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Abstract We aimed to identify the clinical subtypes in individuals starting long-term care in Japan and examined their association with prognoses. Using linked medical insurance claims data and survey data for care-need certification in a large city, we identified participants who started long-term care. Grouping them based on 22 diseases recorded in the past 6 months using fuzzy c-means clustering, we examined the longitudinal association between clusters and death or care-need level deterioration within 2 years. We analyzed 4,648 participants (median age 83 [interquartile range 78–88] years, female 60.4%) between October 2014 and March 2019 and categorized them into (i) musculoskeletal and sensory, (ii) cardiac, (iii) neurological, (iv) respiratory and cancer, (v) insulin-dependent diabetes, and (vi) unspecified subtypes. The results of clustering were replicated in another city. Compared with the musculoskeletal and sensory subtype, the adjusted hazard ratio (95% confidence interval) for death was 1.22 (1.05–1.42), 1.81 (1.54–2.13), and 1.21 (1.00–1.46) for the cardiac, respiratory and cancer, and insulin-dependent diabetes subtypes, respectively. The care-need levels more likely worsened in the cardiac, respiratory and cancer, and unspecified subtypes than in the musculoskeletal and sensory subtype. In conclusion, distinct clinical subtypes exist among individuals initiating long-term care.

ABSTRACT The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others.

Artykuł dostarcza argumentów na rzecz uwzględnienia w wychowaniu moralnym edukacji społeczno-emocjonalnej. W pierwszej części artykułu przedstawia się analizę pojęcia „inteligencja emocjonalna” uwzględniając przy tym historię jego powstania i trudności metodologiczne, jakimi pojęcie to jest obciążone. W drugiej części artykułu sformułowane zostały oczekiwania, jakie można wysuwać pod adresem zajęć z edukacji emocjonalnej. Punktem wyjścia są przy tym badania empiryczne, które dotyczyły skuteczności podejmowanych w przeszłości prób prowadzenia edukacji emocjonalnej u młodzieży i osób dorosłych. W ostatniej części artykułu omawia się założenia powstałego w latach 90. ruchu pedagogicznego, który postuluje prowadzenie zajęć z zakresu tak zwanego „kształtowania charakteru” (Character Education). Omawiane są doświadczenia z zajęć z edukacji emocjonalno-społecznej (Social-Emotional Learning, SEL) opracowane przez Uniwersytet Illinois. W tekście uwzględnione zostały także krótko pierwsze doświadczenia Hiszpanii w zakresie edukacji emocjonalnej.

Abstract Dreaming is a complex phenomenon that occurs during sleep, involving various conscious dream experiences. Lucid dreams (LDs) involve heightened awareness within the dream environment, while out-of-body experiences (OBEs) involve the sensation of being outside one’s physical body. OBEs occur during sleep paralysis (SP), where voluntary movements are inhibited during sleep/wake transitions while remaining aware of the surroundings. The relationship between LDs and OBEs is debated, with some viewing them as distinct phenomena and others considering them different manifestations of the same underlying experience. This study aimed to characterize non-lucid dreams, LDs, and OBEs by analyzing dream reports’ structural properties. OBE reports displayed a condensed and interconnected network structure compared to non-lucid dreams and LDs. Additionally, OBE reports exhibited a specialized network structure, with specific nodes playing a more central role. These findings suggest that OBE dreams may have a more coherent and unified narrative, with certain nodes being pivotal in the network structure.

A variety of techniques have been developed to extract hemp phytochemicals for research and consumption. Some of the most common processes in the industry include supercritical CO2 extraction, hydrodistillation, and solvent-based (ethanol) extractions. Each of these processes has the potential to differentially extract various phytochemicals, which would impact their efficacy, tolerability, and safety. However, despite these differences, there has been no direct comparison of the methods and the resulting phytochemical composition. This work aimed to compare cannabinoid and terpene profiles using the three primary commercial procedures, using hemp inflorescence from a CBD/CBG dominant Cannabis sativa L. cultivar. Extracts were then evaluated for their terpene and cannabinoid content using GC-MS and LC-MS/MS, respectively. Hydrodistilled extracts contained the most variety and abundance of terpenes with β-caryophyllene to be the most concentrated terpene (25–42 mg/g). Supercritical CO2 extracts displayed a minimal variety of terpenes, but the most variety and abundance of cannabinoids with CBD ranging from 12.8–20.6 mg/g. Ethanol extracts contained the most acidic cannabinoids with 3.2–4.1 mg/g of CBDA along with minor terpene levels. The resulting extracts demonstrated substantially different chemical profiles and highlight how the process used to extract hemp can play a large role in product composition and potential biological effects.

