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1. Evaluating WRF-Chem aerosol indirect effects in Southeast Pacific marine stratocumulus during VOCALS-REx

Author

P. E. Saide, S. N. Spak, G. R. Carmichael, M. A. Mena-Carrasco, Q. Yang, S. Howell, D. C. Leon, J. R. Snider, A. R. Bandy, J. L. Collett, K. B. Benedict, S. P. de Szoeke, L. N. Hawkins, G. Allen, I. Crawford, J. Crosier, and S. R. Springston

Subjects
Physics, QC1-999, Chemistry, QD1-999
Abstract

We evaluate a regional-scale simulation with the WRF-Chem model for the VAMOS (Variability of the American Monsoon Systems) Ocean-Cloud-Atmosphere-Land Study Regional Experiment (VOCALS-REx), which sampled the Southeast Pacific's persistent stratocumulus deck. Evaluation of VOCALS-REx ship-based and three aircraft observations focuses on analyzing how aerosol loading affects marine boundary layer (MBL) dynamics and cloud microphysics. We compare local time series and campaign-averaged longitudinal gradients, and highlight differences in model simulations with (W) and without (NW) wet deposition processes. The higher aerosol loadings in the NW case produce considerable changes in MBL dynamics and cloud microphysics, in accordance with the established conceptual model of aerosol indirect effects. These include increase in cloud albedo, increase in MBL and cloud heights, drizzle suppression, increase in liquid water content, and increase in cloud lifetime. Moreover, better statistical representation of aerosol mass and number concentration improves model fidelity in reproducing observed spatial and temporal variability in cloud properties, including top and base height, droplet concentration, water content, rain rate, optical depth (COD) and liquid water path (LWP). Together, these help to quantify confidence in WRF-Chem's modeled aerosol-cloud interactions, especially in the activation parameterization, while identifying structural and parametric uncertainties including: irreversibility in rain wet removal; overestimation of marine DMS and sea salt emissions, and accelerated aqueous sulfate conversion. Our findings suggest that WRF-Chem simulates marine cloud-aerosol interactions at a level sufficient for applications in forecasting weather and air quality and studying aerosol climate forcing, and may do so with the reliability required for policy analysis.

Published
2012
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2. Assessing regional scale predictions of aerosols, marine stratocumulus, and their interactions during VOCALS-REx using WRF-Chem

Author

Q. Yang, W. I. Gustafson Jr., J. D. Fast, H. Wang, R. C. Easter, H. Morrison, Y.-N. Lee, E. G. Chapman, S. N. Spak, and M. A. Mena-Carrasco

Subjects
Physics, QC1-999, Chemistry, QD1-999
Abstract

This study assesses the ability of the recent chemistry version (v3.3) of the Weather Research and Forecasting (WRF-Chem) model to simulate boundary layer structure, aerosols, stratocumulus clouds, and energy fluxes over the Southeast Pacific Ocean. Measurements from the VAMOS Ocean-Cloud-Atmosphere-Land Study Regional Experiment (VOCALS-REx) and satellite retrievals (i.e., products from the MODerate resolution Imaging Spectroradiometer (MODIS), Clouds and Earth's Radiant Energy System (CERES), and GOES-10) are used for this assessment. The Morrison double-moment microphysics scheme is newly coupled with interactive aerosols in the model. The 31-day (15 October–16 November 2008) WRF-Chem simulation with aerosol-cloud interactions (AERO hereafter) is also compared to a simulation (MET hereafter) with fixed cloud droplet number concentrations in the microphysics scheme and simplified cloud and aerosol treatments in the radiation scheme. The well-simulated aerosol quantities (aerosol number, mass composition and optical properties), and the inclusion of full aerosol-cloud couplings lead to significant improvements in many features of the simulated stratocumulus clouds: cloud optical properties and microphysical properties such as cloud top effective radius, cloud water path, and cloud optical thickness. In addition to accounting for the aerosol direct and semi-direct effects, these improvements feed back to the simulation of boundary-layer characteristics and energy budgets. Particularly, inclusion of interactive aerosols in AERO strengthens the temperature and humidity gradients within the capping inversion layer and lowers the marine boundary layer (MBL) depth by 130 m from that of the MET simulation. These differences are associated with weaker entrainment and stronger mean subsidence at the top of the MBL in AERO. Mean top-of-atmosphere outgoing shortwave fluxes, surface latent heat, and surface downwelling longwave fluxes are in better agreement with observations in AERO, compared to the MET simulation. Nevertheless, biases in some of the simulated meteorological quantities (e.g., MBL temperature and humidity) and aerosol quantities (e.g., underestimations of accumulation mode aerosol number) might affect simulated stratocumulus and energy fluxes over the Southeastern Pacific, and require further investigation. The well-simulated timing and outflow patterns of polluted and clean episodes demonstrate the model's ability to capture daily/synoptic scale variations of aerosol and cloud properties, and suggest that the model is suitable for studying atmospheric processes associated with pollution outflow over the ocean. The overall performance of the regional model in simulating mesoscale clouds and boundary layer properties is encouraging and suggests that reproducing gradients of aerosol and cloud droplet concentrations and coupling cloud-aerosol-radiation processes are important when simulating marine stratocumulus over the Southeast Pacific.

Published
2011
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3. COVID-19 and influenza vaccine uptake among pregnant women in national cohorts of England and Wales

Author

Xinchun Gu, Utkarsh Agrawal, William Midgley, Stuart Bedston, Sneha N. Anand, Rosalind Goudie, Rachel Byford, Mark Joy, Gavin Jamie, Uy Hoang, Jose M. Ordóñez-Mena, Chris Robertson, F. D. Richard Hobbs, Ashley Akbari, Aziz Sheikh, and Simon de Lusignan

Subjects
Immunologic diseases. Allergy, RC581-607, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Vaccines against COVID-19 and influenza can reduce the adverse outcomes caused by infections during pregnancy, but vaccine uptake among pregnant women has been suboptimal. We examined the COVID-19 and influenza vaccine uptake and disparities in pregnant women during the COVID-19 pandemic to inform vaccination interventions. We used data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database in England and the Secure Anonymised Information Linkage Databank in Wales. The uptake of at least one dose of vaccine was 40.2% for COVID-19 and 41.8% for influenza among eligible pregnant women. We observed disparities in COVID-19 and influenza vaccine uptake, with socioeconomically deprived and ethnic minority groups showing lower vaccination rates. The suboptimal uptake of COVID-19 and influenza vaccines, especially in those from socioeconomically deprived backgrounds and Black, mixed or other ethnic groups, underscores the necessity for interventions to reduce vaccine hesitancy and enhance acceptance in pregnant women.

Published
2024
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4. Developing a digital phenotype to subdivide adult immunosuppressed COVID-19 outcomes within the English Primary Care Sentinel Network

Author

Meredith Leston, Debasish Kar, Anna Forbes, Gavin Jamie, Rashmi Wimalaratna, Gunjan Jiwani, José M. Ordóñez-Mena, Daniel E. Stewart, Heather Whitaker, Mark Joy, Lennard Y. W. Lee, F. D. Richard Hobbs, and Simon de Lusignan

Subjects
digital health, vaccine, immunosuppressed, disease surveillance, surveillance, CMR, Immunologic diseases. Allergy, RC581-607
Abstract

BackgroundAdults classified as immunosuppressed have been disproportionately affected by the COVID-19 pandemic. Compared to the immunocompetent, certain patients are at increased risk of suboptimal vaccine response and adverse health outcomes if infected. However, there has been insufficient work to pinpoint where these risks concentrate within the immunosuppressed spectrum; surveillance efforts typically treat the immunosuppressed as a single entity, leading to wide confidence intervals. A clinically meaningful and computerised medical record (CMR) compatible method to subdivide immunosuppressed COVID-19 data is urgently needed.MethodsWe conducted a rapid scoping review into COVID-19 mortality across UK immunosuppressed categories to assess if differential mortality risk was a viable means of subdivision. We converted the risk hierarchy that surfaced into a pilot digital phenotype—a valueset and series of ontological rules ready to extract immunosuppressed patients from CMR data and stratify outcomes of interest in COVID-19 surveillance dataflows.ResultsThe rapid scoping review returned COVID-19 mortality data for all immunosuppressed subgroups assessed and revealed significant heterogeneity across the spectrum. There was a clear distinction between heightened COVID-19 mortality in haematological malignancy and transplant patients and mortality that approached the immunocompetent baseline amongst cancer therapy recipients, autoimmune patients, and those with HIV. This process, complemented by expert clinical input, informed the curation of the five-part digital phenotype now ready for testing in real-world data; its ontological rules will enable mutually exclusive, hierarchical extraction with nuanced time and treatment conditions. Unique categorisations have been introduced, including ‘Bone Marrow Compromised’ and those dedicated to differentiating prescriptions related and unrelated to cancer. Codification was supported by existing reference sets of medical codes; absent or redundant codes had to be resolved manually.DiscussionAlthough this work is in its earliest phases, the development process we report has been highly informative. Systematic review, clinical consensus building, and implementation studies will test the validity of our results and address criticisms of the rapid scoping exercise they are predicated on.ConclusionComprehensive testing for COVID-19 has differentiated mortality risks across the immunosuppressed spectrum. This risk hierarchy has been codified into a digital phenotype for differentiated COVID-19 surveillance; this marks a step towards the needs-based management of these patients that is urgently required.

Published
2024
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5. Data visualisation approaches for component network meta-analysis: visualising the data structure

Author

Suzanne C. Freeman, Elnaz Saeedi, José M. Ordóñez-Mena, Clareece R. Nevill, Jamie Hartmann-Boyce, Deborah M. Caldwell, Nicky J. Welton, Nicola J. Cooper, and Alex J. Sutton

Subjects
Component network meta-analysis, Data visualisation, Meta-analysis, Presentational tools, Graphical displays, Multicomponent interventions, Medicine (General), R5-920
Abstract

Abstract Background Health and social care interventions are often complex and can be decomposed into multiple components. Multicomponent interventions are often evaluated in randomised controlled trials. Across trials, interventions often have components in common which are given alongside other components which differ across trials. Multicomponent interventions can be synthesised using component NMA (CNMA). CNMA is limited by the structure of the available evidence, but it is not always straightforward to visualise such complex evidence networks. The aim of this paper is to develop tools to visualise the structure of complex evidence networks to support CNMA. Methods We performed a citation review of two key CNMA methods papers to identify existing published CNMA analyses and reviewed how they graphically represent intervention complexity and comparisons across trials. Building on identified shortcomings of existing visualisation approaches, we propose three approaches to standardise visualising the data structure and/or availability of data: CNMA-UpSet plot, CNMA heat map, CNMA-circle plot. We use a motivating example to illustrate these plots. Results We identified 34 articles reporting CNMAs. A network diagram was the most common plot type used to visualise the data structure for CNMA (26/34 papers), but was unable to express the complex data structures and large number of components and potential combinations of components associated with CNMA. Therefore, we focused visualisation development around representing the data structure of a CNMA more completely. The CNMA-UpSet plot presents arm-level data and is suitable for networks with large numbers of components or combinations of components. Heat maps can be utilised to inform decisions about which pairwise interactions to consider for inclusion in a CNMA model. The CNMA-circle plot visualises the combinations of components which differ between trial arms and offers flexibility in presenting additional information such as the number of patients experiencing the outcome of interest in each arm. Conclusions As CNMA becomes more widely used for the evaluation of multicomponent interventions, the novel CNMA-specific visualisations presented in this paper, which improve on the limitations of existing visualisations, will be important to aid understanding of the complex data structure and facilitate interpretation of the CNMA results.

