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Stable isotopes are an important tool to describe the movement of water through the hydrosphere. They are used as tracers to characterize hydrograph properties. In field studies, stable isotope analyses using hourly and bulk end-member calculations can be used to estimate baseflow/precipitation contributions and to relate hydrograph response to land cover across a watershed. To enable proper planning of paved surface expansions and the nature of storm drainage systems, advanced understanding of the influences of spatial land-use patterns on Mediterranean streamflow regimes are needed to support water management in peri-urban catchments. This study focuses on Ribeira dos Covões, a small peri-urban catchment (around 6 km2), located in central continental Portugal. The catchment is composed of sandstone in the west portion (56%) and limestone in the east portion (41%), with some alluvial deposits (3%) in the main valleys. Flow and precipitation data were collected every five minutes during storms for several years. In 2018, sampling campaigns also included the collection of pre-event, event, and post-event water stable isotopes in different seasons of the year for streamflow at four sites, representing distinct land coverage and lithological landscape combinations. Preliminary results using precipitation and baseflow fraction calculations based on oxygen-18 measurements show that the catchment outlet provides a 49% baseflow contribution (old water fraction) at the beginning of the dry season and 36% in the wet season. An 85% baseflow contribution was estimated for Quinta (mainly forest area in sandstone) during the dry season, and 64-74% for Espírito Santo (largely urban in sandstone) during the wet season. The baseflow contribution at Porto Bordalo (urban area in limestone) is not significant because the flow is controlled by precipitation. Further investigation will involve connecting the results of most recent stable isotope data analyses to the approaches that were used in the past (e.g. separation of baseflow based on low-pass digital filters). Such connection will clarify streamflow response from distinct peri-urban pattern and lithological landscape combinations and their contributions to catchment runoff, aiming to explore the similarities and differences among these methods and quantify the effects of hydrological regime and land use changing patterns over time.

Despite major advances in precision treatments and new biomarkers, only 55% of UK cancers are detected at an early stage. Ovarian cancer (OC) remains the most lethal gynaecological malignancy with survival, quality of life, and fertility implications, as most women present with advanced stage disease. Endometrial cancer (EC) is the most common gynaecological malignancy, with an incidence that is rising exponentially. Unfortunately, an effective screening program does not exist for EC and OC, to facilitate early detection. Conventional healthcare cannot facilitate real-time monitoring of an individual’s health risks. However, digital footprints (e.g. online search activity) with their temporally dense nature could enable regular ‘health’ monitoring. The utilisation of online search data to identify those at risk of specific diseases has been suggested in other studies but were based on individuals with a proxy diagnosis, inferred through online search patterns, rather than confirmed clinical diagnosis. We evaluated the use of online search data to detect gynaecological cancer in individuals with a known confirmed diagnosis. There was a difference in online search patterns between those with benign and malignant diagnoses, as early as 360 days prior to primary care (GP) referral with a suspected cancer. A classification model based on online search data achieved its highest AUC (0.82) using data 60 days before the GP referral, in individuals who routinely performed health-related online search queries. Our experiments indicate that online search data could provide individualised gynaecological cancer risk profiles, which are not reliant on individuals recognising key symptom patterns. Online search data could provide an accessible disease screening tool to facilitate the earlier detection of gynaecological malignancy, complementing currently established approaches. More generally, we advocate that online search data could provide early insights into numerous conditions including a range of cancers.