Abstract Metformin has been shown to modulate meta-inflammation, an important pathogenesis in knee osteoarthritis (OA). The study aimed to test the association between regular metformin use with total knee replacement (TKR) in patients with diabetes. This is a retrospective study with electronic records retrieved in Hong Kong public primary care. Patients with diabetes aged ≥ 45 who visited during 2007 to 2010, were followed up for a four-year period from 2011 to 2014 to determine the incidence of TKR. Propensity score matching based on age, sex, co-medications and chronic conditions was conducted to adjust for confounding. Cox regression was implemented to examine the association between metformin use and TKR. In total, 196,930 patients were eligible and 93,330 regular metformin users (defined as ≥ 4 prescriptions over the previous year) and non-users were matched. Among 46,665 regular users, 184 TKRs were conducted, 17.1% fewer than that among non-users. Cox regression showed that regular metformin users had a 19%-lower hazard of TKR [hazard ratio (HR) = 0.81, 95% confidence interval: 0.67 to 0.98, P = 0.033], with a dose–response relationship. Findings suggest a potential protective effect of metformin on knee OA progression and later TKR incidence among diabetic patients.

Background COVID‐19 vaccines have demonstrated effectiveness against SARS‐CoV‐2 infection, hospitalization, and mortality. The association between vaccination and risk of cardiovascular complications shortly after SARS‐CoV‐2 infection among patients with cardiovascular disease remains unknown. Methods and Results A case–control study was conducted with cases defined as patients who had myocardial infarction or stroke within 28 days after SARS‐CoV‐2 infection between January 1, 2022 and August 15, 2022. Controls were defined as all other patients who attended any health services and were not cases. Individuals without history of cardiovascular disease were excluded. Each case was randomly matched with 10 controls according to sex, age, Charlson comorbidity index, and date of hospital admission. Adjusted odds ratio with 95% CI was estimated using conditional logistic regression. We identified 808 cases matched with 7771 controls among all patients with cardiovascular disease. Results showed that vaccination with BNT162b2 or CoronaVac was associated with a lower risk of myocardial infarction or stroke after SARS‐CoV‐2 infection with a dose–response relationship. For BNT162b2, risk decreased from 0.49 (95% CI, 0.29–0.84) to 0.30 (95% CI, 0.20–0.44) and 0.17 (95% CI, 0.08–0.34) from 1 to 3 doses, respectively. Similar trends were observed for CoronaVac, with risk decreased from 0.69 (95% CI, 0.57–0.85) to 0.42 (95% CI, 0.34–0.52) and 0.32 (95% CI, 0.21–0.49) from 1 to 3 doses, respectively. Conclusions Vaccination with BNT162b2 or CoronaVac is associated with a lower risk of myocardial infarction or stroke after SARS‐CoV‐2 infection among patients with cardiovascular disease.

Abstract Background The World Health Organization has defined a list of adverse events of special interest (AESI) for safety surveillance of vaccines. AESI have not been adequately assessed following COVID-19 vaccination in patients with cancer contributing to vaccine hesitancy in this population. We aimed to evaluate the association between BNT162b2 and CoronaVac vaccines and the risk of AESI in adults with active cancer or a history of cancer. Patients and methods We conducted a territory-wide cohort study using electronic health records managed by the Hong Kong Hospital Authority and vaccination records provided by the Department of Health. Patients with a cancer diagnosis between January 1, 2018, and September 30, 2021, were included and stratified into two cohorts: active cancer and history of cancer. Within each cohort, patients who received two doses of BNT162b2 or CoronaVac were 1:1 matched to unvaccinated patients using the propensity score. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for AESI 28 days after the second vaccine dose. Results A total of 74,878 patients with cancer were included (vaccinated: 25,789 [34%]; unvaccinated: 49,089 [66%]). Among patients with active cancer, the incidence of AESI was 0.31 and 1.02 per 10,000 person-days with BNT162b2 versus unvaccinated patients and 0.13 and 0.88 per 10,000 person-days with CoronaVac versus unvaccinated patients. Among patients with history of cancer, the incidence was 0.55 and 0.89 per 10,000 person-days with BNT162b2 versus unvaccinated patients and 0.42 and 0.93 per 10,000 person-days with CoronaVac versus unvaccinated patients. Neither vaccine was associated with a higher risk of AESI for patients with active cancer (BNT162b2: HR 0.30, 95% CI 0.08–1.09; CoronaVac: 0.14, 95% CI 0.02–1.18) or patients with history of cancer (BNT162b2: 0.62, 95% CI 0.30–1.28; CoronaVac: 0.45, 95% CI 0.21–1.00). Conclusions In this territory-wide cohort study of patients with cancer, the incidence of AESI following vaccination with two doses of either BNT162b2 or CoronaVac vaccines was low. The findings of this study can reassure clinicians and patients with cancer about the overall safety of BNT162b2 and CoronaVac in patients with cancer, which could increase the COVID-19 vaccination rate in this vulnerable group of patients.

