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We use a mathematical model to investigate the effect of basal topography and ice surface slope on transport and deposition of sediment within a water-filled subglacial channel. In our model, three zones of different behaviour occur. In the zone furthest upstream, variations in basal topography lead to sediment deposition under a wide range of conditions. In this first zone, even very small and gradually varying basal undulations (~5 m amplitude) can lead to the deposition of sediment within a modelled channel. Deposition is concentrated on the downstream gradient of subglacial ridges, and on the upstream gradient of subglacial troughs. The thickness and steepness of the ice sheet has a substantial impact on deposition rates, with shallow ice profiles strongly promoting both the magnitude and extent of sediment deposition. In a second zone, all sediment is transported downstream. Finally, a third zone close to the ice margin is characterised by high rates of sediment deposition. The existence of these zones has implications for esker formation and the dynamics of the subglacial environment.

Abstract Background Hypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data. Methods This was a retrospective cohort study of national medical records from all National Health Service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease, was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies. Results Amongst 2,359,386 first live births, there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were n = 8668, 57.1 (95% CI: 55.9–58.3) per 100,000 person-years; n = 521, 85.8 (78.6–93.5) per 100,000 person-years; and n = 518, 99.3 (90.9–108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were aHR (95% CI) = 1.45 (1.33–1.59) for women with prior gestational hypertension and aHR = 1.62 (1.48–1.78) for women with prior pre-eclampsia. Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR = 2.85 (1.67–4.86), and unstable angina, aHR = 1.92 (1.33–2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR = 3.27 (1.49–7.19), and acute myocardial infarction, aHR = 2.46 (1.72–3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies. Conclusions Women with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.

ObjectiveTo provide quantitative evidence for systematically prioritising individuals for full formal cardiovascular disease (CVD) risk assessment using primary care records with a novel tool (eHEART) with age- and sex- specific risk thresholds.Methods and analysiseHEART was derived using landmark Cox models for incident CVD with repeated measures of conventional CVD risk predictors in 1,642,498 individuals from the Clinical Practice Research Datalink. Using 119,137 individuals from UK Biobank, we modelled the implications of initiating guideline-recommended statin therapy using eHEART with age- and sex-specific prioritisation thresholds corresponding to 5% false negative rates to prioritise adults aged 40-69 years in a population in England for invitation to a formal CVD risk assessment.ResultsFormal CVD risk assessment on all adults would identify 76% and 49% of future CVD events amongst men and women respectively, and 93 (95% CI: 90, 95) men and 279 (95% CI: 259, 297) women would need to be screened (NNS) to prevent one CVD event. In contrast, if eHEART was first used to prioritise individuals for formal CVD risk assessment, we would identify 73% and 47% of future events amongst men and women respectively, and a NNS of 75 (95% CI: 72, 77) men and 162 (95% CI: 150, 172) women. Replacing the age- and sex-specific prioritisation thresholds with a 10% threshold identify around 10% less events.ConclusionsThe use of prioritisation tools with age- and sex-specific thresholds could lead to more efficient CVD assessment programmes with only small reductions in effectiveness at preventing new CVD events.

Abstract Objective The identification of methodology for modelling cardiovascular disease (CVD) risk using longitudinal data and risk factor trajectories. Methods We screened MEDLINE-Ovid from inception until 3 June 2020. MeSH and text search terms covered three areas: data type, modelling type and disease area including search terms such as “longitudinal”, “trajector*” and “cardiovasc*” respectively. Studies were filtered to meet the following inclusion criteria: longitudinal individual patient data in adult patients with ≥3 time-points and a CVD or mortality outcome. Studies were screened and analyzed by one author. Any queries were discussed with the other authors. Comparisons were made between the methods identified looking at assumptions, flexibility and software availability. Results From the initial 2601 studies returned by the searches 80 studies were included. Four statistical approaches were identified for modelling the longitudinal data: 3 (4%) studies compared time points with simple statistical tests, 40 (50%) used single-stage approaches, such as including single time points or summary measures in survival models, 29 (36%) used two-stage approaches including an estimated longitudinal parameter in survival models, and 8 (10%) used joint models which modelled the longitudinal and survival data together. The proportion of CVD risk prediction models created using longitudinal data using two-stage and joint models increased over time. Conclusions Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.