Published
2023
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6. Implementation of chronic kidney disease guidelines for sodium-glucose co-transporter-2 inhibitor use in primary care in the UK: a cross-sectional studyResearch in context

Author

Anna K. Forbes, William Hinton, Michael D. Feher, William Elson, Mark Joy, José M. Ordóñez-Mena, Xuejuan Fan, Nicholas I. Cole, Debasish Banerjee, Rebecca J. Suckling, Simon de Lusignan, and Pauline A. Swift

Subjects
Sodium-glucose transporter 2 inhibitors, Electronic health records, Guideline adherence, Primary health care, Chronic kidney disease, Medicine (General), R5-920
Abstract

Summary: Background: The cardiovascular and kidney benefits of sodium-glucose co-transporter-2 (SGLT2) inhibitors in people with chronic kidney disease (CKD) are well established. The implementation of updated SGLT2 inhibitor guidelines and prescribing in the real-world CKD population remains largely unknown. Methods: A cross-sectional study of adults with CKD registered with UK primary care practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre network on the 31st December 2022 was undertaken. Pseudonymised data from electronic health records held securely within the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) were extracted. An update to a previously described ontological approach was used to identify the study population, using a combination of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) indicating a diagnosis of CKD and laboratory confirmed CKD based on Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria. We examined the extent to which SGLT2 inhibitor guidelines apply to and are then implemented in adults with CKD. A logistic regression model was used to identify factors associated with SGLT2 inhibitor prescribing, reported as odds ratios (ORs) with 95% confidence intervals (CI). The four guidelines under investigation were the United Kingdom Kidney Association (UKKA) Clinical Practice Guideline SGLT2 Inhibition in Adults with Kidney Disease (October 2021), American Diabetes Association (ADA) and KDIGO Consensus Report on Diabetes Management in CKD (October 2022), National Institute for Health and Care Excellence (NICE) Guideline Type 2 Diabetes in Adults: Management (June 2022), and NICE Technology Appraisal Dapagliflozin for Treating CKD (March 2022). Findings: Of 6,670,829 adults, we identified 516,491 (7.7%) with CKD, including 32.8% (n = 169,443) who had co-existing type 2 diabetes (T2D). 26.8% (n = 138,183) of the overall CKD population had a guideline directed indication for SGLT2 inhibitor treatment. A higher proportion of people with CKD and co-existing T2D were indicated for treatment, compared to those without T2D (62.8% [n = 106,468] vs. 9.1% [n = 31,715]). SGLT2 inhibitors were prescribed to 17.0% (n = 23,466) of those with an indication for treatment, and prescriptions were predominantly in those with co-existing T2D; 22.0% (n = 23,464) in those with T2D, and

Published
2024
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7. Competencia global y educación literaria: fundamentos teóricos y aportes críticos

Author

María Bermúdez-Martínez and Eva M. Iñesta-Mena

Subjects
Competencia global, educación literaria, educación intercultural, alfabetización crítica, literatura infantil y juvenil, Special aspects of education, LC8-6691, Literature (General), PN1-6790
Abstract

El objetivo de este trabajo es presentar los resultados de una revisión teórica sistemática de alcance internacional sobre la noción emergente de competencia global, identificando su potencial para la educación literaria. Las fuentes revisadas son artículos y trabajos de investigación publicados en los últimos quince años, y seleccionados en bases de datos especializadas. El estudio revela cómo la competencia global se configura desde la movilización de dimensiones como comprender múltiples perspectivas, comunicar eficazmente con audiencias diversas, indagar sobre el mundo y emprender acciones éticamente responsables, junto con componentes como la conciencia intercultural y la alfabetización crítica. En este escenario educativo, se analiza el papel que debe desempeñar una educación literaria que conecte al alumnado con el mundo, acompañándole en el descubrimiento, análisis e interpretación de cuestiones globales y multiculturales, desde la literatura infantil y juvenil. Como conclusión, se afirma que esta perspectiva implica la revisión del canon literario y la aplicación de propuestas metodológicas de mediación que focalicen la gestión del aula y las estrategias de interacción comunicativa a partir de los textos.

Published
2023
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9. Prominent positioning and food swaps are effective interventions to reduce the saturated fat content of the shopping basket in an experimental online supermarket: a randomized controlled trial

Author

Dimitrios A. Koutoukidis, Susan A. Jebb, José M. Ordóñez-Mena, Michaela Noreik, Melina Tsiountsioura, Sarah Kennedy, Sarah Payne-Riches, Paul Aveyard, and Carmen Piernas

Subjects
Saturated fat, Swaps, Default order, Online shopping, Supermarket, Food purchases, Nutritional diseases. Deficiency diseases, RC620-627, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Interventions to reduce the saturated fat (SFA) content of food purchases may help reduce SFA consumption and lower cardiovascular risk. This factorial RCT aimed to examine the effect of altering the default order of foods and being offered a swap on the SFA content of food selected during an online shopping experiment. Methods UK adults who were the primary grocery shoppers for their household were recruited online and invited to select items in a custom-made experimental online supermarket using a 10-item shopping list. Participants were randomly allocated to one of four groups (i) to see products within a category ranked in ascending order of SFA content, (ii) receive an offer to swap to a product with less SFA, (iii) a combination of both interventions, or (iv) no intervention. The primary outcome was the difference in percentage energy from SFA in the shopping basket between any of the four groups. The outcome assessors and statistician were blinded to intervention allocation. Results Between March and July 2018, 1240 participants were evenly randomised and 1088 who completed the task were analysed (88%). Participants were 65% female and aged 38y (SD 12). Compared with no intervention (n = 275) where the percentage energy from SFA was 25.7% (SD 5.6%), altering the order of foods (n = 261) reduced SFA by [mean difference (95%CI)] -5.0% (− 6.3 to − 3.6) and offering swaps (n = 279) by − 2.0% (− 3.3 to − 0.6). The combined intervention (n = 273) was significantly more effective than swaps alone (− 3.4% (− 4.7 to − 2.1)) but not different than altering the order alone (− 0.4% (− 1.8 to 0.9)), p = 0.04 for interaction. Conclusions Altering the default order to show foods in ascending order of SFA and offering a swap with lower SFA reduced percentage energy from SFA in an experimental online supermarket. Environmental-level interventions, such as altering the default order, may be a more promising way to improve food purchasing than individual-level ones, such as offering swaps. Trial registration ISRCTN13729526 https://doi.org/10.1186/ISRCTN13729526 26th February 2018.

Published
2019
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11. Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function.

Author

Jennifer A Hirst, José M Ordóñez Mena, Chris A O'Callaghan, Emma Ogburn, Clare J Taylor, Yaling Yang, and F D Richard Hobbs

Subjects
Medicine, Science
Abstract

ObjectivesTo establish the prevalence of multimorbidity in people with chronic kidney disease (CKD) stages 1-5 and transiently impaired renal function and identify factors associated with multimorbidity.Design and settingProspective cohort study in UK primary care.Participants861 participants aged 60 and older with decreased renal function of whom, 584 (65.8%) had CKD and 277 (32.2%) did not have CKD.InterventionsParticipants underwent medical history and clinical assessment, and blood and urine sampling.Primary and secondary outcome measuresMultimorbidity was defined as presence of ≥2 chronic conditions including CKD. Prevalence of each condition, co-existing conditions and multimorbidity were described and logistic regression was used to identify predictors of multimorbidity.ResultsThe mean (±SD) age of participants was 74±7 years, 54% were women and 98% were white. After CKD, the next most prevalent condition was hypertension (n = 511, 59.3%), followed by obesity (n = 265, 30.8%) ischemic heart disease (n = 145, 16.8%) and diabetes (n = 133, 15.4%). Having two co-existing conditions was most common (27%), the most common combination of which was hypertension and obesity (29%). One or three conditions was the next most prevalent combination (20% and 21% respectively). The prevalence of multimorbidity was 73.9% (95%CI 70.9-76.8) in all participants and 86.6% (95%CI 83.9-89.3) in those with any-stage CKD. Logistic regression found a significant association between increasing age (OR 1.07, 95%CI 1.04-0.10), increasing BMI (OR 1.15, 95%CI 1.10-1.20) and decreasing eGFR (OR 0.99, 95%CI 0.98-1.00) with multimorbidity.ConclusionsThis analysis is the first to provide an accurate estimate of the prevalence of multimorbidity in a screened older primary care population living with or at risk of CKD across all stages. Hypertension and obesity were the most common combination of conditions other than CKD that people were living with, suggesting that there may be multiple reasons for closely monitoring health status in individuals with CKD.

Published
2021
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12. Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Author