Background: No dairy breed or crossbreed has superior overall performance in all environments; therefore, it is necessary to determine which crossbreed is the most suitable for the Mexican tropic and what proportion of European breed is optimum for reproduction. Objective: To assess the effect of the proportion of Bos taurus (Bt) genes on reproductive performance of Holstein×Zebu (HZ) and Brown Swiss×Zebu (BZ) cows, and compare reproductive performance of these genotypes in a dual-purpose production system. Methods: Cows were maintained in a rotational grazing system on African star grass (Cynodon plectostachyus) in Veracruz, Mexico. Cows were milked twice daily. Calves were kept tied to the side of their dams while the cows were milked. Results: The percentage of Bt genes did not affect (p>0.05) fertility traits (age at first calving, days to first service after calving, services per conception, conception rate at first service, days open until conception, gestation length, and calving interval) of BZ cows. In contrast, HZ cows with less than 75% Holstein (H) genes were 0.3 years younger (p

Tensor models have been used extensively in signal processing applications to design different types of communication systems. This paper proposes, for the first time, the use of tensor models for optical communications. The signals of an optical dual-core coupler network are modeled as a multiway array (tensor), which satisfies a generalized Tucker train decomposition. This tensor model is then used to develop an estimation algorithm that enables the network parameters to be estimated from the input and output signals. The performance of this algorithm was evaluated by means of computer simulations, in terms of NMSE of the estimated parameters and convergence speed. For the tested configurations, good levels of NMSE with fast convergence were obtained, demonstrating the effectiveness of the proposed method as a promising tool for studying and designing optical devices, with a wide range of applications in the context of lightwave systems.

ABSTRACT This paper proposes geothermal energy as an alternative solution to the water–energy dilemma in the northeastern region of Brazil (NEB). The main application of this study was to provide a theoretical basis to support a different approach to policies minimizing water scarcity and ensuring sustainability. The analysis developed in this study compares the levelized cost of electricity (LCOE) for many different energy sources. The novelty of this study is the use of geothermal energy in the context of the Brazilian Northeast, focusing on water desalination processes, which are expensive in terms of energy. Therefore, this study is highly important because it offers the potential of addressing the energy/economic barrier related to water desalination in environments with economically viable geothermal energy. This is the case in Northeast Brazil with potential for reuse of abandoned oil wells. In the form of enhanced geothermal systems (EGS), geothermal energy is a competitive energy source compared to other sources in the Brazilian Energy Matrix, especially when considering factors in addition to the economic benefits. In the form of EGS, geothermal energy is a suitable option for addressing water scarcity in the northeast region in a sustainable and low-emission manner. This is a strategic opportunity for NEB in the context of energy production and freshwater production through desalination.

Aim of study: To advance implementation of sustainable agriculture from organic production system on almond crop by means of the assessment of physiological and agronomical responses of commercial almond cultivars. Area of study: Irrigated almond in the Guadalquivir River Valley. Material and methods: Physiological and agronomic aspects of almond such as defoliation, phenology, tree growth, N and P leaf reserves, susceptibility to aphids and fruit yield were assessed on five almond cultivars under organic and conventional production management during four consecutive seasons from 2017 to 2021. Main results: A lower flower density, tree growth, and almond production, an earlier and more intense defoliation degree, and a higher susceptibility to aphids were observed in the organic plot compared to the conventional orchard. 'Lauranne' was the cultivar that showed the best productivity under organic and conventional management. 'Marcona' showed the higher flower density and medium vigor, although was the most susceptible cultivar to aphids and the less productive cultivar under both managements. Research highlights: Cultivation of irrigated almond still presents numerous difficulties, especially the control of pests and diseases due to the use of environmentally friendly pesticides which are less effective than chemicals. These pathogenic factors and others such as nutrition especially affect the yield of the crop, although the differences with the conventional system are reduced over time. Despite these difficulties, the high added value of organic almonds together with the increasing demands by consumers of healthy environmental practices and food safety are a stimulus to continue and develop research on sustainable agriculture.

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

Among the many biological entities employed in the development of biosensors, enzymes have attracted the most attention. Nanotechnology has been fostering excellent prospects in the development of enzymatic biosensors, since enzyme immobilization onto conductive nanostructures can improve characteristics that are crucial in biosensor transduction, such as surface-to-volume ratio, signal response, selectivity, sensitivity, conductivity, and biocatalytic activity, among others. These and other advantages of nanomaterial-based enzymatic biosensors are discussed in this work via the compilation of several reports on their applications in different industrial segments. To provide detailed insights into the state of the art of this technology, all the relevant concepts around the topic are discussed, including the properties of enzymes, the mechanisms involved in their immobilization, and the application of different enzyme-derived biosensors and nanomaterials. Finally, there is a discussion around the pressing challenges in this technology, which will be useful for guiding the development of future research in the area.