Background and Purpose: The COVID-19 pandemic resulted in an overload of health services and healthcare professionals. The result is a setback in health promotion and prevention, delays in diagnosis, and deaths from other diseases that are currently receiving inadequate attention. This article illustrates the risk of this negligence.Case report: This study aimed to report a case of coinfection of disseminated cryptococcosis and BK virus in a patient without a previous diagnosis of human immunodeficiency virus infection and COVID-19 negative in the context of the COVID-19 pandemic. Despite receiving antifungal therapy, the patient died.Conclusion: This fatal case is a warning regarding delay of diagnosis and neglect ofother serious illnesses owing to the current pandemic, including fungal diseases and neglected diagnoses.

Infection with Aspergillus fumigatus polymycovirus 1 (AfuPmV-1) affects Aspergillus fumigatus Af293’s growth in vitro, iron metabolism, resistance in intermicrobial competition with Pseudomonas aeruginosa, resistance to osmotic stress, and resistance to the chitin synthase inhibitor nikkomycin Z. Here, we show that response to high temperature, Congo Red-induced stress, and hydrogen peroxide are also dependent on the viral infection status of A. fumigatus. AfuPmV-1- infected Af293 was more susceptible than virus-free Af293 to growth inhibition by high temperature, hydrogen peroxide, Congo Red exposure, and nutrient restriction. Increased resistance of virus-free fungus was observed when cultures were started from conidia but, in the case of high temperature and hydrogen peroxide, not when cultures were started from hyphae. This indicates that the virus impairs the stress response during the growth phase of germination of conidia and development into hyphae. In conclusion, our work indicates that AfuPmV-1 infection in A. fumigatus impairs host responses to stress, as shown by exposure to high temperature, oxidative stress such as hydrogen peroxide, and some cell wall stresses, as shown by exposure to Congo Red (in agreement with our previous observations using nikkomycin Z) and nutrient restriction.

Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.

Moderate to vigorous physical activity (MVPA) interventions reduce the severity of obstructive sleep apnoea (OSA); however, little epidemiological research exists to confirm these findings. 789 participants from the population-based Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent polysomnography. MVPA was assessed using the Active Australia questionnaire, which was completed when participants were first recruited to the MAILES study (2002–2006), and again in 2010. Multinomial logistic regressions established odds ratio between OSA severity categories with MVPA, whilst adjusted linear models determined associations between OSA metrics with MVPA. Cross-sectionally, each hour of MVPA was associated with reduced severity of mean oxygen desaturation (unstandardised β (B)=−0.002, p=0.043) and reduced time below 90% oxygen saturation (B=−0.03, p=0.034). Longitudinally, each hour increase in MVPA was associated with a 4% reduction in the odds of severe OSA and less severe mean oxygen desaturation (B=−0.003, p=0.014), time below 90% oxygen saturation (B=−0.02, p=0.02), and mean duration of apnoeas (B=−0.004, p=0.016). MVPA is associated with reduced hypoxaemia in a cohort of community dwelling males, approximately half of whom had untreated OSA. As nocturnal intermittent hypoxaemia is associated with cardiometabolic disorders, MVPA may offer protection for patients with OSA.