BackgroundThe homeless population is aging, with early onset of cognitive and functional impairments. It is unclear whether older homeless adults receive caregiving assistance that could prevent long-term disability.ObjectiveWe describe characteristics of older homeless-experienced adults with caregiving need and determine factors associated with having unmet need.Design and participantsCross-sectional analysis of a longitudinal study, Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME), examining health, life course events, and functional status among older homeless-experienced (i.e., currently and recently homeless) adults. We recruited 350 homeless adults (July 2013-June 2014) and an additional 100 (August 2017 to July 2018) in Oakland, California; this study includes 303 participants who completed caregiving interviews.MeasurementsWe defined caregiving need as difficulty with activities of daily living (ADLs), instrumental activities of daily living (IADLs), falls, Short Physical Performance Battery (SPPB) score < 10, or Modified Mini-Mental State (3MS) exam impairment. We defined unmet need as having caregiving need and reporting not receiving caregiving assistance in the last 6 months. Using logistic regression, we analyzed associations between respondent characteristics and unmet caregiving need.ResultsAmong 303 participants, the mean age was 61.3 ± 5.0 years; 73% were men and 82% were Black. Eighty-one percent had caregiving needs, and in 82% of those, their caregiving needs were unmet. Better self-rated health (AOR 2.13, CI [1.02-4.46], p = 0.04) and being a man (AOR 2.30, CI [1.12-4.69], p = 0.02) were associated with higher odds of unmet need. Moderate or high-risk substance use (AOR 0.47, CI [0.23, 0.94], p = 0.03) was associated with lower odds of unmet need.ConclusionsOlder homeless-experienced adults have high prevalence of unmet caregiving need. Interventions that increase caregiving access for homeless-experienced individuals may help avoid poor health outcomes and costly long-term-care needs due to untreated disabilities.

Diarrhea is the commonest gastrointestinal symptom in patients with common variable immunodeficiency (CVID). Different pathologies in patients’ bowel biopsies have been described and links with infections have been demonstrated. The aim of this study was to analyze the bowel histology of CVID patients in the Royal-Free-Hospital (RFH) London CVID cohort. Ninety-five bowel histology samples from 44 adult CVID patients were reviewed and grouped by histological patterns. Reasons for endoscopy and possible causative infections were recorded. Lymphocyte phenotyping results were compared between patients with different histological features. There was no distinctive feature that occurred in most diarrhea patients. Out of 44 patients (95 biopsies), 38 lacked plasma cells. In 14 of 21 patients with nodular lymphoid hyperplasia (NLH), this was the only visible pathology. In two patients, an infection with Giardia lamblia was associated with NLH. An IBD-like picture was seen in two patients. A coeliac-like picture was found in six patients, four of these had norovirus. NLH as well as inflammation often occurred as single features. There was no difference in blood lymphocyte phenotyping results comparing groups of histological features. We suggest that bowel histology in CVID patients with abdominal symptoms falls into three major histological patterns: (i) a coeliac-like histology, (ii) IBD-like changes, and (iii) NLH. Most patients, but remarkably not all, lacked plasma cells. CVID patients with diarrhea may have an altered bowel histology due to poorly understood and likely diverse immune-mediated mechanisms, occasionally driven by infections.

ImportanceThe population of homeless older adults is growing and experiences premature mortality. Little is known about factors associated with mortality among homeless older adults.ObjectiveTo identify the prevalence and factors associated with mortality in a cohort of homeless adults 50 years and older.Design, Setting, and ParticipantsIn this prospective cohort study (Health Outcomes in People Experiencing Homelessness in Older Middle Age [HOPE HOME]), 450 adults 50 years and older who were homeless at baseline were recruited via venue-based sampling in Oakland, California. Enrollment occurred in 2 phases, from July 2013 to June 2014 and from August 2017 to July 2018, and participants were interviewed at 6-month intervals.ExposuresBaseline and time-varying characteristics, including sociodemographic factors, social support, housing status, incarceration history, chronic medical conditions, substance use, and mental health problems.Main Outcomes and MeasuresMortality through December 31, 2021, based on state and local vital records information from contacts and death certificates. All-cause mortality rates were compared with those in the general population from 2014 to 2019 using age-specific standardized mortality ratios with 95% CIs.ResultsOf the 450 included participants, median (IQR) age at baseline was 58.1 (54.5-61.6) years, 107 (24%) were women, and 360 (80%) were Black. Over a median (IQR) follow-up of 55 (38-93) months, 117 (26%) participants died. Median (IQR) age at death was 64.6 (60.3-67.5) years. In multivariable analyses, characteristics associated with mortality included a first episode of homelessness at 50 years and older (adjusted hazard ratio [aHR], 1.62; 95% CI, 1.13-2.32), homelessness (aHR, 1.82; 95% CI, 1.23-2.68) or institutionalization (aHR, 6.36; 95% CI, 3.42-11.82) at any follow-up compared with being housed, fair or poor self-rated health (aHR, 1.64; 95% CI, 1.13-2.40), and diabetes (aHR, 1.55; 95% CI, 1.06-2.26). Demographic characteristics, substance use problems, and mental health problems were not independently associated. All-cause standardized mortality was 3.5 times higher (95% CI, 2.5-4.4) compared with adults in Oakland. The most common causes of death were heart disease (n = 17 [14.5%]), cancer (n = 17 [14.5%]), and drug overdose (n = 14 [12.0%]).Conclusions and RelevanceThe cohort study found that premature mortality was common among homeless older adults and associated factors included late-life homelessness and ongoing homelessness. There is an urgent need for policy approaches to prevent and end homelessness among older adults in the US.