The cost of treatment for rare diseases is notoriously high imposing threats to the global healthcare system. Existing market-based tools for orphan drugs are not designed to reduce drug prices and could be hampered by adverse selection. We propose an alternative insurance mechanism, Massive Group Insurance (MGI), which aims at reducing the prices of orphan drugs through offering separate Intellectual Property Right (IPR) Fees to the drug company from an MGI Agency, which will collect insurance premiums from each country on each orphan drug that the country wants all its citizens to enjoy access to. The premiums will be calculated so as to ensure that the drug company will collect a profit no smaller than what it enjoys under the traditional model. The plan uses the group insurance concept and will generate a significant increase in drug use. Blockchain technology is used to facilitate authentication and effective IPR payments and ensure data security and low administrative cost. This model can potentially be extended to other categories of expensive drugs and vaccines.

Abstract Background Research comparing sex differences in the effects of antipsychotic medications on acute ischemic heart disease (IHD) is limited and the findings ambiguous. This study aimed to investigate these associations within a primary care setting. Methods Hong Kong public general outpatient electronic records of patients aged 45+ during 2007–2010 were extracted, with the last consultation date as the baseline for a 4-year follow-up period to observe acute IHD hospitalizations (2011–2014). Antipsychotic use was defined as any prescription over the previous 12 months from a list of 16 antipsychotics, while acute IHD was defined by ICD-9: 410.00–411.89. Both sex-specific and sex-combined (both sexes) mixed-effects Cox models (random intercept across 74 clinics) were implemented to examine the association and test the interaction between antipsychotics and sex. Results Among 1,043,236 included patients, 17,780 (1.7%) were prescribed antipsychotics, and 8342 (0.8%) developed IHD. In sex-specific analyses, antipsychotic prescription was associated with a 32% increased hazard rate of acute IHD among women (95% CI 1.05–1.67) but not among men. A likelihood ratio test comparing sex-combined models with and without the interaction between antipsychotic use and sex suggested significant interaction (χ 2 = 4.72, P = 0.030). The association between antipsychotic use and IHD among women attenuated and became non-significant when haloperidol was omitted from the operationalization of antipsychotic use (HR = 1.23, 95% CI 0.95–1.60). Conclusion Our results suggest that antipsychotic prescription is moderately associated with an increased risk of acute IHD among women in primary care and this relationship may be explained by specific antipsychotics. Further research should observe and capture the potential intermediary mechanisms and the dose-response relationship of this association to provide more rigorous evidence to establish causality and inform clinical practices.

El objetivo fue comparar las prevalencias de anticuerpos contra diferentes serovares de Leptospira interrogans entre los estados de Puebla, Tabasco y Veracruz, así como entre algunos de sus municipios, y determinar si el estatus sanitario de las vacas influye en su fertilidad. Se tomaron muestras de sangre de 423 vacas (Bos taurus x Bos indicus y Bos indicus) de 24 ranchos de 11 municipios de los estados mencionados. Las prevalencias de los serovares Hardjo e Inifap fueron mayores (P0.05). El número de serovares en el estado de Veracruz fue mayor (P0.05); sin embargo, se recomienda la vacunación del ganado contra Leptospira interrogans, con el fin de disminuir los riesgos asociados con esta bacteria en bovinos y humanos.

Introducción y objetivo: La restricción del crecimiento intrauterino (RCIU), expresión insuficiente del potencial genético de crecimiento fetal, complica el 5-8% de los embarazos, con unas altas tasas de morbimortalidad perinatal. De origen multifactorial, puede ser causada por patologías maternas, fetales o placentarias. El tratamiento es limitado, optándose por un seguimiento riguroso con eventual interrupción del embarazo según la evolución. Se han utilizado diferentes estrategias terapéuticas para su prevención y manejo, surgiendo el citrato de sildenafil (CS), inhibidor de la fosfodiesterasa tipo 5, como fármaco que podría mejorar el flujo sanguíneo uteroplacentario y ofrecer mejores resultados perinatales en fetos con RCIU. Se propone realizar una revisión de la literatura disponible en relación al CS como tratamiento del RCIU. Método: Se realizó una búsqueda de literatura en inglés y español. De 105 artículos seleccionados, se excluyeron 94. La información obtenida fue clasificada y utilizada como soporte para la realización de esta revisión, siguiendo el modelo PRISMA. Resultados: Se encontraron 11 estudios que contrastan el uso de placebo y CS en pacientes con RCIU. Respecto al aumento de peso al nacimiento, solo dos estudios demostraron evidencia significativa. Se reportaron 40 casos de muerte fetal/ neonatal asociada al tratamiento con CS. Conclusiones: No se encontró evidencia suficiente que justifique el uso sistemático de CS en casos de RCIU. Aún es necesario realizar estudios con muestras de mayor tamaño y posterior metaanálisis para confirmar el beneficio farmacológico en cuanto al aumento de peso de nacimiento, la prolongación del embarazo y los posibles efectos adversos a largo plazo.