Jitendra PS. Sawhney, Veerappa A. Kothiwale, Vikas Bisne, Rajashekhar Durgaprasad, Praveen Jadhav, Manoj Chopda, Velam Vanajakshamma, Ramdhan Meena, Govindan Vijayaraghavan, Kamaldeep Chawla, Jagan Allu, Karen S. Pieper, A. John Camm, Ajay K. Kakkar, Jean-Pierre Bassand, David A. Fitzmaurice, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Werner Hacke, Lorenzo G. Mantovani, Frank Misselwitz, Alexander G.G. Turpie, Martin van Eickels, Freek W.A. Verheugt, Gloria Kayani, Keith A.A. Fox, Bernard J. Gersh, Hector Lucas Luciardi, Harry Gibbs, Marianne Brodmann, Frank Cools, Antonio Carlos Pereira Barretto, Stuart J. Connolly, Alex Spyropoulos, John Eikelboom, Ramon Corbalan, Dayi Hu, Petr Jansky, Jørn Dalsgaard Nielsen, Hany Ragy, Pekka Raatikainen, Jean-Yves Le Heuzey, Harald Darius, Matyas Keltai, Sanjay Kakkar, Jitendra Pal Singh Sawhney, Giancarlo Agnelli, Giuseppe Ambrosio, Yukihiro Koretsune, Carlos Jerjes Sánchez Díaz, Hugo Ten Cate, Dan Atar, Janina Stepinska, Elizaveta Panchenko, Toon Wei Lim, Barry Jacobson, Seil Oh, Xavier Viñolas, Marten Rosenqvist, Jan Steffel, Pantep Angchaisuksiri, Ali Oto, Alex Parkhomenko, Wael Al Mahmeed, David Fitzmaurice, D.Y. Hu, K.N. Chen, Y.S. Zhao, H.Q. Zhang, J.Z. Chen, S.P. Cao, D.W. Wang, Y.J. Yang, W.H. Li, Y.H. Yin, G.Z. Tao, P. Yang, Y.M. Chen, S.H. He, Ying Wang, Yong Wang, G.S. Fu, X. Li, T.G. Wu, X.S. Cheng, X.W. Yan, R.P. Zhao, M.S. Chen, L.G. Xiong, P. Chen, Y. Jiao, Y. Guo, L. Xue, F.Z. Wang, H. Li, Z.M. Yang, C.L. Bai, J. Chen, J.Y. Chen, X. Chen, S. Feng, Q.H. Fu, X.J. Gao, W.N. Guo, R.H. He, X.A. He, X.S. Hu, X.F. Huang, B. Li, J. Li, L. Li, Y.H. Li, T.T. Liu, W.L. Liu, Y.Y. Liu, Z.C. Lu, X.L. Luo, T.Y. Ma, J.Q. Peng, X. Sheng, X.J. Shi, Y.H. Sun, G. Tian, K. Wang, L. Wang, R.N. Wu, Q. Xie, R.Y. Xu, J.S. Yang, L.L. Yang, Q. Yang, Y. Ye, H.Y. Yu, J.H. Yu, T. Yu, H. Zhai, Q. Zhan, G.S. Zhang, Q. Zhang, R. Zhang, Y. Zhang, W.Y. Zheng, B. Zhou, Z.H. Zhou, X.Y. Zhu, S. Kakkar, J.P.S. Sawhney, P. Jadhav, R. Durgaprasad, A.G. Ravi Shankar, R.K. Rajput, K. Bhargava, R. Sarma, A. Srinivas, D. Roy, U.M. Nagamalesh, M. Chopda, R. Kishore, G. Kulkarni, P. Chandwani, R.A. Pothiwala, M. Padinhare Purayil, S. Shah, K. Chawla, V.A. Kothiwale, B. Raghuraman, G. Vijayaraghavan, V.M. Vijan, G. Bantwal, V. Bisne, A. Khan, J.B. Gupta, S. Kumar, D. Jain, S. Abraham, D. Adak, A. Barai, H. Begum, P. Bhattacharjee, M. Dargude, D. Davies, B. Deshpande, P. Dhakrao, V. Dhyani, S. Duhan, M. Earath, A. Ganatra, S. Giradkar, V. Jain, R. Karthikeyan, L. Kasala, S. Kaur, S. Krishnappa, A. Lawande, B. Lokesh, N. Madarkar, R. Meena, P. More, D. Naik, K. Prashanth, M. Rao, N.M. Rao, N. Sadhu, D. Shah, M. Sharma, P. Shiva, S. Singhal, S. Suresh, V. Vanajakshamma, S.G. Panse, Y. Koretsune, S. Kanamori, K. Yamamoto, K. Kumagai, Y. Katsuda, K. Sadamatsu, F. Toyota, Y. Mizuno, I. Misumi, H. Noguchi, S. Ando, T. Suetsugu, M. Minamoto, Hiroshi Oda, K. Shiraishi, S. Adachi, K. Chiba, H. Norita, M. Tsuruta, T. Koyanagi, H. Ando, T. Higashi, K. Okada, S. Azakami, S. Komaki, K. Kumeda, T. Murayama, J. Matsumura, Y. Oba, R. Sonoda, K. Goto, K. Minoda, Y. Haraguchi, H. Suefuji, H. Miyagi, H. Kato, Tadashi Nakamura, Tsugihiro Nakamura, H. Nandate, R. Zaitsu, Yoshihisa Fujiura, A. Yoshimura, H. Numata, J. Ogawa, H. Tatematsu, Y. Kamogawa, K. Murakami, Y. Wakasa, M. Yamasawa, H. Maekawa, S. Abe, H. Kihara, S. Tsunoda, Katsumi Saito, Kazuyuki Saito, T. Fudo, K. Obunai, H. Tachibana, I. Oba, T. Kuwahata, S. Higa, M. Gushiken, T. Eto, H. Yoshida, D. Ikeda, Yoshitake Fujiura, M. Ishizawa, M. Nakatsuka, K. Murata, C. Ogurusu, M. Shimoyama, M. Akutsu, I. Takamura, F. Hoshino, N. Yokota, T. Iwao, K. Tsuchida, M. Takeuchi, Y. Hatori, Y. Kitami, Yoichi Nakamura, R. Oyama, M. Ageta, Hiroyuki Oda, Y. Go, K. Mishima, T. Unoki, S. Morii, Yuhei Shiga, H. Sumi, T. Nagatomo, K. Sanno, K. Fujisawa, Y. Atsuchi, T. Nagoshi, T. Seto, T. Tabuchi, M. Kameko, K. Nii, K. Oshiro, H. Takezawa, S. Nagano, N. Miyamoto, M. Iwaki, Yuichiro Nakamura, M. Fujii, M. Okawa, Masahiko Abe, Masatake Abe, Mitsunori Abe, T. Saito, T. Mito, K. Nagao, J. Minami, T. Mita, I. Sakuma, T. Taguchi, S. Marusaki, H. Doi, M. Tanaka, T. Fujito, M. Matsuta, T. Kusumoto, S. Kakinoki, K. Ashida, N. Yoshizawa, J. Agata, O. Arasaki, M. Manita, M. Ikemura, S. Fukuoka, H. Murakami, S. Matsukawa, Y. Hata, T. Taniguchi, T. Ko, H. Kubo, M. Imamaki, M. Akiyama, M. Inagaki, H. Odakura, T. Ueda, Y. Katsube, A. Nakata, H. Watanabe, M. Techigawara, M. Igarashi, K. Taga, T. Kimura, S. Tomimoto, M. Shibuya, M. Nakano, K. Ito, T. Seo, S. Hiramitsu, H. Hosokawa, M. Hoshiai, M. Hibino, K. Miyagawa, Hajime Horie, N. Sugishita, Yukio Shiga, A. Soma, K. Neya, Tetsuro Yoshida, Tomoki Yoshida, M. Mizuguchi, M. Ishiguro, T. Minagawa, M. Wada, H. Mukawa, F. Okuda, S. Nagasaka, Y. Abe, Sen Adachi, Susumu Adachi, T. Adachi, K. Akahane, T. Amano, K. Aoki, T. Aoyama, H. Arai, S. Arima, T. Arino, H. Asano, T. Asano, J. Azuma, T. Baba, T. Betsuyaku, H. Chibana, H. Date, J. Doiuchi, Y. Emura, M. Endo, Y. Fujii, R. Fujiki, A. Fujisawa, Y. Fujisawa, T. Fukuda, T. Fukui, N. Furukawa, T. Furukawa, W. Furumoto, T. Goto, M. Hamaoka, N. Hanazono, K. Hasegawa, T. Hatsuno, Y. Hayashi, K. Higuchi, K. Hirasawa, H. Hirayama, M. Hirose, S. Hirota, M. Honda, Hideki Horie, T. Ido, O. Iiji, H. Ikeda, K. Ikeda, K. Ikeoka, M. Imaizumi, H. Inaba, T. Inoue, F. Iseki, A. Ishihara, N. Ishioka, N. Ito, T. Iwase, H. Kakuda, J. Kamata, H. Kanai, H. Kanda, M. Kaneko, H. Kano, T. Kasai, T. Kato, Y. Kato, Y. Kawada, K. Kawai, K. Kawakami, S. Kawakami, T. Kawamoto, S. Kawano, J. Kim, T. Kira, H. 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Sterry, T. Wong, M. Boon, R. Bunney, R. Haria-Shah, R.T. Baron, S. Davies, T. Schatzberger, N. Hargreaves, T. Stephenson, H. Choi, R. Batson, L. Lucraft, T. Myhill, S. Estifano, D. Geatch, J. Wilkinson, R. Veale, K. Forshaw, T. Davies, K. Zaman, P. Vinson, C. Liley, M. Bandrapalli, P. McGinty, R. Wastling, P. McEleny, A. Beattie, P. Cooke, M. Wong, J. Gunasegaram, M. Pugsley, S. Ahmad, C. A'Court, J. Ayers, J. Bennett, S. Cartwright, S. Dobson, C. Dooldeniya, A. Flynn, R. Fox, J. Goram, A. Halpin, A. Hay, P. Jacobs, L. Jeffers, L. Lomax, I. Munro, R. Muvva, M. Nadaph, K. Powell, S. Randfield, D. Redpath, R. Reed, M. Rickenbach, G. Rogers, P.B. Saunders, C. Seamark, J. Shewring, P. Simmons, H. Simper, H. Stoddart, A. Sword, N. Thomas, A. Thomson, H. Gibbs, A. Blenkhorn, B. Singh, W. Van Gaal, W. Abhayaratna, R. Lehman, P. Roberts-Thomson, J. Kilian, D. Coulshed, A. Catanchin, D. Colquhoun, H. Kiat, D. Eccleston, J. French, L. Zimmett, B. Ayres, T. Phan, P. Blombery, D. Crimmins, D. O'Donnell, A. Choi, P. Astridge, M. Arstall, N. Jepson, M. Binnekamp, A. Lee, J. Rogers, G. Starmer, P. Carroll, J. Faunt, A. Aggarwala, L. Barry, C. Batta, R. Beveridge, A. Black, M. Bonner, J. Boys, E. Buckley, M. Campo, L. Carlton, A. Connelly, B. Conway, D. Cresp, H. Dimitri, S. Dixon, M. Dolman, M. Duroux, M. Eskandari, R. Eslick, A. Ferreira-Jardim, T. Fetahovic, D. Fitzpatrick, R. Geraghty, J. Gibbs, T. Grabek, M.H. Modi, K. Hayes, M.P. Hegde, L. Hesketh, B. Hoffmann, B. Jacobson, K. Johnson, C. Juergens, I. Kassam, V. Lawlor, M. Lehman, S. Lehman, D. Leung, S. Mackay, M. MacKenzie, C. McCarthy, C. McIntosh, L. McKeon, H. Morrison, C. Mussap, J.-D. Myers, V. Nagalingam, G. Oldfield, V. O'May, J. Palmer, L. Parsons, K. Patching, T. Patching, V. Paul, M. Plotz, S. Preston, H. Rashad, M. Ratcliffe, S. Raynes, J. Rose, L. Sanders, M. Seremetkoska, H. Setio, S. Shone, P. Shrestha, C. Singh, C. Singleton, N. Stoyanov, S. Sutcliffe, K. Swaraj, J. Tarrant, S. Thompson, I.M. Tsay, M. Vorster, A. Waldman, L. Wallis, E. Wilford, K. Wong, S.J. Connolly, A. Spyropoulos, J. Eikelboom, R. Luton, M. Gupta, A.S. Pandey, S. Cheung, R. Leader, P. Beaudry, F. Ayala-Paredes, J. Berlingieri, J. Heath, G. Poirier, M. Du Preez, R. Nadeau, G. Dresser, R. Dhillon, T. Hruczkowski, B. Schweitzer, B. Coutu, P. Angaran, P. MacDonald, S. Vizel, S. Fikry, R. Parkash, A. Lavoie, J. Cha, B. Ramjattan, J. Bonet, K. Ahmad, L. Aro, T. Aves, K. Beaudry, C. Bergeron, J. Bigcanoe, N. Bignell, L. Breakwell, E. Burke, L. Carroll, B. Clarke, T. Cleveland, S. Daheb, P. Dehghani, I. Denis, Z. Djaidani, P. Dorian, S. Douglass, J. Dunnigan, A. Ewert, D. Farquhar, A. Fearon, L. Ferleyko, D. Fournier, B. Fox, M.-C. Grenier, W. Gulliver, K. Haveman, C. Hines, K. Hines, A.M. Jackson, C. Jean, G. Jethoo, R. Kahlon, S. Kelly, R. Kim, V. Korley, J. Kornder, L. Kwan, J. Largy, C. Lewis, S. Lewis, I. Mangat, R. Moor, J. Navratil, I. Neas, J. Otis, R. Otis, M. Pandey, F. Petrie, A. Pinter, M. Raines, P. Roberts, M. Robinson, G. Sas, S. Schulman, L. Snell, S. Spearson, J. Stevenson, T. Trahey, S. Wong, D. Wright, H. Ragy, A. Abd El-Aziz, S.K. Abou Seif, M.G. El Din, S. El Etriby, A. Elbahry, A. El-Etreby, M. Elkhadem, A. Katta, T. Khairy, A. Mowafy, M. Nawar, A. Ohanissian, A. Reda, M. Reda, H. Salem, N. Sami, S. Samir, M. Setiha, M. Sobhy, A. Soliman, N. Taha, M. Tawfik, E. Zaatout, D. Kettles, J. Bayat, H. Siebert, A. Horak, Y. Kelfkens, R. Garda, T. Pillay, M. Guerra, L. van Zyl, H. Theron, A. Murray, R. Louw, D. Greyling, P. Mntla, V. Ueckermann, R. Loghdey, S. Ismail, F. Ahmed, J. Engelbrecht, A. Ramdass, S. Maharajh, W. Oosthuysen, G. Angel, C. Bester, M. Booysen, C. Boshoff, C. Cannon, S. Cassimjee, C. Chami, G. Conway, A. Davids, L. de Meyer, G. Du Plessis, T. Ellis, L. Henley, M. Karsten, E. Loyd, J. Marks, L. Mavhusa, M. Mostert, A. Page, L. Rikhotso, M. Salie, J. Sasto, F. Shaik, A. Skein, L. Smith, G. Tarr, T. Tau, F. van Zyl, W. Al Mahmeed, G. Yousef, A. Agrawal, M. Nathani, M. Ibrahim, E.M. Esheiba, R. Singh, A. Naguib, M. Abu-Mahfouz, M. Al Omairi, A. Al Naeemi, R. Maruthanayagam, N. Bazargani, A. Wassef, R. Gupta, M. Khan, B. Subbaraman, A. Abdul, A. Al Mulla, S. El Bardisy, P. Haridas, S. Jadhav, K. Magdaluyo, M. Makdad, I. Maqsood, R. Mohamed, N. Sharma, R. Sharma, M. Thanzeel, S.Z. Goldhaber, R. Canosa, P. Rama, E. Blumberg, J. Garcia, P. Mullen, V. Wilson, A. Quick, K. Ferrick, W.M. Kutayli, M. Cox, M. Franco, S. Falkowski, R. Mendelson, M. Williams, S. Miller, S. Beach, A. Alfieri, T. Gutowski, I. Haque, R. Reddy, W. Ahmed, P. Delafontaine, D. Diercks, D. Theodoro, K. Remmel, M. Alberts, R. Ison, H. Noveck, P. Duffy, S. Pitta, D. Nishijima, C. Treasure, N. Asafu-Adjaye, K. Ball, M. Bartlett, M. Bentley, S. Bowers, A. Brown, A. Browne, J. Cameron-Watts, M. Canova, D. Cassidy, K. Cervellione, S. Congal, J. DePauw, A. Dickerson, M. Eley, L. Evans, S. Felpel, K. Ferdinand, D. Fielder, P. Gentry, A. Haideri, F. Hakimi, T. Harbour, E. Hartranft, B. Hawkins, M. Headlee, L. Henson, C. Herrick, T. Hicks, S. Jasinski, A. Jones, L. Jones, P. Jones, S. Karl, M. Keeling, J. Kerr, P. Knowles, J. Langdon, M. Lay, J.A. Lee, T. Lincoln, E. Malone, A. Merliss, D. Merritt, J. Minardo, B. Mooso, C. Orosco, V. Palumbo, M. Parker, T. Parrott, S. Paserchia, G. Pearl, J. Peterson, N. Pickelsimer, T. Purcell, J. Raynor, S. Raziano, C. Richard, T. Richardson, C. Robertson, A. Sage, T. Sanghera, P. Shaw, J. Shoemaker, K. Smith, B. Stephanie, A. Thatcher, H. Theobald, N. Thompson, L. Treasure, T. Tripti, C. Verdi, and V. Worthy