This article presents a low-cost educational platform to teach human gait instability assessment using the Lyapunov exponents. The system consists of a cellphone used to measure the acceleration or angular velocity of human body segments, a head-mounted display device, a second cellphone used to visualize the virtual environment developed in Unity3D, a device used to measure the gait speed, and a MATLAB application for data processing. The proposed platform was tested on ten healthy subjects (33.4±9.1 years) under three walking conditions: (i) in a real-world environment, (ii) in a virtual corridor, and (iii) by adding optical flow perturbations to the virtual environment. A survey conducted in the elective class Automatic Systems of Analysis and Capture of Human Gait at Universidad del Cauca, showed the usability of the proposed platform.

Diarrhea is the commonest gastrointestinal symptom in patients with common variable immunodeficiency (CVID). Different pathologies in patients' bowel biopsies have been described and links with infections have been demonstrated. The aim of this study was to analyze the bowel histology of CVID patients in the Royal-Free-Hospital (RFH) London CVID cohort. Ninety-five bowel histology samples from 44 adult CVID patients were reviewed and grouped by histological patterns. Reasons for endoscopy and possible causative infections were recorded. Lymphocyte phenotyping results were compared between patients with different histological features. There was no distinctive feature that occurred in most diarrhea patients. Out of 44 patients (95 biopsies), 38 lacked plasma cells. In 14 of 21 patients with nodular lymphoid hyperplasia (NLH), this was the only visible pathology. In two patients, an infection with Giardia lamblia was associated with NLH. An IBD-like picture was seen in two patients. A coeliac-like picture was found in six patients, four of these had norovirus. NLH as well as inflammation often occurred as single features. There was no difference in blood lymphocyte phenotyping results comparing groups of histological features. We suggest that bowel histology in CVID patients with abdominal symptoms falls into three major histological patterns: (i) a coeliac-like histology, (ii) IBD-like changes, and (iii) NLH. Most patients, but remarkably not all, lacked plasma cells. CVID patients with diarrhea may have an altered bowel histology due to poorly understood and likely diverse immune-mediated mechanisms, occasionally driven by infections.

El proceso de enseñanza debiera conducir a un aprendizaje óptimo, el proceso de transición hacia la aplicación del enfoque por competencias, se está dando, aún no se concretiza, por ello, haré un esfuerzo por caracterizar y aportar a la mejora de los aprendizajes. El propósito de este trabajo es determinar la eficacia de la aplicación de los niveles del pensamiento matemático en la enseñanza de la matemática en estudiantes del segundo año de educación secundaria de la Institución Educativa Emblemática Francisco Antonio de Zela, respecto a las evaluaciones censales regionales y nacionales tomadas en el año 2018. Esto implicó varias etapas, desde la capacitación a los docentes, la elaboración de recursos y materiales hasta su aplicación, para ello se sometió a su validación mediante aplicación de cálculos estadísticos y su respectiva interpretación. Al analizar los resultados, demuestro que la aplicación de los niveles del pensamiento matemático en la enseñanza de la matemática en estudiantes del segundo año de educación secundaria de la Institución Educativa Emblemática Francisco Antonio de Zela sí dio resultados satisfactorios.