A comparative study of organic and conventional farming systems was conducted in almond orchards to determine the effect of management practices on their fungal and bacterial communities. Soils from two orchards under organic (OM) and conventional (CM), and nearby nonmanaged (NM) soil were analyzed and compared. Several biochemical and biological parameters were measured (soil pH, electrical conductivity, total nitrogen, organic material, total phosphorous, total DNA, and fungal and bacterial DNA copies). Massive parallel sequencing of regions from fungal ITS rRNA and bacterial 16 S genes was carried out to characterize their diversity in the soil. We report a larger abundance of bacteria and fungi in soils under OM, with a more balanced fungi:bacteria ratio, compared to bacteria-skewed proportions under CM and NM. The fungal phylum Ascomycota corresponded to around the 75% relative abundance in the soil, whereas for bacteria, the phyla Proteobacteria, Acidobacteriota and Bacteroidota integrated around 50% of their diversity. Alpha diversity was similar across practices, but beta diversity was highly clustered by soil management. Linear discriminant analysis effect size (LEfSE) identified bacterial and fungal taxa associated with each type of soil management. Analyses of fungal functional guilds revealed 3–4 times larger abundance of pathogenic fungi under CM compared to OM and NM treatments. Among them, the genus Cylindrocarpon was more abundant under CM, and Fusarium under OM.

Cannabis is a complex biosynthetic plant, with a long history of medicinal use. While cannabinoids have received the majority of the attention for their psychoactive and pharmacological activities, cannabis produces a diverse array of phytochemicals, such as terpenes. These compounds are known to play a role in the aroma and flavor of cannabis but are potent biologically active molecules that exert effects on infectious as well as chronic diseases. Furthermore, terpenes have the potential to play important roles, such as synergistic and/or entourage compounds that modulate the activity of the cannabinoids. This review highlights the diversity and bioactivities of terpenes in cannabis, especially minor or secondary terpenes that are less concentrated in cannabis on a by-mass basis. We also explore the question of the entourage effect in cannabis, which studies to date have supported or refuted the concept of synergy in cannabis, and where synergy experimentation is headed, to better understand the interplay between phytochemicals within Cannabis sativa L.

Background: Multimorbidity, defined as the co-occurrence of ≥2 chronic conditions, is clinically diverse. Such complexity hinders the development of integrated/collaborative care for multimorbid patients. In addition, the universality of multimorbidity patterns is unclear given scarce research comparing multimorbidity profiles across populations. This study aims to derive and compare multimorbidity profiles in Hong Kong (HK, PRC) and Zurich (ZH, Switzerland).Methods: Stratified by sites, hierarchical agglomerative clustering analysis (dissimilarity measured by Jaccard index) was conducted with the objective of grouping inpatients into clinically meaningful clusters based on age, sex, and 30 chronic conditions among 20,000 randomly selected discharged multimorbid inpatients (10,000 from each site) aged ≥ 45 years. The elbow point method based on average within-cluster dissimilarity, complemented with a qualitative clinical examination of disease prevalence, was used to determine the number of clusters.Results: Nine clusters were derived for each site. Both similarities and dissimilarities of multimorbidity patterns were observed. There was one stroke-oriented cluster (3.9% in HK; 6.5% in ZH) and one chronic kidney disease-oriented cluster (13.1% in HK; 11.5% ZH) in each site. Examples of site-specific multimorbidity patterns, on the other hand, included a myocardial infarction-oriented cluster in ZH (2.3%) and several clusters in HK with high prevalence of heart failure (>65%) and chronic pain (>20%).Conclusion: This is the first study using hierarchical agglomerative clustering analysis to profile multimorbid inpatients from two different populations to identify universalities and differences of multimorbidity patterns. Our findings may inform the coordination of integrated/collaborative healthcare services.

Glucosinolate extracts from sprouts of common Brassica nigra, B. juncea cv. Scala, B. carinata cv. Eleven, and Sinapis alba cv. Ludique were analysed by reversed phase high-performance liquid chromatography-diode array detection-mass spectrometry. The effect of the glucosinolate-myrosinase system on in vitro mycelial growth of Phytophthora cinnamomi Rands and Pythium spiculum B. Paul was assessed. Likewise, sinigrin and sinalbin monohydrate commercial standards were also tested. The extracts from B. carinata, which contained 159 mmol/g plant DW equivalent (85% sinigrin, 5% gluconapin, and 3% glucotropaeolin), were the most effective against Phytophthora and Pythium isolates used in this study. However, the extract from S. alba, which contained 1 180 mmol/g (100% sinalbin), did not inhibit the mycelial growth of the isolates tested. The use of the glucosinolate-myrosinase system provides important additional information to advance in the implementation of field application of brassicaceous amendments for the control of soil-borne pathogens.