BackgroundPolygenic risk scores (PRSs) can stratify populations into cardiovascular disease (CVD) risk groups. We aimed to quantify the potential advantage of adding information on PRSs to conventional risk factors in the primary prevention of CVD.Methods and findingsUsing data from UK Biobank on 306,654 individuals without a history of CVD and not on lipid-lowering treatments (mean age [SD]: 56.0 [8.0] years; females: 57%; median follow-up: 8.1 years), we calculated measures of risk discrimination and reclassification upon addition of PRSs to risk factors in a conventional risk prediction model (i.e., age, sex, systolic blood pressure, smoking status, history of diabetes, and total and high-density lipoprotein cholesterol). We then modelled the implications of initiating guideline-recommended statin therapy in a primary care setting using incidence rates from 2.1 million individuals from the Clinical Practice Research Datalink. The C-index, a measure of risk discrimination, was 0.710 (95% CI 0.703-0.717) for a CVD prediction model containing conventional risk predictors alone. Addition of information on PRSs increased the C-index by 0.012 (95% CI 0.009-0.015), and resulted in continuous net reclassification improvements of about 10% and 12% in cases and non-cases, respectively. If a PRS were assessed in the entire UK primary care population aged 40-75 years, assuming that statin therapy would be initiated in accordance with the UK National Institute for Health and Care Excellence guidelines (i.e., for persons with a predicted risk of ≥10% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), then it could help prevent 1 additional CVD event for approximately every 5,750 individuals screened. By contrast, targeted assessment only among people at intermediate (i.e., 5% to ConclusionsOur results suggest that addition of PRSs to conventional risk factors can modestly enhance prediction of first-onset CVD and could translate into population health benefits if used at scale.

BackgroundNew York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City's public hospital system.MethodsWe reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed.Results22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes.Conclusions and relevanceThis is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

Understanding the spatial variability in highly heterogeneous natural environments such as savannas and river corridors is an important issue in characterizing and modeling energy fluxes, particularly for evapotranspiration (ET) estimates. Currently, remote-sensing-based surface energy balance (SEB) models are applied widely and routinely in agricultural settings to obtain ET information on an operational basis for use in water resources management. However, the application of these models in natural environments is challenging due to spatial heterogeneity in vegetation cover and complexity in the number of vegetation species existing within a biome. In this research effort, small unmanned aerial systems (sUAS) data were used to study the influence of land surface spatial heterogeneity on the modeling of ET using the Two-Source Energy Balance (TSEB) model. The study area is the San Rafael River corridor in Utah, which is a part of the Upper Colorado River Basin that is characterized by arid conditions and variations in soil moisture status and the type and height of vegetation. First, a spatial variability analysis was performed using a discrete wavelet transform (DWT) to identify a representative spatial resolution/model grid size for adequately solving energy balance components to derive ET. The results indicated a maximum wavelet energy between 6.4 m and 12.8 m for the river corridor area, while the non-river corridor area, which is characterized by different surface types and random vegetation, does not show a peak value. Next, to evaluate the effect of spatial resolution on latent heat flux (LE) estimation using the TSEB model, spatial scales of 6 m and 15 m instead of 6.4 m and 12.8 m, respectively, were used to simplify the derivation of model inputs. The results indicated small differences in the LE values between 6 m and 15 m resolutions, with a slight decrease in detail at 15 m due to losses in spatial variability. Lastly, the instantaneous (hourly) LE was extrapolated/upscaled to daily ET values using the incoming solar radiation (Rs) method. The results indicated that willow and cottonwood have the highest ET rates, followed by grass/shrubs and treated tamarisk. Although most of the treated tamarisk vegetation is in dead/dry condition, the green vegetation growing underneath resulted in a magnitude value of ET.

Abstract Background As nanoparticles (NPs) become more prevalent in the pharmaceutical industry, questions have arisen from both industry and regulatory stakeholders about the long term effects of these materials. This study was designed to evaluate whether gold (10 nm), silver (50 nm), or silica (10 nm) nanoparticles administered intravenously to mice for up to 8 weeks at doses known to be sub-toxic (non-toxic at single acute or repeat dosing levels) and clinically relevant could produce significant bioaccumulation in liver and spleen macrophages. Results Repeated dosing with gold, silver, and silica nanoparticles did not saturate bioaccumulation in liver or spleen macrophages. While no toxicity was observed with gold and silver nanoparticles throughout the 8 week experiment, some effects including histopathological and serum chemistry changes were observed with silica nanoparticles starting at week 3. No major changes in the splenocyte population were observed during the study for any of the nanoparticles tested. Conclusions The clinical impact of these changes is unclear but suggests that the mononuclear phagocytic system is able to handle repeated doses of nanoparticles.

