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Daniel Puebla Neira,1 Mohammed Zaidan,2 Shawn Nishi,2 Alexander Duarte,2 Christopher Lau,1 Sairam Parthasarathy,3 Jiefei Wang,4 Yong-Fang Kuo,4 Gulshan Sharma2 1Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA; 2Division of Pulmonary Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA; 3Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA; 4Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USACorrespondence: Daniel Puebla Neira, Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine-Phoenix, 1111 E McDowell Road, Phoenix, AZ, 85006, USA, Email dpueblaneira@arizona.eduRationale: There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection.Objective: To assess whether COPD is an independent risk factor for increased post-discharge HCU.Methods: We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum’s de-identified Clinformatics® Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on “post-discharge”) in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates.Results: We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (± 9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53– 1.60), 50% (RR 1.50; 95% CI 1.46– 1.54), 55% (RR 1.55; 95% CI 1.53– 1.56), 18% (RR 1.18; 95% CI 1.14– 1.22), 16% (RR 1.16; 95% CI 1.16– 1.17), and 28% (RR 1.28; 95% CI 1.24– 1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU.Conclusion: Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.Keywords: COPD, Healthcare Utilization disease, COVID-19

Microseismic sensing networks are important tools for the assessment and control of geomechanical hazards in underground mining operations. In such a setting, the maintenance of a healthy network, that is, one that accurately registers all microseisms above some minimum energy level with acceptable levels of noise, is crucially relevant. In this paper, we develop a nondisruptive method to monitor the health of such a network, by associating with each sensor a set of performance indexes, inspired from reliability engineering, which are estimated from the set of registered signals. Our method addresses 2 relevant features of each of the sensors' behavior, namely, what type of noise is or might be affecting the registering process, and how effective at registering microseisms the sensor is. The method is evaluated through a case study with microseismic data registered at the Chilean underground mine El Teniente. This study illustrates our method's capability to discriminate and rank sensors with satisfactory, poor, or defective sensing performances, as well as to characterize their failure profile or type, an information that can be used to plan or optimize the network maintenance procedures. [ABSTRACT FROM AUTHOR]

Pseudomonas corrugata, the causal agent of pith necrosis, is an ubiquitous bacterium initially found in tomato plants and, subsequently, in pepper, geranium and chrysanthemum. This bacterium has been isolated from roots and rhizosphere of symptomless plants and from soil, and has been used for the biocontrol of plant pathogenic bacteria and fungi. In Sardinia pith necrosis has been observed in tomato and chrysanthemum plants showing similar symptoms, i.e. adventitious roots, brown to black lesions and a whitish mucous exudate on stems; chlorosis and necrosis of the leaves; hyperhydrosis, necrosis and/or hollowing of the pith; loss of turgidity, rotting and blight of the plants. The observations were focused on chrysanthemums plants grown in greenhouses located in central and southern Sardinia. Isolations were made from plants, rhizosphere and soil. Based on morphology on nutrient dextrose agar and hypersensitivity on tobacco leaves, a total of 28 isolates were selected. These were tested for pathogenicity on chrysanthemum, pepper and tomato and were characterized by morphological and physiological tests, serological agglutination test, Biolog using microplates Gen III, and PCR using specific primers PC1/1, PC1/2 and PC5/1, PC5/2. All isolates were identified as Pseudomonas corrugata. Biolog results showed a variable utilization of organic compounds. Cluster analysis performed using Biolog results produced different groupings. Further genomic characterization is now in progress to evaluate the differences found in the chrysanthemum population of P. corrugata. [ABSTRACT FROM AUTHOR]

Based on the pathogenic ability of strains isolated from different hosts, the populations of Pseudomonas savastanoi are subdivided in six pathovars: savastanoi, nerii, fraxini, retacarpa, glycinea and phaseolicola. The typical symptom caused by pvs savastanoi, nerii and retacarpa is an outgrowth of plant cell tissue called knot, to whose differentiation concur auxins and cytokinins synthesized by the bacterium. The ash strains P. s . pv fraxini induce wart-like excrescences, while the strains from bean and soybean P. s . pvs glycinea and phaseolicola cause halo blight and blight on their respective hosts. Regarding phenotypic characters a great heterogeneity has been reported among the pvs savastanoi, nerii, fraxini and retacarpa as well as between strains belonging to the same pathovar. The presence of P. savastanoi on Myrtus communis has only recently been reported and a comparative analysis of the variability that exists within bacterial populations associated to this host has never been carried out. In this study we have characterized a set of strains originally isolated from myrtle in three different Mediterranean countries with a polyphasic approach, including multilocus sequence analysis, substrate metabolisation profiles, phytohormone production and cross inoculation tests. While MLSA showed a low degree of variability, we observed a great heterogeneity both on phenotypic and phytopathogenic characters, suggesting the existence of a very com- plex population structure of P. savastanoi associated with this host. [ABSTRACT FROM AUTHOR]