Jubaea chilensis (Molina) Baill., also named Chilean palm, is an endemic species found in the coastal area of Mediterranean sclerophyllous forest in Chile. It has a highly restricted and fragmented distribution along the coast, being under intense exploitation and anthropogenic impact. Based on 1038 SNP markers, we evaluated the genetic diversity and population structure among six J. chilensis natural groups encompassing 96% of the species distribution. We observed low levels of genetic diversity, a deficit of heterozygotes (mean HE = 0.024; HO = 0.014), and high levels of inbreeding (mean FIS = 0.424). The fixation index (FST) and Nei’s genetic distance pairwise comparisons indicated low to moderate structuring among populations. There was no evidence of isolation by distance (r = −0.214, p = 0.799). In the cluster analysis, we observed a closer relationship among Culimo, Cocalán, and Candelaria populations. Migration rates among populations were low, except for some populations with moderate values. The K value that best represented the spatial distribution of genetic diversity was ∆K = 3. Habitat fragmentation, deterioration of the sclerophyllous forest, lack of long-distance dispersers, and a natural regeneration deficit may have driven inbreeding and low levels of genetic diversity in the palm groves of J. chilensis. Although extant populations are not at imminent risk of extinction, the rate of inbreeding could increase and migration could decrease if the effects of climate change and human impact become more acute.

The Late Cretaceous dinosaur record in southern South America has been improved recently; particularly with findings from Chorrillo and Cerro Fortaleza formations, both bearing ankylosaur remains, a clade that was not previously recorded in the Austral Basin. The dinosaur fauna of the type locality of Cerro Fortaleza Formation is known from -and biased to- large-sized sauropod remains and a single described taxon, the titanosaur Dreadnoughtus schrani. Here, we report the taxonomic composition of a site preserving thirteen isolated teeth and several osteoderms belonging to three dinosaur clades (Abelisauridae, Titanosauria, and Nodosauridae), and at least one clade of notosuchian crocodyliforms (Peirosauridae). They come from sediments positioned at the mid-section of the Cerro Fortaleza Formation, which is Campanian-Maastrichtian in age, adding valuable information to the abundance and biodiversity of this Cretaceous ecosystem. Since non-titanosaur dinosaur bones are almost absent in the locality, the teeth presented here provide a window onto the archosaur biodiversity of the Late Cretaceous in southern Patagonia. The nodosaurid tooth and small armor ossicles represent the first record of ankylosaurs for this stratigraphic unit. The peirosaurid material also represents the most austral record of the clade in South America.

Abstract Background Hantavirus pulmonary syndrome (HPS) is an infection endemic in Chile and Argentina, caused by Andes hantavirus (ANDV). The rodent Oligoryzomys longicaudatus is suggested as the main reservoir, although several other species of Sigmodontinae are known hosts of ANDV. Here, we explore potential ANDV transmission risk to humans in southern South America, based on eco-epidemiological associations among: six rodent host species, seropositive rodents, and human HPS cases. Methods We used ecological niche modeling and macroecological approaches to determine potential geographic distributions and assess environmental similarity among rodents and human HPS cases. Results Highest numbers of rodent species (five) were in Chile between 35° and 41°S latitude. Background similarity tests showed niche similarity in 14 of the 56 possible comparisons: similarity between human HPS cases and the background of all species and seropositive rodents was supported (except for Abrothrix sanborni). Of interest among the results is the likely role of O. longicaudatus, Loxodontomys micropus, Abrothrix olivaceus, and Abrothrix longipilis in HPS transmission to humans. Conclusions Our results support a role of rodent species’ distributions as a risk factor for human HPS at coarse scales, and suggest that the role of the main reservoir (O. longicaudatus) may be supported by the broader rodent host community in some areas.

In this paper, we propose a novel face recognition system based on fusing thermal and visible descriptors. The proposed approach is divided in two steps: training and validation. In the training stage, the system obtained the optimal weights from the particle swarm optimization (PSO) algorithm to maximize the recognition rates obtained from different combinations of local descriptor methods using a standard thermal face database (Equinox database). The weights were then used to fuse visible and thermal face descriptors to achieve high recognition rates during the validation stage using the Pontificia Universidad Católica de Valparaiso-Visible Thermal Face (PUCV-VTF) database. Three local matching methods were used to perform the face recognition: local binary pattern, histograms of the oriented gradients, and local derivative pattern. In addition, this paper considers a comparison with the following methods: a previous work based on Genetic Algorithms and a modified PSO approach. The results of this paper show recognition rates over 99% for the PUCV-VTF database, largely surpassing the results for Genetic Algorithms. The fusion methodology is found to be unaffected to variations in illumination and expression conditions, combining the visible and thermal information efficiently through the PSO algorithm, and thus choosing the optimal regions where a given spectrum is more relevant.