Subjects
Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. Methods and results: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P

Published
2018
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14. The well-being of the gynecological surgeon improves with the robot-assisted surgery

Author

P.J. Coronado Martín, M. Gracia, M. Ramirez Mena, M. Bellón del Amo, J. García-Santos, and M. Fasero Laiz

Subjects
General Medicine
Abstract

Objectives: To demonstrate that robotic surgery benefits the ergonomics of the surgeon and his assistant compared to conventional laparoscopy through an ergonomics and satisfaction survey. Methods: Cross-sectional observational study of consecutive gynecological surgeries, which involve at least one hysterectomy, performed with robotic assistance (Da Vinci System) or with conventional laparoscopy at the Hospital Clínico San Carlos during the years 2008 and 2021. A questionnaire was administered to the main surgeon and the assistant in order to know their subjective impressions regarding comfort, ergonomics, and satisfaction with the da Vinci robotic system or laparoscopy. The responses were collected using a visual analog scale that scored from 1 (worst condition) to 10 (best condition). The comparison of the variables was made using the Student’s t test or the Mann-Whitney U test for independent samples. Significance was considered with a value of p

Published
2023
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15. Fine Spatial Scale, Frequent Morphological Monitoring of Urbanised Beaches to Improve Coastal Management

Author

Kelis M. Hinestroza-Mena, Vladimir G. Toro, Gloria S. Londoño-Colorado, Valeria Chávez, Julieth K. García-Blanco, and Rodolfo Silva

Subjects
coastal erosion, beach accretion, coastal management, k index, Turbo, Colombia, Naval architecture. Shipbuilding. Marine engineering, VM1-989, Oceanography, GC1-1581
Abstract

Between 1959 and 2010, a coastline retreat of 2.4 m/year and erosion of up to 174 m were recorded around Turbo, in northern Colombia. This degraded coastal system is the result of a poorly planned coastal defence scheme, combined with a lack of formal technical methodologies for diagnosis and monitoring. The coastal system cannot provide the protection services required by the local community. From 2017 to 2019, the group monitored urban beach profiles in a small area close to the town of Turbo, in the wet and the dry seasons, as part of a coastline analysis to identify morphodynamic trends in the area. The results show a net shoreline accretion of up to 30 m and positive sedimentary accumulation of up to 45.8 m3/m. To the north of the study area, sediment accumulation is evident at the Turbo River Delta. The 34 coastal protection structures in the study area have a high k index (~0.7), suggesting that they are the main drivers controlling the trend of sediment accumulation. The correlation of geomorphological, oceanographic, and anthropic variables related to the presence of coastal structures, is necessary in order to set up efficient coastal protection schemes.

Published
2021
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16. Parasitosis febriles

Author

C. Hernández Gutiérrez, M. Novella Mena, D. Alonso Menchén, and H. Moza Moríñigo

Subjects
General Medicine
Published
2022
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22. Relationship of Weather Types on the Seasonal and Spatial Variability of Rainfall, Runoff, and Sediment Yield in the Western Mediterranean Basin

Author

D. Peña-Angulo, E. Nadal-Romero, J.C. González-Hidalgo, J. Albaladejo, V. Andreu, H. Bahri, S. Bernal, M. Biddoccu, R. Bienes, J. Campo, M.A. Campo-Bescós, A. Canatário-Duarte, Y. Cantón, J. Casali, V. Castillo, E. Cavallo, A. Cerdà, P. Cid, N. Cortesi, G. Desir, E. Díaz-Pereira, T. Espigares, J. Estrany, J. Farguell, M. Fernández-Raga, C.S. Ferreira, V. Ferro, F. Gallart, R. Giménez, E. Gimeno, J.A. Gómez, A. Gómez-Gutiérrez, H. Gómez-Macpherson, O. González-Pelayo, O. Kairis, G.P. Karatzas, S. Keesstra, S. Klotz, C. Kosmas, N. Lana-Renault, T. Lasanta, J. Latron, R. Lázaro, Y. Le Bissonnais, C. Le Bouteiller, F. Licciardello, J.A. López-Tarazón, A. Lucía, V.M. Marín-Moreno, C. Marín, M.J. Marqués, J. Martínez-Fernández, M. Martínez-Mena, L. Mateos, N. Mathys, L. Merino-Martín, M. Moreno-de las Heras, N. Moustakas, J.M. Nicolau, V. Pampalone, D. Raclot, M.L. Rodríguez-Blanco, J. Rodrigo-Comino, A. Romero-Díaz, J.D. Ruiz-Sinoga, J.L. Rubio, S. Schnabel, J.M. Senciales-González, A. Solé-Benet, E.V. Taguas, M.T. Taboada-Castro, M.M. Taboada-Castro, F. Todisco, X. Úbeda, E.A. Varouchakis, L. Wittenberg, A. Zabaleta, and M. Zorn

Subjects
weather types, rainfall, runoff, erosion, sediment yield, seasonal analyses, Meteorology. Climatology, QC851-999
Abstract

Rainfall is the key factor to understand soil erosion processes, mechanisms, and rates. Most research was conducted to determine rainfall characteristics and their relationship with soil erosion (erosivity) but there is little information about how atmospheric patterns control soil losses, and this is important to enable sustainable environmental planning and risk prevention. We investigated the temporal and spatial variability of the relationships of rainfall, runoff, and sediment yield with atmospheric patterns (weather types, WTs) in the western Mediterranean basin. For this purpose, we analyzed a large database of rainfall events collected between 1985 and 2015 in 46 experimental plots and catchments with the aim to: (i) evaluate seasonal differences in the contribution of rainfall, runoff, and sediment yield produced by the WTs; and (ii) to analyze the seasonal efficiency of the different WTs (relation frequency and magnitude) related to rainfall, runoff, and sediment yield. The results indicate two different temporal patterns: the first weather type exhibits (during the cold period: autumn and winter) westerly flows that produce the highest rainfall, runoff, and sediment yield values throughout the territory; the second weather type exhibits easterly flows that predominate during the warm period (spring and summer) and it is located on the Mediterranean coast of the Iberian Peninsula. However, the cyclonic situations present high frequency throughout the whole year with a large influence extended around the western Mediterranean basin. Contrary, the anticyclonic situations, despite of its high frequency, do not contribute significantly to the total rainfall, runoff, and sediment (showing the lowest efficiency) because of atmospheric stability that currently characterize this atmospheric pattern. Our approach helps to better understand the relationship of WTs on the seasonal and spatial variability of rainfall, runoff and sediment yield with a regional scale based on the large dataset and number of soil erosion experimental stations.

Published
2020
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24. Data from Serum 25-Hydroxyvitamin D and Cancer Risk in Older Adults: Results from a Large German Prospective Cohort Study

Author

Hermann Brenner, Bernd Holleczek, Lutz Schomburg, Josef Köhrle, Heiko Müller, Ulrike Haug, Ben Schöttker, and José M. Ordóñez-Mena

Abstract

Background: Several observational studies assessed the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of cancer but results were inconclusive.Methods: We measured 25(OH)D concentrations in a population-based cohort study of 9,949 men and women ages 50 to 74 years in Saarland, Germany. Comprehensively adjusted Cox regression models were applied to estimate HRs and 95% confidence intervals (CI) for the association between season-standardized 25(OH)D concentrations and total and site-specific cancer incidence.Results: Overall, during a median of 8 years of follow-up, 873 subjects developed cancer; the most common being prostate (171), breast (137), lung (136), and colorectal (136) cancer. Low season-standardized 25(OH)D (Conclusions: 25(OH)D concentrations were significantly associated with overall cancer incidence in subgroups of this large cohort from Germany. No significant association was observed with site-specific cancers but this could be due to a limited statistical power for these endpoints.Impact: Further research should clarify whether and to what extent specific risk groups might profit from vitamin D supplementation. Cancer Epidemiol Biomarkers Prev; 22(5); 905–16. ©2013 AACR.

