survival varies geographically throughout California. The objective of this study is to determine the impact of living in disadvantaged communities on spatial patterns of survival disparities. Including a bivariate spatial smooth of geographic location within the Cox proportional hazard models is an effective approach for spatial analyses of cancer survival. Women diagnosed with advanced Stage IIIC/IV epithelial ovarian cancer (1996–2006) were identified from the California Cancer Registry. The impact of living in disadvantaged communities, as measured by the California Office of Environmental Health Hazard Assessment cumulative CalEnviroScreen 2.0 score, on geographic disparities in survival was assessed while controlling for age, tumor characteristics, quality of care, and race. Community-level air quality indicators and socioeconomic status (SES) were also independently examined in secondary analyses. The Cox proportional hazard spatial methods are available in the MapGAM package implemented in R. An increase in the community disadvantage from the 5th (less disadvantage) to the 95th percentile (more disadvantage) was significantly associated with poorer ovarian cancer survival (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.07–1.26). Ozone levels and SES were the most influential indicators on geographic disparities that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential air quality-related predictors of geographic disparities.

Se detectaron presuntas hipnosporas de Perkinsus sp. en una población silvestre de la almeja Megapitaria squalida (enero-diciembre 2013) al norte del estado de Sinaloa, México, con la técnica de tinción de tioglicolato (MFTR). Se colectaron 30 almejas cada mes (64.08 ± 4.75 mm altura de la concha y 68.76 ± 14.34 g de peso). Se obtuvieron los parámetros fisicoquímicos del agua (temperatura, salinidad, pH, oxígeno disuelto, profundidad y transparencia). La prueba MFTR detectó células esféricas de color obscuro, indicando la presencia de presuntas hipnosporas de Perkinsus sp. todos los meses de muestreo menos en diciembre. La intensidad de la infección promedio fluctuó de negativa a ligera, mientras que la prevalencia máxima fue de 70% observada en mayo. La carga parasitaria mostró correlación con los indicadores métricos de la almeja. No se obtuvo correlación (p > 0.05) entre la prevalencia del patógeno con todos los parámetros estudiados. Los resultados sugieren que M. squalida es poco susceptible a la infección de Perkinsus sp.

Residing in lower socioeconomic status (SES) neighborhoods is associated with increased risk of morbidity and mortality. Few studies have examined this association for cardiovascular disease (CVD) outcomes in a treated population in New York City (NYC). The purpose of this study was to determine the relationship between neighborhood level poverty and 1-year clinical outcomes (rehospitalization and/or death) among hospitalized patients with CVD. Data on rehospitalization and/or death at 1-year were collected from consecutive patients admitted at a university medical center in NYC from November 2009 to September 2010. NYC residents totaled 2,198. U.S. Census 2000 zip code data was used to quantify neighborhood SES into quintiles of poverty (Q1 = lowest poverty to Q5 = highest poverty). Univariate analyses were used to determine associations between neighborhood poverty and baseline characteristics and comorbidities. A logistic regression analysis was used to calculate odds ratios for the association between quintiles of poverty and rehospitalization/death at 1 year. Fifty-five percent of participants experienced adverse outcomes. Participants in Q5 (9 %) were more likely to be female [odds ratio (OR) = 0.49, 95 % confidence interval (CI) 0.33-0.73], younger (OR = 0.50, 95 % CI 0.34-0.74), of minority race/ethnicity (OR = 18.24, 95 % CI 11.12-29.23), and have no health insurance (OR = 4.79, 95 % CI 2.92-7.50). Living in Q5 was significantly associated with increased comorbidities, including diabetes mellitus and hypertension, but was not a significant predictor of rehospitalization/death at 1 year. Among patients hospitalized with CVD, higher poverty neighborhood residence was significantly associated with a greater prevalence of comorbidities, but not of rehospitalization and/or death. Affordable, accessible resources targeted at reducing the risk of developing CVD and these comorbidities should be available in these communities.

Concern over the need for effective and accessible healthcare for individuals with advanced chronic illness has drawn attention to the significant gaps in our knowledge of palliative medicine. To advance our understanding of this field, community-based participatory research (CBPR) is proposed as a tool for future research initiatives. This paper offers a rationale for how CBPR may be employed to address specific gaps in palliative care research. Several examples where this approach has been used previously are described, and potential obstacles to implementing this research method are delineated. Despite challenges to incorporating CBPR to palliative care research, this approach holds substantial potential to advance our current understanding of the field and promote sensitivity for future programs, practices and policies.

"We evaluated the presence of the protozoan Perkinsus sp. by determining of its prevalence and level of infection in Atrina maura during 2012. Pen shells were collected per season beside an oyster farm located at Estero La Piedra, Sinaloa, Mexico, and analyzed by Ray’s fluid thioglycollate medium and polymerase chain reaction. The higher prevalence (90%) and infection level (2.3) were obtained when temperature and salinity were higher. The Mackin scale showed a non-infected to moderate infection range. PCR was positive to Perkinsus sp. This is the first record of the presence of Perkinsus sp. in A. maura in Sinaloa, Mexico."

El proposito del estudio fue caracterizar las practicas de crianza del cuidador principal respecto a calidad del cuidado, practicas disciplinarias, relaciones de apego tempranas nino-cuidador y desarrollo infantil en 10 diadas caso (cuidador-hijo), en situacion de desplazamiento forzado por conflicto armado interno en Colombia con ninos en primera infancia. El diseno fue mixto explicativo con instrumentos observacionales derivados de la Teoria del Apego y medidas de autorreporte. Se encontraron asociaciones significativas entre sensibilidad del cuidador con desarrollo infantil (r = 0.63, p < 0.05), entre apego infantil con dominios de cuidado materno (r = 0.91, p < 0.01) y practicas disciplinarias moderadas asociadas negativamente con la seguridad del apego infantil (r = -0.88, p < 0.01). Siguiendo los principios metodologicos de la Teoria Fundamentada, se obtuvieron categorias emergentes sobre transmision intergeneracional de patrones de crianza y practicas de cuidado infantil. Los resultados permiten identificar algunos factores protectores (procesos reflexivos respecto al uso de patrones inadecuados de crianza) y de riesgo (mantenimiento de practicas de castigo fisico, en especial con ninas).

A lo largo de los años, se han dado a conocer diferentes corrientes pe-dagógicas con la finalidad de mejorar los procesos de enseñanza - aprendizaje, en Colombia por mucho tiempo se ha adoptado una co-rriente tradicional donde el contenido es algo memorístico, mecánico y en realidad muy poco analítico, de modo que se torna aburrido para el educando y genera desinterés por aprender, en consecuencia se preten-de implementar un estilo de enseñanza, partiendo de la Teoría de las Inteligencias Múltiples (Howard Gardner, 1983), con el fin de desarrollar las inteligencias en las estudiantes de la IED Liceo Femenino Mercedes Nariño. ya que “La idea fundamental de la teoría es que no existe una sola capacidad mental subyacente, sino una variedad de inteligencias que actúan en combinación y son las que ayudan a explicar cómo las personas adoptan diversos roles dentro de una sociedad2” (Gardner, 2001). Este trabajo se realiza a partir de un portafolio, que contiene acti-vidades que potencializan algunas inteligencias múltiples.