Background Determining the infection rate and mortality probability in healthy patients who have undergone orthopedic and trauma surgeries (OTS) during a period of uncontrolled COVID-19 transmission may help to inform preparations for future waves. This study performed a survival analysis in a cohort of non-infected OTS patients and determined the effect of COVID-19 on mortality. Methods This observational study included 184 patients who underwent OTS in the month before surgical activities ceased and before the implementation of special measures. Four groups of surgery (GS) were established based on the location of the surgery and the grade of inflammation produced. Crude risk of infection and infection rates were assessed. Survival and failure functions by GS were analyzed. Comparison of the Kaplan-Meier survival curves by GS was assessed. Cox regression and Fine-Gray models were used to determine the effect of different confounders on mortality. Results The crude risk of COVID-19 diagnosis was 14.13% (95% CI: 9.83–19.90%). The total incidence rate was 2.67 (1000 person-days, 95% CI: 1.74–3.91). At the end of follow-up, there was a 94.42% chance of surviving 76 days or more after OTS. The differences in K-M survivor curves by GS indicated that GS 4 presented a lower survival function (Mantel-Cox test, p = 0.024; Wilcoxon-Breslow test, p = 0.044; Tarone-Ware test, p = 0.032). One of the best models to determine the association with mortality was the age-adjusted model for GS, high blood pressure, and respiratory history, with a hazard ratio of 1.112 in Cox regression analysis (95% CI: 1.005–1.230) and a sub hazard ratio of 1.111 (95% CI: 1.046–1.177) in Fine-Gray regression analysis for competitive risk. Conclusions The infection risk after OTS was similar to that of the general population in a community transmission area; the grade of surgical aggression did not influence this rate. The survival probability was extremely high if patients had not previously been infected. With higher grades of surgical aggression, the risk of mortality was higher in OTS patients. Adjusting for age and other confounders (e.g., GS, high blood pressure and respiratory history) was associated with higher mortality rates.

Summary Primary Immunodeficiencies (PIDs) belong to the group of rare diseases. The European Society for Immunodeficiencies (ESID) operates an international research database application for continuous long-term documentation of patient data. The system is a web application which runs in a standard browser. Therefore, the system is easy to access from any location. Technically, the system is based on Gails backed by MariaDB with high standard security features to comply with the demands of a modern research platform. Availability and implementation The ESID Online Database is accessible via the official website: https://esid.org/Working-Parties/Registry-Working-Party/ESID-Registry. A demo system is available via: https://cci-esid-reg-demo-app.uniklinik-freiburg.de/EERS with user demouser and password Demo-2019.

Tuberculosis disease causes thousands of deaths worldwide and, currently, the used drugs are either not enough or obsolete for its treatment. Therefore, new compounds that combat this disease are been seek. Thus, the antituberculosis activity of the alkaloids ocoxilonine (1), ocoteine (2), dicentrine (3) and 1,2-methylenedioxy-3,10,11-trimethoxyaporphine (4), isolated from Ocotea discolor wood was evaluated. Their structures were identified by analysis of nuclear magnetic resonance spectroscopic data (NMR 1D – 1H, 13C, 2D – COSY, HSQC and HMBC), mass spectra, and comparison with literature data. All the isolated compounds demonstrated antituberculosis activity, with ocoteine (2) being the most active compound, with a minimum inhibitory concentration value of 140 μM against the virulent strain Mycobacterium tuberculosis H37Rv. All the isolated compounds showed antituberculosis activity, with a variation range in the minimum inhibitory concentration between 140 to 310 μM, being ocoteine (2) the most active compound against the virulent strain Mycobacterium tuberculosis H37Rv.

The Internet of Things technology is taking advantage of the advancements in hardware and software platforms for enabling new application domains like smart buildings and in a general sense, smart (indoor) environments. Some of the key requirements are security and flexibility. Access control plays an important role in granting access to resources like network and data storage and retrieval to devices joining the security domain. This article introduces a solution for enabling dynamic security domains in which devices join in a trustful way via an authentication framework. In the present paper we document the addressed usecases and requirements, the background technology evolution from 4G to 5G core network, together with the proposed solution and its results using a laboratory testbed.