Published
2023
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25. A BOVINOCULTURA DE CORTE FRENTE AO PARASITISMO: REVISÃO DE LITERATURA

Author

I. A. CIPRIANO, G. M. FAVARE, T. A. CARMO, M. O. MENA, G. J. GUELPA, and R. V. G. SOUTELLO

Abstract

As infecções por nematódeos do trato gastrintestinal influenciam de maneira negativa na produtividade e no bem-estar dos bovinos, sendo necessário que se promovam medidas de controle e profilaxia que as minimizem. Devido a esta característica e ao clima tropical brasileiro, a produção é afetada por vários fatores, como a baixa disponibilidade e qualidade de pasto durante determinadas épocas do ano, manejo errôneo, ocorrência de parasitos, doenças e carências minerais. Em território nacional, os bovinos criados em pastagens naturais estão expostos à infecção por larvas de nematódeos gastrintestinais e pulmonar, particularmente dos gêneros: Cooperia spp., Haemonchus spp., Ostertagia spp., Strongylus spp., Trichostrongylus spp., Oesophagostomum spp., e Dictyocaulus spp. O uso mais frequente de controlar as infecções parasitárias se dá ao uso de anti-helmínticos, porém, os mesmos já apresentam baixo histórico de ineficácia, devido ao uso frequente e continuado de uma mesma base farmacológica destinada ao controle dos parasitas e esta pressão de seleção é gradativa e silenciosa, caso não diagnosticada precocemente somente será detectada quando atingir níveis com danos aos animais.

Published
2023
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26. UTILIZAÇÃO DE IVERMECTINA SOB DIFERENTES VIAS DE ADMINISTRAÇÃO EM EQUINOS

Author

G. M. FAVARE, I. A. CIPRIANO, M. O. MENA, T. A. CARMO, G. J. GUELPA, D. S. ROMÃO, and R. V. G. SOUTELLO

Abstract

O rebanho de equinos no Brasil é de aproximadamente 6 milhões de animais, sendo o estado de São Paulo com 348.124 número de cabeças, o que permite o país ocupar a 3ª posição no ranking dos países com maiores rebanhos equinos no mundo, atrás somente dos Estados Unidos e México . O parasitismo dos equinos ocupa lugar de destaque devido aos prejuízos causados pelas infecções gastrintestinais. O tratamento para tais infeções é realizado por meio da administração de drogas anti-helmínticas, sendo encontradas no mercado apenas em apresentação por via oral para esta espécie. Os tipos de vias de administração podem causar importantes alterações na atuação e eficácia dos princípios ativos, o que torna estudos farmacológicos mais profundos sobre os anti-helmínticos. Pequenas diferenças nas formulações podem eventualmente causar importantes e significativas alterações na atuação e eficácia, o que torna imprescindíveis estudos farmacológicos mais aprofundados sobre os anti helmínticos. Portanto , sua atividade anti-helmíntica depende da concentração, do tempo de exposição ao parasito, da condição corpórea, da via de administração e da espécie. Sendo assim, é de extrema importância um estudo que avalie a eficácia da droga anti-helmíntica em diferentes vias de administração, e também as possíveis alterações no local da aplicação. Visto que não há recomendações de tratamento com lactonas macrocíclicas injetáveis disponíveis no mercado para equinos e que o custo do produto injetável é muito inferior ao da apresentação oral, tornando o produto mais viável e de grande interesse aos criadores.

Published
2023
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27. Change in glomerular filtration rate over time in the Oxford Renal Cohort Study: observational study

Author

Jennifer A Hirst, Maarten W Taal, Simon DS Fraser, José M Ordóñez Mena, Chris A O’Callaghan, Richard J McManus, Clare J Taylor, Yaling Yang, Emma Ogburn, and FD Richard Hobbs

Subjects
Cohort Studies, Risk Factors, Disease Progression, Humans, Renal Insufficiency, Chronic, Kidney, Family Practice, Glomerular Filtration Rate
Abstract

BackgroundDecline in kidney function can result in adverse health outcomes. The Oxford Renal Cohort Study has detailed baseline assessments from 884 participants ≥60 years of age.AimTo determine the proportion of participants with a decline in estimated glomerular filtration rate (eGFR), identify determinants of decline, and determine proportions with chronic kidney disease (CKD) remission.Design and settingObservational cohort study in UK primary care.MethodData were used from baseline and annual follow-up assessments to monitor change in kidney function. Rapid eGFR decline was defined as eGFR decrease >5 ml/min/1.73 m2/year, improvement as eGFR increase >5 ml/min/1.73 m2/year, and remission in those with CKD at baseline and eGFR >60 ml/min/1.73 m2 during follow-up. Cox proportional hazard models were used to identify factors associated with eGFR decline.ResultsThere was a net decline in eGFR in the 884 participants over 5 years of follow-up. In 686 participants with >2 eGFR tests with a median follow-up of 2.1 years, 164 (24%) evidenced rapid GFR decline, 185 (27%) experienced eGFR improvement, and 82 of 394 (21%) meeting CKD stage 1–4 at baseline experienced remission. In the multivariable analysis, smoking status, higher systolic blood pressure, and being known to have CKD at cohort entry were associated with rapid GFR decline. Those with CKD stage 3 at baseline were less likely to exhibit GFR decline compared with normal kidney function.ConclusionThis study established that 24% of people evidenced rapid GFR decline whereas 21% evidenced remission of CKD. People at risk of rapid GFR decline may benefit from closer monitoring and appropriate treatment to minimise risks of adverse outcomes, although only a small proportion meet the National Institute for Health and Care Excellence criteria for referral to secondary care.

Published
2021
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28. Sediment flow paths and associated organic carbon dynamics across a Mediterranean catchment

Author

C. Boix-Fayos, E. Nadeu, J. M. Quiñonero, M. Martínez-Mena, M. Almagro, and J. de Vente

Subjects
Technology, Environmental technology. Sanitary engineering, TD1-1066, Geography. Anthropology. Recreation, Environmental sciences, GE1-350
Abstract

Terrestrial sedimentation buries large amounts of organic carbon (OC) annually, contributing to the terrestrial carbon sink. The temporal significance of this sink will strongly depend on the attributes of the depositional environment, but also on the characteristics of the OC reaching these sites and its stability upon deposition. The goal of this study was to characterise the OC during transport and stored in the depositional settings of a medium-sized catchment (111 km2) in SE Spain, to better understand how soil erosion and sediment transport processes determine catchment-scale OC redistribution. Total organic carbon (TOC), mineral-associated organic carbon (MOC), particulate organic carbon (POC), total nitrogen (N) and particle size distributions were determined for soils (i), suspended sediments (ii) and sediments stored in a variety of sinks such as sediment wedges behind check dams (iii), channel bars (iv), a small delta in the conjunction of the channel and a reservoir downstream (v), and the reservoir at the outlet of the catchment (vi). The data show that the OC content of sediments was approximately half of that in soils (9.42 ± 9.01 g kg−1 versus 20.45 ± 7.71 g kg−1, respectively) with important variation between sediment deposits. Selectivity of mineral and organic material during transport and deposition increased in a downstream direction. The mineralisation, burial or in situ incorporation of OC in deposited sediments depended on their transport processes and on their post-sedimentary conditions. Upstream sediments (alluvial wedges) showed low OC contents because they were partially mobilised by non-selective erosion processes affecting deeper soil layers and with low selectivity of grain sizes (e.g. gully and bank erosion). We hypothesise that the relatively short transport distances, the effective preservation of OC in microaggregates and the burial of sediments in the alluvial wedges gave rise to low OC mineralisation, as is arguably indicated by C : N ratios similar to those in soils. Deposits in middle stream areas (fluvial bars) were enriched in sand, selected upon deposition and had low OC concentrations. Downstream, sediment transported over longer distances was more selected, poorly microaggregated, and with a prevalence of silt and clay fractions and MOC pool. Overall, the study shows that OC redistribution in the studied catchment is highly complex, and that the results obtained at finer scales cannot be extrapolated at catchment scale. Selectivity of particles during detachment and transport, and protection of OC during transport and deposition are key for the concentration and quality of OC found at different depositional settings. Hence, eco-geomorphological processes during the different phases of the erosion cycle have important consequences for the temporal stability and preservation of the buried OC and in turn for the OC budget.

Published
2015
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29. Quality of life in older adults with chronic kidney disease and transient changes in renal function: findings from the Oxford Renal Cohort

Author

Isabella Busa, José M. Ordóñez-Mena, Yaling Yang, Jane Wolstenholme, Stavros Petrou, Clare J. Taylor, Chris A. O’Callaghan, Simon D. S. Fraser, Maarten W. Taal, Richard J. McManus, Jennifer A. Hirst, and F. D. Richard Hobbs

Subjects
Cross-Sectional Studies, Multidisciplinary, Surveys and Questionnaires, Quality of Life, Humans, Renal Insufficiency, Chronic, Kidney, Aged
Abstract

Background Quality of life (QoL) is an important measure of disease burden and general health perception. The relationship between early chronic kidney disease (CKD) and QoL remains poorly understood. The Oxford Renal Study (OxRen) cohort comprises 1063 adults aged ≥60 years from UK primary care practices screened for early CKD, grouped according to existing or screen-detected CKD diagnoses, or biochemistry results indicative of reduced renal function (referred to as transient estimated glomerular filtration rate (eGFR) reduction). Objectives This study aimed to compare QoL in participants known to have CKD at recruitment to those identified as having CKD through a screening programme. Methods Health profile data and multi-attribute utility scores were reported for two generic questionnaires: 5-level EuroQol-5 Dimension (EQ-5D-5L) and ICEpop CAPability measure for Adults (ICECAP-A). QoL was compared between patients with existing and screen-detected CKD; those with transient eGFR reduction served as the reference group in univariable and multivariable linear regression. Results Mean and standard deviation utility scores were not significantly different between the subgroups for EQ-5D-5L (screen-detected:0.785±0.156, n = 480, transient:0.779±0.157, n = 261, existing CKD:0.763±0.171, n = 322, p = 0.216) or ICECAP-A (screen-detected:0.909±0.094, transient:0.904±0.110, existing CKD:0.894±0.115, p = 0.200). Age, smoking status, and number of comorbidities were identified as independent predictors of QoL in this cohort. Conclusion QoL of participants with existing CKD diagnoses was not significantly different from those with screen-detected CKD or transient eGFR reduction and was similar to UK mean scores for the same age, suggesting that patient burden of early CKD is minor. Moreover, CKD-related comorbidities contribute more significantly to disease burden in earlier stages of CKD than renal function per se. Larger prospective studies are required to define the relationship between QoL and CKD progression more precisely. These data also confirm the essentially asymptomatic nature of CKD, implying that routine screening or case finding are required to diagnose it.