The surface-atmosphere turbulent exchanges couple the water, energy and carbon budgets in the Earth system. The biosphere plays an important role in the evaporation process, and vegetation related parameters such as the leaf area index (LAI), vertical root distribution and stomatal resistance are poorly constrained due to sparse observations at the spatio-temporal scales at which land surface models (LSMs) operate. In this study, we use the Carbon Hydrology Tiled European Center for Medium-Range Weather Forecasts (ECMWF) Scheme for Surface Exchanges over Land (CHTESSEL) model and investigate the sensitivity of the simulated turbulent fluxes to these vegetation related parameters. Observed data from 17 FLUXNET towers were used to force and evaluate model simulations with different vegetation parameter configurations. The replacement of the current LAI climatology used by CHTESSEL, by a new high-resolution climatology, representative of the station’s location, has a small impact on the simulated fluxes. Instead, a revision of the root profile considering a uniform root distribution reduces the underestimation of evaporation during water stress conditions. Despite the limitations of using only one model and a limited number of stations, our results highlight the relevance of root distribution in controlling soil moisture stress, which is likely to be applicable to other LSMs.

Evapotranspiration (ET) is a key variable for hydrology and irrigation water management, with significant importance in drought-stricken regions of the western US. This is particularly true for California, which grows much of the high-value perennial crops in the US. The advent of small Unmanned Aerial System (sUAS) with sensor technology similar to satellite platforms allows for the estimation of high-resolution ET at plant spacing scale for individual fields. However, while multiple efforts have been made to estimate ET from sUAS products, the sensitivity of ET models to different model grid size/resolution in complex canopies, such as vineyards, is still unknown. The variability of row spacing, canopy structure, and distance between fields makes this information necessary because additional complexity processing individual fields. Therefore, processing the entire image at a fixed resolution that is potentially larger than the plant-row separation is more efficient. From a computational perspective, there would be an advantage to running models at much coarser resolutions than the very fine native pixel size from sUAS imagery for operational applications. In this study, the Two-Source Energy Balance with a dual temperature (TSEB2T) model, which uses remotely sensed soil/substrate and canopy temperature from sUAS imagery, was used to estimate ET and identify the impact of spatial domain scale under different vine phenological conditions. The analysis relies upon high-resolution imagery collected during multiple years and times by the Utah State University AggieAirTM sUAS program over a commercial vineyard located near Lodi, California. This project is part of the USDA-Agricultural Research Service Grape Remote Sensing Atmospheric Profile and Evapotranspiration eXperiment (GRAPEX). Original spectral and thermal imagery data from sUAS were at 10 cm and 60 cm per pixel, respectively, and multiple spatial domain scales (3.6, 7.2, 14.4, and 30 m) were evaluated and compared against eddy covariance (EC) measurements. Results indicated that the TSEB2T model is only slightly affected in the estimation of the net radiation (Rn) and the soil heat flux (G) at different spatial resolutions, while the sensible and latent heat fluxes (H and LE, respectively) are significantly affected by coarse grid sizes. The results indicated overestimation of H and underestimation of LE values, particularly at Landsat scale (30 m). This refers to the non-linear relationship between the land surface temperature (LST) and the normalized difference vegetation index (NDVI) at coarse model resolution. Another predominant reason for LE reduction in TSEB2T was the decrease in the aerodynamic resistance (Ra), which is a function of the friction velocity ( u * ) that varies with mean canopy height and roughness length. While a small increase in grid size can be implemented, this increase should be limited to less than twice the smallest row spacing present in the sUAS imagery. The results also indicated that the mean LE at field scale is reduced by 10% to 20% at coarser resolutions, while the with-in field variability in LE values decreased significantly at the larger grid sizes and ranged between approximately 15% and 45%. This implies that, while the field-scale values of LE are fairly reliable at larger grid sizes, the with-in field variability limits its use for precision agriculture applications.