Two hundred and twenty-five Diaporthe isolates were collected from 2005 to 2019 in almond orchards showing twig cankers and shoot blight symptoms in five different regions across Spain. Multilocus DNA sequence analysis with five loci (ITS, tub, tef-1α, cal and his), allowed the identification of four known Diaporthe species, namely: D. amygdali, D. eres, D. foeniculina and D. phaseolorum. Moreover, a novel phylogenetic species, D. mediterranea, was described. Diaporthe amygdali was the most prevalent species, due to the largest number of isolates (85.3%) obtained from all sampled regions. The second most frequent species was D. foeniculina (10.2%), followed by D. mediterranea (3.6%), D. eres and D. phaseolorum, each with only one isolate. Pathogenicity tests were performed using one-year-old almond twigs cv. Vayro and representative isolates of the different species. Except for D. foeniculina and D. phaseolorum, all Diaporthe species were able to cause lesions significantly different from those developed on the uninoculated controls. Diaporthe mediterranea caused the most severe symptoms. These results confirm D. amygdali as a key pathogen of almonds in Spain. Moreover, the new species, D. mediterranea, should also be considered as a potential important causal agent of twig cankers and shoot blight on this crop.

Introduction Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO. Methods We evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function 20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve. Results Nineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy—grades 3 (segmental) or 4 (diffuse)—was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases. Conclusions Although DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.

Many psychiatric disorders, despite their specific characteristics, share deficits in the cognitive domain including executive functions, emotional control and memory. However, memory deficits have been in many cases undervalued compared with other characteristics. The expression of Immediate Early Genes (IEGs) such as, c-fos, Egr1 and arc are selectively and promptly upregulated in learning and memory among neuronal subpopulations in regions associated with these processes. Changes in expression in these genes have been observed in recognition, working and fear related memories across the brain. Despite the enormous amount of data supporting changes in their expression during learning and memory and the importance of those cognitive processes in psychiatric conditions, there are very few studies analyzing the direct implication of the IEGs in mental illnesses. In this review, we discuss the role of some of the most relevant IEGs in relation with memory processes affected in psychiatric conditions.

Cartesian philosophy has traditionally been considered as an almost absolute beginning in the history of philosophy. Nevertheless, the well-known hypotheses of the «evil genius» and «deceiving God», fundamental pieces in the artifice of «methodical doubt» in Metaphysical Meditations, can be found in Suárez’s Metaphysical Disputation 9 (the only mention of Suárez in the entire work of Descartes, specifically in the «Responses» to the Meditations). It seems quite clear, considering the correspondence between Descartes and Mersenne, as well as his doctrine about the sources of error, that Descartes borrowed both fictions directly from Suárez.

ABSTRACT Dry tropical forests are a key component in the global carbon cycle and their biomass estimates depend almost exclusively of fitted equations for multi-species or individual species data. Therefore, a systematic evaluation of statistical models through validation of estimates of aboveground biomass stocks is justifiable. In this study was analyzed the capacity of generic and specific equations obtained from different locations in Mexico and Brazil, to estimate aboveground biomass at multi-species levels and for four different species. Generic equations developed in Mexico and Brazil performed better in estimating tree biomass for multi-species data. For Poincianella bracteosa and Mimosa ophthalmocentra, only the Sampaio and Silva (2005) generic equation was the most recommended. These equations indicate lower tendency and lower bias, and biomass estimates for these equations are similar. For the species Mimosa tenuiflora, Aspidosperma pyrifolium and for the genus Croton the specific regional equations are more recommended, although the generic equation of Sampaio and Silva (2005) is not discarded for biomass estimates. Models considering gender, families, successional groups, climatic variables and wood specific gravity should be adjusted, tested and the resulting equations should be validated at both local and regional levels as well as on the scales of tropics with dry forest dominance.