Published
2022

30. Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis

Author

David Fawkner-Corbett, Gail Hayward, Mohammed Alkhmees, Ann Van Den Bruel, Jose M Ordóñez-Mena, and Gea A Holtman

Subjects
Inflammation, Leukocyte Count, C-Reactive Protein, Hematologic Tests, ACCIDENT & EMERGENCY MEDICINE, PAEDIATRICS, Humans, General Medicine, Child, Appendicitis, Sensitivity and Specificity, PAEDIATRIC SURGERY
Abstract

ObjectivePossible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell count (WCC), neutrophil(count or percentage), C reactive protein (CRP) and/or procalcitonin) for childhood appendicitis.DesignA systematic review and diagnostic meta-analysis. Data sources included MEDLINE, EMBASE, Central, Web of Science searched from inception-March 2022 with reference searching and authors contacted for missing/unclear data. Eligibility criteria was studies reporting the diagnostic accuracy of the four blood tests compared to the reference standard (histology or follow-up). Risk of bias was assessed (QUADAS-2), pooled sensitivity and specificity were generated for each test and commonly presented cut-offs. To provide insight into clinical impact, we present strategies using a hypothetical cohort.Results67 studies were included (34 839 children, 13 342 with appendicitis), all in the hospital setting. The most sensitive tests were WCC (≥10 000 cells/µL, 53 studies sensitivity 0.85 (95% CI 0.80 to 0.89)) and absolute neutrophil count (ANC) (≥7500 cells/µL, five studies sensitivity 0.90 (95% CI 0.85 to 0.94)). Combination of WCC or CRP increased sensitivity further(≥10 000 cells/µL or ≥10 mg/L, individual patient data (IPD) of 6 studies, 0.97 (95% CI 0.93 to 0.99)).Applying results to a hypothetical cohort(1000 children with appendicitis symptoms, of whom 400 have appendicitis) 60 and 40 children would be wrongly discharged based solely on WCC and ANC, respectively, 12 with combination of WCC or CRP.The most specific tests were CRP alone (≥50 mg/L, 38 studies, specificity 0.87 (95% CI 0.80 to 0.91)) or combined with WCC (≥10 000 cells/µL and ≥50 mg/L, IPD of six studies, 0.93 (95% CI 0.91 to 0.95)).ConclusionsThe best performing single blood tests for ruling-out paediatric appendicitis are WCC or ANC; with accuracy improved combining WCC and CRP. These tests could be used at the point of care in combination with clinical prediction rules. We provide insight into the best cut-offs for clinical application.PROSPERO registration numberCRD42017080036

Published
2022

31. Body mass index and survival in people with heart failure

Author

N Jones, J M Ordonez-Mena, A K Roalfe, C Goyder, F D R Hobbs, and C J Taylor

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background People with obesity are twice as likely to develop heart failure (HF) compared to people with a healthy body mass index (BMI) [1]. However, among people with HF a higher BMI has been linked to a reduced risk of all-cause mortality, a concept known as the “obesity paradox” [2]. Purpose To examine the association between BMI and survival in patients with chronic HF among a large primary care cohort. Methods We extracted data from the Clinical Practice Research Datalink of primary care records from 1st January 2000 to 31st December 2017 and included 47,531 patients with an incident diagnosis of HF, who were aged 45 years and over and who had a recorded BMI. Patients were stratified into categories of baseline BMI as underweight (BMI Results There were 25,013 deaths during the study follow-up. The average age of participants was 77.1 years (SD 10.6) and mean BMI was 27.9 (SD 6.1). In an age- and sex-adjusted analysis, people who were underweight were at increased risk of all-cause mortality compared to people with healthy weight (HR 1.52, 95% CI 1.41 to 1.64). People with overweight (HR 0.81, 95% CI 0.79 to 0.84), obesity class I (HR 0.79, 95% CI 0.76 to 0.82) and obesity class II (HR 0.78, 95% CI 0.74 to 0.82) were at decreased risk of all-cause mortality. People with obesity class III had no difference in risk of death compared to people with healthy weight (HR 0.95, 95% CI 0.88 to 1.02). In a Kaplan-Meier analysis, there was an inverse relationship between body weight and risk of death, even within the first year of follow-up. Conclusion In our large community cohort of people with HF, we found an inverse relationship between BMI and survival. Underweight people with HF have the poorest prognosis and should be identified as high-risk. Conversely, people with HF who are overweight or obese (class I and II) are at lower risk of death confirming the obesity paradox in a real-world primary care population. These findings suggest a more cautious approach to weight management in overweight and obese patients may be needed for people with HF in primary care. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The SurviveHF study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust and the Wellcome Institutional Strategic Fund. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication.

Published
2022
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32. Natriuretic peptide level at heart failure diagnosis and risk of hospitalisation and death in England 2004–2018

Author

Fd Richard Hobbs, Nicholas R Jones, José M Ordóñez-Mena, Andrea K Roalfe, Clare J Taylor, Sarah Lay-Flurrie, and Clare Goyder

Subjects
Male, medicine.medical_specialty, Referral, Coronavirus disease 2019 (COVID-19), medicine.drug_class, Population, 030204 cardiovascular system & hematology, Cohort Studies, Secondary care, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Natriuretic Peptide, Brain, Natriuretic peptide, Humans, Medicine, 030212 general & internal medicine, education, Aged, Heart Failure, education.field_of_study, SARS-CoV-2, business.industry, Mortality rate, COVID-19, medicine.disease, Peptide Fragments, 3. Good health, Hospitalization, Heart failure, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Cohort study
Abstract

ObjectiveHeart failure (HF) is a malignant condition requiring urgent treatment. Guidelines recommend natriuretic peptide (NP) testing in primary care to prioritise referral for specialist diagnostic assessment. We aimed to assess association of baseline NP with hospitalisation and mortality in people with newly diagnosed HF.MethodsPopulation-based cohort study of 40 007 patients in the Clinical Practice Research Datalink in England with a new HF diagnosis (48% men, mean age 78.5 years). We used linked primary and secondary care data between 1 January 2004 and 31 December 2018 to report one-year hospitalisation and 1-year, 5-year and 10-year mortality by NP level.Results22 085 (55%) participants were hospitalised in the year following diagnosis. Adjusted odds of HF-related hospitalisation in those with a high NP (NT-proBNP >2000 pg/mL) were twofold greater (OR 2.26 95% CI 1.98 to 2.59) than a moderate NP (NT-proBNP 400–2000 pg/mL). All-cause mortality rates in the high NP group were 27%, 62% and 82% at 1, 5 and 10 years, compared with 19%, 50% and 77%, respectively, in the moderate NP group and, in a competing risks model, risk of HF-related death was 50% higher at each timepoint. Median time between NP test and HF diagnosis was 101 days (IQR 19–581).ConclusionsHigh baseline NP is associated with increased HF-related hospitalisation and poor survival. While healthcare systems remain under pressure from the impact of COVID-19, research to test novel strategies to prevent hospitalisation and improve outcomes—such as a mandatory two-week HF diagnosis pathway—is urgently needed.

Published
2021
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33. Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study

Author

Clare J Taylor, José M Ordóñez-Mena, Sarah L Lay-Flurrie, Clare R Goyder, Kathryn S Taylor, Nicholas R Jones, Andrea K Roalfe, and FD Richard Hobbs

Subjects
Heart Failure, Primary Health Care, Predictive Value of Tests, Natriuretic Peptide, Brain, Chronic Disease, Humans, Family Practice, Referral and Consultation, Secondary Care, Peptide Fragments, Biomarkers
Abstract

BackgroundNatriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis.AimTo report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds.Design and settingDiagnostic accuracy study using linked primary and secondary care data (2004 to 2018).MethodThe sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NP testing for HF diagnosis was assessed.ResultsIn total, 229 580 patients had an NP test and 21 102 (9.2%) were diagnosed with HF within 6 months. The ESC NT-proBNP threshold ≥125 pg/mL had a sensitivity of 94.6% (95% confidence interval [CI] = 94.2 to 95.0) and specificity of 50.0% (95% CI = 49.7 to 50.3), compared with sensitivity of 81.7% (95% CI = 81.0 to 82.3) and specificity of 80.3% (95% CI = 80.0 to 80.5) for the NICE NT-proBNP ≥400 pg/mL threshold. PPVs for an NT-proBNP test were 16.4% (95% CI = 16.1 to 16.6) and 30.0% (95% CI = 29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with an NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9%, 95% CI = 98.8 to 99.0 and NICE 97.7%, 95% CI = 97.6 to 97.8).ConclusionAt the higher NICE chronic HF guideline NP thresholds, one in five cases are initially missed in primary care but the lower ESC thresholds require more diagnostic assessments. NP is a reliable ‘rule-out’ test at both cut-points. The optimal NP threshold will depend on the priorities and capacity of the healthcare system.

Published
2022

34. National trends in heart failure mortality in men and women,<scp>United Kingdom</scp>, 2000–2017

Author

Clare J Taylor, FD Richard Hobbs, Nicholas R Jones, Sarah Lay-Flurrie, Andrea K Roalfe, José M Ordóñez-Mena, and Tom Marshall

Subjects
Male, Survival, 030204 cardiovascular system & hematology, Lower risk, New diagnosis, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Risk Factors, Humans, Medicine, National trends, Mortality, Sex Differences, Proportional Hazards Models, Cause of death, Heart Failure, Sex Characteristics, business.industry, Mortality rate, Hazard ratio, Gender, Middle Aged, Prognosis, medicine.disease, United Kingdom, Confidence interval, Hospitalization, Heart failure, Sex, Female, Cardiology and Cardiovascular Medicine, business, Research Article, Demography
Abstract

© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Aims: To understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time. Methods and results: We analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age-adjusted lower risk of all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84–0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96–1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80–0.85). Conclusions: Women are diagnosed with heart failure older than men but have a better age-adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.

Published
2020
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35. Movilización de carbono orgánico por distintos procesos erosivos en la conexión ladera-cauce

Author

E. Nadeu, C. Boix-Fayos, J. de Vente, J. López, and M. Martínez-Mena

Subjects
procesos erosivos, carbono orgánico del suelo, razón de enriquecimiento, cuenca, conexión ladera-cauce, Ecology, QH540-549.5
Abstract

Con el fin de caracterizar la cantidad y tipo (lábil o recalcitrante) de carbono orgánico (CO) movilizado por distintos procesos erosivos identificados en las conexiones ladera-cauce, se estudiaron las características de los depósitos de erosión concentrada en cárcavas, erosión hídrica laminar, erosión lateral-gravitacional y erosión por laboreo en el contacto ladera-cauce de una cuenca de pequeño tamaño (10 ha) y se relacionaron con las características de los suelos-fuentes originales de donde procedían. La selectividad en el arranque y transporte de suelo de los distintos procesos se pudo asociar a diferentes contenidos y tipos de CO en los depósitos. Las razones de enriquecimiento de carbono orgánico sedimento/suelo fueron bajas (~0,40 ± 0,26), a pesar de haber un ligero enriquecimiento en partículas finas (correlacionadas positivamente con el CO) en los depósitos. Todo ello se atribuyó a los efectos de la mineralización en un cauce muy activo con pocas zonas de deposición y abundantes procesos de erosión no selectiva.

Published
2010
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36. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses

Author

Nicola Lindson, Annika Theodoulou, Jonathan Livingstone-Banks, Paul Aveyard, Thomas R Fanshawe, José M Ordóñez-Mena, Alex J Sutton, Suzanne C Freeman, Sanjay Agrawal, and Jamie Hartmann-Boyce

Subjects
Pharmacology (medical)
Abstract

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To conduct component network meta‐analyses (cNMAs) to investigate the comparative effectiveness, safety and tolerability of different smoking cessation pharmacotherapies and electronic cigarettes (EC), singly and combined, when helping people to stop smoking tobacco. To investigate: how the different characteristics of smoking cessation pharmacotherapies and EC interventions (e.g. intervention subtype, dose, length of intervention, whether the intervention is used prequit as well as from quit date or from quit date only) influence efficacy, safety and tolerability; whether identifiable participant characteristics and behavioural support suggest different optimal intervention strategies.

Published
2022

37. INFLUÊNCIA DO TRATAMENTO ANTI-HELMÍNTICO EM BOVINOS CRIADOS SOB SISTEMA DE CONFINAMENTO

Author

M. O. MENA, T. A. CARMO, I. A. CIPRIANO, G. M. FAVARE, G. J. GUELPA, and R. V. G. SOUTELLO

Abstract

A terminação de bovinos no Brasil, em sua maior parte, ainda é feita em pasto. Em 2015, das 41 milhões de cabeças abatidas, 84% foram terminadas em pastagens que diante do clima tropical brasileiro, é afetado por fatores negativos, como: baixa e alta disponibilidade e qualidade de pasto durante determinadas épocas do ano, manejo errôneo, ocorrência de parasitos, doenças e carências minerais. O confinamento vem se mostrando uma alternativa viável, rentável e cada vez mais utilizada frente à demanda do mercado, estratégia que concentra a produção em um menor espaço e tempo para a engorda dos animais, por meio de maior inclusão de energia na dieta oferecida. Nos últimos anos, o número de animais confinados no Brasil aumentou aproximadamente 63%, tal estratégia, demanda cuidados, pois com maior uso de tecnologia, maior o custo de produção, portanto, o planejamento, conhecimento e análise dos custos na determinação das operações são primordiais para obtenção de resultados positivos. Portanto, objetivou-se relatar que não há influência do tratamento anti-helmíntico no desempenho dos animais tratados e não tratados com anti-helmínticos em sistema de confinamento, devido à manipulação nutricional utilizada nestes sistemas. O fornecimento de dieta de alto concentrado, ou seja, com níveis de nutrientes disponíveis balanceados e ausência de desafio para reinfecção por helmintos, são suficientes para promover a eliminação da carga parasitária.