Introducción: Las representaciones sociales son un tipo de conocimiento de sentido común por medio del cual los individuos y las comunidades convierten una realidad física en construcciones perceptibles de aquello que les rodea, convirtiendo lo extraño en familiar. El objetivo primordial de este estudio fue comprender las representaciones sociales de los líderes de organizaciones de base comunitaria sobre el consumo de sustancias psicoactivas en un sector barrial de la comuna 18 en la ciudad de Cali. Método: Se desarrolló un estudio bajo un enfoque investigativo cualitativo y su diseño se asumió como un estudio de representaciones sociales, el cual se suscribe al paradigma interpretativo-constructivista. Resultados: Los líderes comunitarios definieron el fenómeno de manera bidimensional; por un lado, como un problema de salud, evidenciando una serie de saberes científicos en los participantes que influyen en la constitución de la representación social de consumo de sustancias psicoactivas como una enfermedad, y por otro lado, como un problema social asociado a determinantes sociales y políticas que están fuera del alcance del consumo en tanto fenómeno. Conclusión: Las representaciones sociales que los líderes y organizaciones de base comunitaria le atribuyen al uso de sustancias psicoactivas en el sector de la Comuna 18; están caracterizadas por significados que se tejen entre un saber científico sobre el consumo de sustancias, un discurso institucional y el sistema de valoración moral establecido en el contexto de la comunidad.

Sleep-disordered breathing (SDB), encompassing both obstructive and central sleep apnea, is prevalent in at least 50% of stroke patients. Small studies have shown vast improvements in post-stroke functional recovery outcomes after the treatment of SDB by continuous positive airway pressure. However, compliance to this therapy is very poor in this complex patient group. There are alternative therapy options for SDB that may be more amenable for use in at least some post-stroke patients, including mandibular advancement, supine avoidance, and oxygen therapy. There are few studies, however, that demonstrate efficacy and compliance with these alternative therapies currently. Furthermore, novel SDB-phenotyping approaches may help to provide important clinical information to direct therapy selection in individual patients. Prior to realizing individualized therapy, we need a better understanding of the pathophysiology of SDB in post-stroke patients, including the role of inherent phenotypic traits, as well as the contribution of stroke size and location. This review summarizes the available literature on SDB pathophysiology and treatment in post-stroke patients, identifies gaps in the literature, and sets out areas for further research.

El presente artículo pretende inducir a una discusión crítica acerca de las nociones conceptuales de la prevención aplicados al fenómeno del consumo de sustancias psicoactivas. Se realizó un recorrido teórico sobre las nociones acerca de la enfermedad y como estas preceden el concepto de prevención. De la misma se abordan aproximaciones al término de prevención y algunos de los modelos existentes, los cuales han sido bandera de las Ciencias de la salud y finalmente estableciendo puntos de encuentro y desencuentro, lo cual abre un espacio necesario para que las Ciencias Sociales realicen sus aportaciones. Finalmente, se discute sobre la imposibilidad de la prevención bajo el marco conceptual y metodológico existente.

Over the past decade, much research has focused on the behaviour of structures following the failure of a key structural component. Particular attention has been given to sudden column loss, though questions remain as to whether this event-independent scenario is relevant to actual extreme events such as explosion. Few studies have been conducted to assess the performance of floor slabs above a failed column, and the computational tools used have not been validated against experimental results. The research program presented in this paper investigates the adequacy of sudden column loss as an idealisation of local damage caused by realistic explosion events, and extends prior work by combining the development of accurate computational models with large-scale testing of a typical floor system in a prototypical steel-framed structure. The floor system consists of corrugated decking topped by a lightly reinforced concrete slab that is connected to the floor beams through shear studs. The design is consistent with typical building practices in the US. The first test has been completed, and subsequent tests are currently being planned. This paper addresses the importance of robustness design for localized damage and includes a detailed description regarding how the research program advances the current state of knowledge for assessing robustness of compositely constructed steel-framed buildings.