Prune perineum syndrome (PPS) is a rare anomaly, with only two previous case reports, both dying in the perinatal period. We report the first case of PPS that reached childhood. The patient presented with a hypoplastic genitalia and bilateral cryptorchidism. There was no evidence of an anal orifice. A significant prune-like mass was observed, extending from the perineum to both gluteal regions and to a cephalic mid-line bony prominence, with a 1cm central orifice that discharged urine. MRI confirmed the previous findings and revealed a right crossed ectopic kidney, intestinal malrotation, a hypoplastic infrarenal inferior vena cava and a hypoplastic right iliac artery. Endoscopic evaluation through the orifice revealed a cavity lined by urothelial mucosa, with a small communication to the anterior urethra in its anterior wall. A staged reconstruction was planned, with a first-step urinary diversion through a continent abdominal reservoir associated to bilateral orchiopexy. He was discharged from the hospital three weeks later under intermittent catheterization. The next surgical step would be the resection of the perineal mass and its cavity associated to the removal of the prominent sacrococcygeal bones. Unfortunately, four months after the first surgery the patient developed an acute abdomen and was submitted to a laparotomy that revealed a necrotic ileal segment secondary to obstructive adherences. He developed severe malabsorption followed by septic shock, dying five weeks after the procedure. Due to the lack of literature, there is no consensus for the management of these cases. The wish of the family for a better quality of life and social acceptance, compelled us to perform a urinary diversion, to be followed by a plastic and orthopedic reconstruction. Despite the successful initial result, the patient developed a late abdominal obstruction that was misdiagnosed, precipitating his untimely death five months after the first procedure.

PURPOSE: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. MATERIALS AND METHODS: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. RESULTS: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. CONCLUSION: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.

In this study, we compared demographic responses of Eschscholzia californica populations located at different altitude, under the basic assumption that altitudinal gradients impose environmental limitation to the spread at the upper edge of the gradient. We detected significant differences among populations either in terms of life history attributes and the finite rate of increase. In general, coastal population expressed higher finite population rates than mountain populations, although these differences were not statistically significant. Mountain populations (Corral Quemado and Farellones) expressed a finite population rate not significant different of 1. These result suggest that at the upper front of invasion the species is in a demographic equilibrium because in spite of we detected a higher plant fecundity, there exist ecological constraints a seed stage level. We proposed to address more specific studies assessing from one hand, seed movement from lower altitudes and the efficiency of domestic cattle as biotic vector; we also propose to examine the feasibility of this species to establish positive interactions with cushion plants, and therefore to expand its geographic range due to this facilitation effect.En este estudio comparamos las respuestas demográficas de las poblaciones de Eschscholzia californica ubicadas a diferentes altitudes, bajo el supuesto básico de que los gradientes altitudinales imponen limitaciones a la invasión. Se detectaron diferencias significativas entre las poblaciones, ya sea en términos de atributos de la historia de vida y tasa finita de crecimiento. En general, las poblaciones costeras expresaron mayores tasas de crecimiento que las poblaciones de montaña, aun cuando éstas no fueron estadísticamente significativas. Las poblaciones de montaña (Corral Quemado y Farellones) fueron las únicas que mostraron una tasa de crecimiento similar a 1. Estos resultados sugieren que las poblaciones ubicadas en el frente superior de invasión estarían en un equilibrio demográfico debido a que aun cuando se detectó una elevada fecundidad, existen restricciones ecológicas a nivel de las semillas. Proponemos hacer estudios más específicos para evaluar un posible movimiento de semillas desde altitudes más bajas y la eficiencia del ganado doméstico como vector transportador de estas semillas; proponemos también examinar la posibilidad que tiene esta planta de establecer interacciones positivas con las plantas en cojín, ubicadas a mayores alturas y, por lo tanto, ampliar su rango altitudinal debido a este efecto de facilitación.

Realizamos un experimento de laboratorio para evaluar el efecto de la luz blanca en la germinación de cinco taxa de Eriosyce subgen. Neoporteria. Todas las taxa germinaron profusamente con presencia de luz, mientras que en oscuridad casi no se registró germinación. Se discute que este rasgo fisiológico podría ser una respuesta conservada en el grupo Neoporteria.

PURPOSE: Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS: A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS: The mean operative and warm ischemia times were longer in the video-laparoscopic group (p

John Locke has been considered one of the leading figures in the His- tory of Philosophy, specially for his two famous treatises An Essay concerning Human understanding and Two Treatises on Government. None the less his work in Pedagogy, Some thougths concerning Education, is no less important, and provides the leading strings of that what ought to be the education of the gentleman, whose unavoidable foundation must be a solid education in virtue grounded in the moral principles of Christianity. Key words: Locke, Moral education, Spanish authors of the XVIth century.

PURPOSE: Although laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes. MATERIALS AND METHODS: From November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years). RESULTS: Median age of the patients was 4.2 years (42 days - 18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0%, 1.4% and 1.9% for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5%, 8.2% and 7.8% for age groups A to C, respectively (p = 0.88). CONCLUSIONS: Most renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.

INTRODUCTION: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. MATERIALS AND METHODS: We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1%) had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. RESULTS: We obtained an overall 88% success rate with the 2 stage Fowler-Stephens approach and only 33% rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. CONCLUSIONS: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.