Published
2022
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38. Effects of modafinil on electroencephalographic microstates in healthy adults

Author

Samantha R, Linton, Michael, Murphy, Hans S, Schroder, Micah, Breiger, Ann M, Iturra-Mena, Brian D, Kangas, Jack, Bergman, William A, Carlezon, Victoria B, Risbrough, Samuel A, Barnes, Andre, Der-Avakian, and Diego A, Pizzagalli

Subjects
Adult, Brain, Humans, Cognitive Dysfunction, Electroencephalography, Modafinil, Cognition Disorders
Abstract

Modafinil has been proposed as a potentially effective clinical treatment for neuropsychiatric disorders characterized by cognitive control deficits. However, the precise effects of modafinil, particularly on brain network functions, are not completely understood.To address this gap, we examined the effects of modafinil on resting-state brain activity in 30 healthy adults using microstate analysis. Electroencephalographic (EEG) microstates are discrete voltage topographies generated from resting-state network activity.Using a placebo-controlled, within-subjects design, we examined changes to microstate parameters following placebo (0 mg), low (100 mg), and high (200 mg) modafinil doses. We also examined the functional significance of these microstates via associations between microstate parameters and event-related potential indexes of conflict monitoring and automatic error processing (N2 and error-related negativity) and behavioral responses (accuracy and RT) from a subsequent flanker interference task.Five microstates emerged following each treatment condition, including four canonical microstates (A-D). Modafinil increased microstate C proportion and occurrence regardless of dose, relative to placebo. Modafinil also decreased microstate A proportion and microstate B proportion and occurrence relative to placebo. These modafinil-related changes in microstate parameters were not associated with similar changes in flanker ERPs or behavior. Finally, modafinil made transitions between microstates A and B less likely and transitions from A and B to C more likely.Previous fMRI work has correlated microstates A and B with auditory and visual networks and microstate C with a salience network. Thus, our results suggest modafinil may deactivate large-scale sensory networks in favor of a higher order functional network during resting-state in healthy adults.

Published
2021

39. Impacto do resíduo das lactonas macrocíclicas nos microorganismos presentes no ambiente e na decomposição das fezes de bovinos

Author

T. A. CARMO, G. M. FAVARE, I. A. CIPRIANO, M. O. MENA, G. J. GUELPA, Y. S. DIAS, and R. V. G. SOUTELLO

Abstract

Os parasitos influenciam de maneira significativa a bovinocultura no Brasil, sendo a aplicação de endectocidas da família das lactonas macrocíclicas umas das formas mais utilizadas para o controle, porém podem proporcionar contaminação ao ambiente, visto que sua eliminação é principalmente via fezes e urina. as altas concentrações destes fármacos excretadas nas fezes, principalmente nas primeiras semanas pós-tratamento, afetam as populações de fauna coprófaga que mantiveram contato com estas fezes e há espécies vulneráveis mesmo em concentrações mínimas destes fármacos sendo que a ivermectina possui um forte poder de adsorção ao solo e a matéria orgânica possuindo baixo potencial de dessorção e, consequentemente, baixo potencial de lixiviação. Portanto, os distúrbios que as lactonas macrocíclicas podem produzir em invertebrados não alvo e sobre a participação dos seus associados na degradação do esterco e reciclagem de elementos no solo são imprevisíveis, e podem influenciar negativamente a biodiversidade e a sustentabilidade dos ecossistemas agrícolas.

Published
2021
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40. The association between vitamin D levels and caries experience in children and youth participating in National Health and Nutrition Examination Survey 2011-2016: A cross-sectional study

Author

Karin, Herzog and José M, Ordóñez-Mena

Subjects
Cross-Sectional Studies, Adolescent, Dental Caries Susceptibility, Humans, Dental Caries, Vitamin D, Child, Nutrition Surveys, Vitamin D Deficiency
Abstract

Given equivocal findings from existing nationally representative studies, the authors sought to determine associations between vitamin D levels and caries experience in US children using updated National Health and Nutrition Examination Survey data.The authors used data from 2011-2016 National Health and Nutrition Examination Survey. Vitamin D status was assessed on the basis of the sufficiency thresholds of 50 and 75 nmol/L for serum 25-hydroxyvitamin D (25[OH]D) recommended by the Institute of Medicine (now National Academy of Medicine) and Endocrine Society, respectively. Caries experience was defined as the total number of decayed or filled tooth surfaces (dfs) and decayed, missing, or filled tooth surfaces (DMFS) and a binary measure of any dfs and DMFS. Associations between 25(OH)D and any or total dfs and DMFS were examined in children aged 2 through 5, 6 through 8, 9 through 11, and 12 through 18 years, using multivariable logistic and linear regression models after adjustment for covariates.Children aged 2 through 5 years with 25(OH)D above 75 nmol/L experienced fewer total dfs (β = -1.94; 95% CI, -3.60 to -0.28) than those with 25(OH)D below 75 nmol/L. Children 6 through 8 years with 25(OH)D above 75 nmol/L had lower presence of any dfs (odds ratio, 0.59; 95% CI, 0.36 to 0.95) than those with 25(OH)D below 75 nmol/L, and those with 25(OH)D above 50 nmol/L had lower presence of any DMFS (odds ratio, 0.38; 95% CI, 0.19 to 0.79) than those with 25(OH)D below 50 nmol/L. There were no associations of 25(OH)D status with either any or total DMFS in children 12 through 18 years CONCLUSIONS: There were no consistent associations of 25(OH)D status with caries experience across age groups.Vitamin D status was not associated consistently with reduced caries experience.

Published
2021

41. Biotecnologias aplicadas ao parasitismo

Author

I. A. CIPRIANO, G. M. FAVARE, M. O. MENA, T. A. CARMO, G. J. GUELPA, and R. V. G. SOUTELLO

Abstract

Acredita-se que a resitência está relacionada a herança de genes ou locos genômicos que através da expressão de moléculas, regulam a imunidade do hospedeiro com a principal função de limitar e controlar a patologia. Os principais tipos de marcadores moleculares, evidencia-se os marcadores RFLP e microssatélite ou locos VNRT (Variable Number of Tandem Repeats), nos quais funcionam utilizando o princípio de hibridização ou amplificação de DNA. Contudo esses marcadores demandam muito tempo para seleção convencional e nem sempre serão expressados os genes esperados. Atualmente, a busca por novos marcadores moleculares vem sendo estudados, como a epigenética. Tendo em vista a importância do controle dos parasitas, se faz necessária a busca por alternativas como o uso de animais resistentes aos mesmos e o estudo da diversidade genética do genoma do hospedeiro. Dessa forma, essa revisão bibliográfica abordará como os mecanismos epigenéticos podem ser utilizados como ferramenta para a identificação e possível seleção de animais resistentes.

Published
2021
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42. Resistência anti-helmíntica em equinos

Author

G. M. FAVARE, I. A. CIPRIANO, T. A. CARMO, M. O. MENA, G. J. GUELPA, B. X. DAVI, and R. V. G, SOUTELLO

Abstract

Dos fatores que devem ser levados em consideração no quesito sanidade dos equinos, as infecções helmínticas ocupam lugar de destaque devido aos prejuízos consequentes causados pelos parasitos gastrintestinais. O uso indiscriminado de drogas na tentativa do combate desses parasitos pode levar ao surgimento da resistência anti-helmíntica, que representa um problema crescente na produção animal. Tendo em vista a carência de informação relacionada à eficácia das drogas anti-helmínticas utilizadas em rebanhos de equinos no estado de São Paulo e a situação alarmante da resistência no Brasil e no mundo, com o presente estudo pretende-se detectar a existência da resistência anti-helmíntica, em rebanhos de equinos na região oeste do estado de São Paulo / Brasil. Para tanto foram avaliadas as principais classes dos anti-helmínticos mais utilizados: benzimidazois (Fenbendazole), avermectinas (ivermectina) e milbemicinas (moxidectina), aplicados em pasta por via oral. A distribuição dos animais nos grupos foi realizada de forma homogênea, conforme os valores da contagem de ovos por grama de fezes (OPG) e categoria animal. A avaliação foi realizada em animais de 10 propriedades através do OPG, e coproculturas para a identificação dos parasitas. Os resultados foram analisados por meio do percentual da redução do número de ovos por grama de fezes (R-OPG), utilizando o programa estatístico RESO.

Published
2021
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43. Sazonalidade da infecção helmintica em equinos

Author

G. M. FAVARE, I. A. CIPRIANO, T. A. CARMO, M. O. MENA, G. J. GUELPA, B. X. DAVI, and R. V. G. SOUTELLO

Abstract

Infecções parasitárias são extremamente importantes em equinos, devido aos prejuízos causados, e tendem a acometê-los durante toda a vida do animal. No entanto, a prevalência de helmintos pode aumentar ou diminuir, nas dependências de fatores climáticos ou susceptibilidade do hospedeiro. Diante disso, a observação da dinâmica sazonal da infecção helmíntica em equinos mantidos a pasto é de extrema importância epidemiológica. Foi possível concluir que a estação que os animais mais são acometidos pela verminose é no verão e que as categorias mais susceptíveis à infecção helmíntica são os potros e os animais idosos.

Published
2021
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44. Seleção de animais resistentes ao parasitismo

Author

I. A. CIPRIANO, G. M. FAVARE, M. O. MENA, T. A. CARMO, G. J. GUELPA, C. V. S. TEIXEIRA, and R. V. G. SOUTELLO

Abstract

O uso indiscriminado de anti-helmínticos tem acarratado o aumento de relatos de resistência a esses fármacos. Sendo assim, existe uma busca promissora de alternativas para o controle de parasitas e redução do uso de antiparasitários, como por exemplo, a seleção de animais resistentes. A resistência aos parasitas é a habilidade de suprimir o estabelecimento e/ou subsequente o desenvolvimento da infecção causada pelos vermes, e resiliência, quando o animal suporta a verminose, porém sem comprometimentos na produtividade. A quantificação da carga parasitária é a forma mais precisa de se avaliar a resposta do hospedeiro frente à fonte de infecção, sendo que o método determinado para a identificação da resistência, dependerá de sua relação com a carga parasitária e de sua repetibilidade no estudo do genoma. Dessa forma, essa revisão bibliográfica abordará como a seleção dos animais resistentes é um método alternativo ao uso do genoma do hospedeiro que tem sido implantada para reduzir os prejuízos ocasionados pelos parasitas e assim, procriar animais naturalmente resistentes a endo e ectoparasitas.