Real-time systems are characterised by the fact that they have to meet a set of both functional and temporal requirements. Processor architectures have a significant impact on the predictability of software execution times and can add different sources of indeterminism depending on the features provided. The LEON processor family is the reference platform for space missions of the European Space Agency, with open-source implementations that are written in VHDL language. All versions of the LEON processors conform to the SPARC architecture Version 8. This architecture groups the general-purpose registers into windows to reduce memory transfer overhead in function calls. Unfortunately, this mechanism introduces indeterminism in software execution times at various levels. In this paper, we propose an extension to the original architecture that provides determinism for a configurable subset of tasks and interrupt service routines and eliminates the concurrency-related jitter, all this with a minimum cost in terms of FPGA resource utilisation. For the validation of the proposed solution, we have implemented the extension into the VHDL code of the LEON3 processor and modified the source code of the RTEMS operating system to make use of the new functionality.

Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). We used multivariable logistic regression to examine factors associated with ACP discussions and documentation. The median age of the cohort was 59 (range 52-82), 75.2% were male, and 82.1% were black. Sixty-one percent reported a potential surrogate, 21.5% had discussed ACP, and 19.0% reported ACP documentation. In multivariable models, having 1 to 5 confidants versus none (adjusted odds ratio (aOR)=5.8, 95% confidence interval (CI)=1.7-20.0), 3 or more chronic conditions versus none (aOR=2.3, 95% CI=0.9-5.6), and a recent primary care visit (aOR=2.1, 95% CI=1.0-4.4) were associated with higher odds of ACP discussions and each additional 5 years of homelessness (aOR=0.7, 95% CI=0.5-0.9) with lower odds. Having 1 to 5 confidants (aOR=5.0, 95% CI=1.4-17.5), being black (aOR=5.5, 95% CI=1.5-19.5), and having adequate versus limited literacy (aOR=7.0, 95% CI=1.5-32.4) were associated with higher odds of ACP documentation and illicit drug use (aOR=0.3, 95% CI=0.1-0.9) with lower odds. Although the majority of older homeless-experienced adults have a potential surrogate, few have discussed or documented their ACP wishes; the odds of both were greater with larger social networks. Future interventions must be customized for individuals with limited social networks and address the instability of homelessness, health literacy, and the constraints of safety-net healthcare settings.

BACKGROUND The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. OBJECTIVE This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. METHODS We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants’ comfort with and use of multiple functions associated with these technologies. RESULTS Of the 343 participants alive at the 6-month follow-up, 87.5% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7% (224/300) were male, and 81.0% (243/300) were black. Approximately one-fourth (24.3%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6%, 100/300) had impairments in executive function. Most (72.3%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1%), and did not hold annual contracts (261, 94.2%). Just over half (164, 55%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6%), search for housing and employment (85, 30.7%), and to contact their families (228, 82.3%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95% CI 1.77-8.21). Those with ADL (AOR 0.53, 95% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95% CI 0.10-0.72). CONCLUSIONS Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes.

Introduction: Ochronosis is an inherited metabolic disease that causes a brownish-black pigmentation of the connective tissue. There is currently no specific treatment for ochronosis. The goal of treatment is to control the progress of disease with a multidisciplinary approach and symptomatic relief. Arthroplasty in ochronotic arthropathy patients has shown good to excellent results comparable to arthroplasty performed in patients with degenerative osteoarthritis. Case Report: We report an unusual case of a 69-year-old female who suffered advanced degenerative arthropathy secondary to ochronosis. A staged bilateral total hip arthroplasty was performed on her successfully using a Corail metal on poly total hip prosthesis 9months apart. Conclusion: Ochronoticarthropathy produces degenerative arthritis of large joints in middle-aged patients. In many cases, the patient does not know the disease until the diagnosis of intraoperative suspicion. There is no definitive treatment. After conservative management, joint replacement surgery offers the best symptomatic treatment.