El presente artículo surge como resultado de la fase de revisión bibliográfica del estudio “El Fracaso Escolar Como síntoma Afectivos En Niños Y Niñas Con Experiencias De Abandono”, en donde se buscó indagar acerca del fracaso escolar y la orfandad, definiendo al final que el maltrato infantil y el abandono está íntimamente relacionado con alteraciones en el aprendizaje, alteraciones qué, en su mayoría tienen una naturaleza psicológica, de esta forma preciso comprender el fracaso escolar como otra forma de expresar en el presente el maltrato, el abandono y la negligencia que los niños y niñas han vivido en los primeros años de vida. Finalmente, se plantea que la institucionalización de los niños y las niñas generan también un efecto irreparable en el desarrollo de estos, lo cual posibilita el fracaso escolar.

Resumen Desde la publicación de las guías llamadas Normas para la Excelencia en los Reportes sobre la Mejora de la Calidad (SQUIRE 1.0, Standards for Quality Improvement Reporting Excellence), en 2008, la ciencia en ese campo ha avanzado considerablemente. En este manuscrito se describe el desarrollo de SQUIRE 2.0 y sus componentes clave. La revisión se realizó entre 2012 y 2015 utilizando: (1) entrevistas semiestructuradas y grupos focales para evaluar SQUIRE 1.0 además de la retroalimentación de un grupo directivo internacional, (2) dos reuniones de consenso cara a cara para desarrollar borradores provisionales, y (3) pruebas piloto con los autores y un período de comentarios públicos. SQUIRE 2.0 hace hincapié en el reporte de tres componentes clave de los esfuerzos sistemáticos por mejorar la calidad, el valor y la seguridad de la asistencia sanitaria: el uso de la teoría formal e informal en la planificación, implementación y evaluación de los trabajos de mejora; el contexto en que se realiza el trabajo; y el estudio de la o las intervenciones. SQUIRE 2.0 está diseñado para reportar la gama de métodos utilizados para mejorar la atención sanitaria, reconociendo que esto puede ser complejo y multidimensional. Proporciona una base común para compartir estos hallazgos en la literatura académica (www.squire-statement.org).

El artículo presenta resultados de una revisión bibliográfica en el tema de consumo de drogas en el contexto comunitario, orientado a generar una línea basal que permita identificar los avances, dificultades y brechas en el conocimiento del fenómeno del consumo de drogas en los contextos comunitarios. Para la revisión se realizó una consulta bibliográfica de las fuentes bibliográficas de los últimos 10 años, explorando diferentes disciplinas de ciencias sociales y de la salud. Se cuestiona sobre el papel que juegan las comunidades en la intervención de los problemas de salud pública; se encontró que las comunidades de mayor riesgo son aquellas con los niveles más altos de desventaja en el vecindario.

El articulo presenta resultados de investigación donde se buscó explorar la significación de la figura materna y su posible relación con la dependencia a sustancias psicoactivas en adolescentes institucionalizados en un centro de tratamiento para las adicciones. El estudio asumió una perspectiva psicoanalítica de corte cualitativo, su población fue conformada por tres adolescentes y el método utilizado fue el estudio de caso. Finalmente se encontró que las significaciones que los adolescentes le atribuyen al vínculo con su figura materna posee condiciones similares a la organización adictiva hacia el consumo de sustancias psicoactivas.

IntroductionThe Patient Assessment of Chronic Illness Care (PACIC) survey is a patient-centered instrument for evaluating the quality and patient-centeredness of chronic illness care received according to the Chronic Care Model paradigm. This study validates the Spanish translation of the PACIC in an urban, Spanish-speaking population.MethodsOne hundred Spanish-speaking patients with diabetes completed the translated PACIC and sociodemographic and cultural questionnaires. Test-retest reliability was assessed in a subset of 20 patients who completed the questionnaire 2 to 4 months later. Internal consistency was evaluated with Cronbach α. PACIC score and subscale associations with sociodemographic characteristics were examined.ResultsTest-retest reliability for the overall translated PACIC scale was 0.77. Scores were not associated with patient sociodemographic characteristics, including age, country of birth, years living in the United States, or education level (P >.05).ConclusionThe Spanish translation of the PACIC survey demonstrated high reliability, internal consistency, and test-retest reliability. Scores showed no association with sociodemographic or cultural characteristics. The Spanish version can reliably be used to assess care delivered according to the Chronic Care Model in a heterogeneous Spanish-speaking population.