Published
2021
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45. Uso de fitoterápicos com atividade anti-helmíntica em ovinos

Author

M. O. MENA, R. V. G. SOUTELLO, T. A. CARMO, I. A. CIPRIANO, G. M. FAVARE, G. J. GUELPA, and B. X. DAVID

Abstract

As doenças parasitárias representam impacto negativo em potencial para a produção animal, comprometendo, muitas vezes, o processo de transformação dos produtos de origem animal, com perdas estimadas em 13,96 bilhões de dólares/ano, sendo mais da metade (U$ 7,10 bilhões) relacionadas somente aos nematoides gastrintestinais. A sensibilidade desses animais a estes parasitas tornou-se grande problema na produção devido a estas helmintoses ocorrerem por meio de infecções de várias espécies de parasitas do trato gastrintestinal. Além disso, causam sérios problemas sanitários como perda de peso, anemia, letargia, anorexia e até a morte, levando a prejuízos como diminuição da produção e aumento do valor do produto final. O controle dessas parasitoses é basicamente feito por meio de anti-helmínticos que permanece essencialmente com bases químicas. Decorrente do insuficiente repasse de tecnologia, ou mesmo de informações inadequadas referentes à frequência de tratamento e à utilização incorreta das drogas antiparasitárias em ovinos, foi observada grande diminuição da eficácia desses produtos nas principais regiões produtoras brasileiras, inclusive, com o aparecimento de cepas resistentes a vários grupos químicos disponíveis no mercado. Neste sentido, as pesquisas estão cada vez mais direcionadas à busca por tratamentos alternativos como, por exemplo, a fitoterapia. Produtos naturais quando vindos de espécies vegetais, apresentam grande importância no desenvolvimento de novos medicamentos. A fitoterapia pode trazer grandes benefícios ao produtor, consumidor e meio ambiente. No entanto, estudos in vivo são escassos e carecem de informações. Observa-se que as fontes científicas relacionadas aos fitoterápicos utilizados em ovinos ainda são escassas. Mas muitos autores que utilizaram fitoterápicos obtiveram um resultado satisfatório, sendo assim, é conclusivo que o uso de fitoterápicos no controle das helmintoses em ovinos pode se tornar uma alternativa positiva por ser um produto eficaz, geralmente de fácil acesso e baixo custo, todavia, estudos in vitro devem ser realizados e posteriormente in vivo na busca e validação de plantas que podem ser utilizadas.

Published
2021
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46. Consultations for clinical features of possible cancer and associated urgent referrals before and during the COVID-19 pandemic: an observational cohort study from English primary care

Author

Brian D. Nicholson, José M. Ordóñez-Mena, Sarah Lay-Flurrie, James P. Sheppard, Harshana Liyanage, Dylan McGagh, Julian Sherlock, John Williams, Margaret Smith, Cynthia Wright Drakesmith, Nicholas P. B. Thomas, Eva J. A. Morris, Rafael Perera, Simon de Lusignan, F. D. Richard Hobbs, and Clare R. Bankhead

Subjects
Cohort Studies, Cancer Research, Primary Health Care, Oncology, Epidemiology, Neoplasms, Communicable Disease Control, COVID-19, Humans, Pandemics, Referral and Consultation, Article, Cancer prevention
Abstract

Background It remains unclear to what extent reductions in urgent referrals for suspected cancer during the COVID-19 pandemic were the result of fewer patients attending primary care compared to GPs referring fewer patients. Methods Cohort study including electronic health records data from 8,192,069 patients from 663 English practices. Weekly consultation rates, cumulative consultations and referrals were calculated for 28 clinical features from the NICE suspected cancer guidelines. Clinical feature consultation rate ratios (CRR) and urgent referral rate ratios (RRR) compared time periods in 2020 with 2019. Findings Consultations for cancer clinical features decreased by 24.19% (95% CI: 24.04–24.34%) between 2019 and 2020, particularly in the 6–12 weeks following the first national lockdown. Urgent referrals for clinical features decreased by 10.47% (95% CI: 9.82–11.12%) between 2019 and 2020. Overall, once patients consulted with primary care, GPs urgently referred a similar or greater proportion of patients compared to previous years. Conclusion Due to the significant fall in patients consulting with clinical features of cancer there was a lower than expected number of urgent referrals in 2020. Sustained efforts should be made throughout the pandemic to encourage the public to consult their GP with cancer clinical features.

Published
2021

47. Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008–2018: a retrospective cohort study of electronic health records to inform point-of-care testing

Author

Thomas R. Fanshawe, Dona Foster, José M Ordóñez-Mena, Monique Andersson, A. Sarah Walker, Nicole Stoesser, Sarah Oakley, and Gail Hayward

Subjects
Male, medicine.medical_specialty, Point-of-care testing, Urine, primary care, Pregnancy, Internal medicine, Epidemiology, Electronic Health Records, Humans, Medicine, Diagnostics, Retrospective Studies, Primary Health Care, business.industry, microbiology, Microbiology Test, Retrospective cohort study, General Medicine, Hepatitis B, medicine.disease, United Kingdom, Point-of-Care Testing, epidemiology, Female, Syphilis, business
Abstract

ObjectivesTo inform point-of-care test (POCT) development, we quantified the primary care demand for laboratory microbiology tests by describing their frequencies overall, frequencies of positives, most common organisms identified, temporal trends in testing and patterns of cotesting on the same and subsequent dates.DesignRetrospective cohort study.SettingPrimary care practices in Oxfordshire.Participants393 905 patients (65% female; 49% aged 18–49).Primary and secondary outcome measuresThe frequencies of all microbiology tests requested between 2008 and 2018 were quantified. Patterns of cotesting were investigated with heat maps. All analyses were done overall, by sex and age categories.Results1 596 752 microbiology tests were requested. Urine culture±microscopy was the most common of all tests (n=673 612, 42%), was mainly requested without other tests and was the most common test requested in follow-up within 7 and 14 days. Of all urine cultures, 180 047 (27%) were positive and 172 651 (26%) showed mixed growth, and Escherichia coli was the most prevalent organism (132 277, 73% of positive urine cultures). Antenatal urine cultures and blood tests in pregnancy (hepatitis B, HIV and syphilis) formed a common test combination, consistent with their use in antenatal screening.ConclusionsThe greatest burden of microbiology testing in primary care is attributable to urine culture ± microscopy; genital and routine antenatal urine and blood testing are also significant contributors. Further research should focus on the feasibility and impact of POCTs for these specimen types.

Published
2021

48. Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study

Author

Andrea K Roalfe, José M Ordóñez-Mena, FD Richard Hobbs, Nicholas R Jones, Clare Goyder, Clare J Taylor, and Sarah Lay-Flurrie

Subjects
Pediatrics, medicine.medical_specialty, business.industry, medicine.drug_class, Primary care, Natriuretic peptide testing, medicine.disease, Confidence interval, Secondary care, Heart failure, medicine, Natriuretic peptide, Stage (cooking), Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract

Aims Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time. Methods and results Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004–18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23–0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73–17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017]. Conclusion NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage.

Published
2021

49. The association of malnutrition with mortality and amputation outcomes in critical limb ischemia: a systematic review

Author

A E B Brice, L S Scierka, A A Arham, Z A Ahmed, Y C D Castro-Dominguez, A G Grimshaw, S N Nagpal, S S M Soedamah-Muthu, C M H Mena-Hurtado, and K G S Smolderen

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Introduction Critical limb ischemia (CLI) is a severe stage of peripheral arterial disease with high mortality. Malnutrition has been recognized as a potentially modifiable risk factor that may be prognostic of mortality and amputation outcomes in CLI. Great variability exists in the measurement of malnutrition including surrogate markers such as albumin level and body mass index (BMI) but also validated tools including geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT). Purpose To conduct a systematic review examining the association of malnutrition with mortality and amputation outcomes in patients with CLI. Methods A systematic literature search of AMED, CINAHL, Cochrane Library, Medline, Embase, Pubmed, Scopus, Web of Science, and Google Scholar was conducted through September 12, 2020. The review protocol was registered in PROSPERO. Only CLI patients were included. It was limited by adult human studies and those after 1982, when CLI was first defined. Eligible studies were randomized controlled trials, cohort studies, and case-control studies while case series, case reports, editorials, conference abstracts, and non-English studies were excluded. Malnutrition measured by albumin, BMI, or a validated malnutrition assessment tool was included. Outcomes of interest were mortality, any amputation, amputation free survival (AFS), major adverse limb events (MALE), major adverse cardiovascular events (MACE), or a composite of these. Two reviewers independently performed screening, data extraction, and quality assessment with a third independent reviewer resolving disagreements. Results 3290 initial studies were found. The final 33 eligible studies were from 7 countries published between 2002 to 2020. Of these 30 were retrospective cohort studies, three were prospective cohort studies, and none were randomized controlled trials. No studies were at serious or critical risk of bias by evaluation with ROBINS-I quality tool. The average sample size was 553 patients (range N=21–5110). The median age was 72 years and 67.1% were male. The prognostic association of malnutrition and outcomes varied by malnutrition tool used. Malnutrition as measured by the validated tools of GNRI and CONUT was associated with all mortality outcomes, except for GNRI and cardiovascular mortality. The malnutrition surrogate markers of albumin and BMI were only associated with mortality outcomes in 62.5–75% of results. The validated nutrition tools were also consistently prognostic of amputation outcomes in all results, whereas surrogate markers only in 62.5–67%. Overall malnutrition by validated tools was prognostic in 14/15 (93.3%) of results while surrogate markers in 29/42 (69%) of results. See table 1. Conclusion Malnutrition is prognostically associated with mortality and amputation outcomes in CLI. This association is most consistent when malnutrition is assessed by a validated tool. Funding Acknowledgement Type of funding sources: None.

Published
2021
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50. Natriuretic peptide referral thresholds and heart failure diagnosis: population-based cohort study

Author

José M Ordóñez-Mena, Clare J Taylor, Nicholas R Jones, Andrea K Roalfe, Sarah Lay-Flurrie, Clare Goyder, and F D R Hobbs

Subjects
medicine.medical_specialty, Population based cohort, Referral, business.industry, medicine.drug_class, Heart failure, Internal medicine, medicine, Natriuretic peptide, Cardiology and Cardiovascular Medicine, medicine.disease, business
Abstract

Background Natriuretic peptide (NP) testing is recommended by both the European Society of Cardiology (ESC) and the National Institute for Health and Care Excellence (NICE) for people presenting with symptoms of heart failure (HF) in primary care. However, ESC and NICE guidelines suggest different NP referral thresholds: ESC recommend referral at a lower NP level (BNP≥35pg/ml / NT-proBNP≥125pg/ml) compared to NICE (BNP≥100pg/ml/NT-proBNP≥400pg/ml). Purpose We aimed to evaluate NP test performance for HF diagnosis for ESC and NICE guideline-defined thresholds. Methods Population-based cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink in England between 1st January 2000 and 31st December 2018. Participants were adults aged 45 years and above with a NP result: 74,233 had a BNP and 155,347 had a NT-proBNP measurement. The main outcome measures were diagnostic performance of NP test (sensitivity, specificity, positive predictive value, negative predictive value) by threshold. Results A total of 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF. The ESC NT-proBNP threshold of 125pg/ml had a sensitivity of 94.6% (94.2 to 95.0) and specificity of 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP 400pg/ml threshold. For both guidelines, nearly all patients with a NP level below the threshold did not have HF (negative predictive value ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Similar performance was found for BNP. Conclusions The performance of NP testing is dependent on the guideline-specified threshold for referral. In 100 people with HF, using the NICE threshold would falsely reassure 18 patients, whereas the lower ESC threshold would miss just 5 people but twice as many patients would be referred for diagnostic assessment. The optimal NP threshold for referral for HF diagnosis will depend on the healthcare setting. The trade-off between missing HF cases and overwhelming diagnostic services needs to be determined at a national level. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research

Published
2021
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