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening systemic hyperinflammatory syndrome, rarely associated with bone marrow failure (BMF). Telomere biology disorders (TBD) are caused by inherited defects in telomerase processes and can have heterogeneous presentations including idiopathic pulmonary fibrosis, cirrhosis, and BMF. We report a case of a 10-year-old male from Lima, Peru, who presented with HLH as the initial manifestation of a TBD. He experienced fever, gastrointestinal symptoms, and mucocutaneous involvement. Initial laboratory analyses revealed pancytopenia and elevated inflammatory markers. Despite symptomatic and antibiotic treatment, his clinical condition persisted leading to a suspicion of Kawasaki disease and, subsequently, HLH. Immunomodulatory treatment was initiated with a good clinical response. Bone marrow aspiration revealed severe hypocellular bone marrow and cytophagocytosis. Genetic studies identified a pathogenic variant in the TERC gene (n.110_113del), which was also found in the patient's mother and brother. HLH as the initial manifestation of BMF is rare. This case highlights the importance of considering TBD in children with BMF of unclear etiology and the value of genetic testing in such cases., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2025.)

Objective: To investigate gender disparities in applications and admissions to the medical residency programs in Peru, focusing on differences in application and admission proportions between male and female., Methods: We conducted a cross-sectional study to assess the proportions of female applicants and admissions to medical residency programs in Peru from 2016 to 2023. Bayesian multilevel linear models were employed, incorporating random intercepts and slopes by specialty to account for variability across specialties. This approach provided initial proportions of female in 2016 (intercepts) and annual percentage changes (beta coefficients) for each specialty. A multilevel Poisson regression model with robust variance was used to determine if being female was associated with higher admission frequency., Results: Of the 48,013 applicants, 48% were considered female applicants. Most specialties exhibited an increasing trend in female applicants (+0.2% to +2% annually), except for Family Medicine, Hematology, Pediatric Neurology, and Pathological Anatomy (-0.6%, -0.6%, -0.7%, and -0.9% annually, respectively). The specialties with the highest proportions of female admissions were in Physical Medicine and Rehabilitation (71.9%), Dermatology (71.2%), and Pathological Anatomy (71.2%). In contrast, the lowest proportions were observed in Neurosurgery (18.9%), Thoracic and Cardiovascular Surgery (17.7%), and Urology (15.6%). Declining trends in female admissions were noted in Family Medicine, Hematology, and Pathological Anatomy (-0.6%, -0.6%, and -0.8% annually, respectively). In addition, being female was associated with an 18% lower probability of admission to the medical residency program (prevalence ratio: 0.82; 95% CI: 0.78-0.85; p-value: <0.001)., Conclusion: This study identified persistent gender disparities in medical residency programs in Peru, with female applicants facing reduced probabilities of admission and exhibiting specialty-specific trends from 2016 to 2023., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Medina-Neira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cervical cancer remains a leading cause of mortality in its invasive stages, presenting a significant global public health challenge, particularly in low- and middle-income countries. Despite technological advancements that have improved the quality of cervical images captured during visual inspections, several challenges persist. This article presents key findings from the CITOBOT-COL translational research project, a large-scale initiative focused on designing CITOBOT as a portable cervical cancer screening device. We detail the comprehensive technological development of CITOBOT, guided by a human-centered design approach, smart prototyping, and the integration of AI. Over four design iterations, we developed and refined CITOBOT v4, a portable device. Prototypes were validated through focus groups and testing by experts in cervical cancer prevention, gynecology, nursing, software, artificial intelligence, computer engineering, and public health, utilizing various anatomical models at the Simulated Hospital Laboratory of Pontificia Universidad Javeriana Cali, Colombia. Additionally, we developed AI algorithms using the Inception V3 network, optimized with Transfer Learning and Fine Tuning, for cervical image classification and offline-operating software that guides the physician through the examination and provides a risk assessment for cervical cancer. Feedback was crucial in assessing and refining the device's functionality, focusing on capturing high-quality cervical images. The development of CITOBOT v4 highlights the importance of fostering innovation in resource-limited settings, offering an effective solution to improve cervical cancer screening and potentially save lives in vulnerable communities., Competing Interests: We declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Emerging evidence suggests that there is an increase in healthcare utilization (HCU) in patients due to Coronavirus Disease 2019 (COVID-19). We investigated the change in HCU pre and post hospitalization among patients discharged home from COVID-19 hospitalization for up to 9 months of follow up., Study Design and Methods: This retrospective study from a United States cohort used Optum® de-identified Clinformatics Data Mart; it included adults discharged home post hospitalization with primary diagnosis of COVID-19 between April 2020 and March 2021. We evaluated HCU of patients 9 months pre and post -discharge from index hospitalization. We defined HCU as emergency department (ED), inpatient, outpatient (office), rehabilitation/skilled nursing facility (SNF), telemedicine visits, and length of stay, expressed as number of visits per 10,000 person-days., Results: We identified 63,161 patients discharged home after COVID-19 hospitalization. The cohort of patients was mostly white (58.8%) and women (53.7%), with mean age 72.4 (SD± 12) years. These patients were significantly more likely to have increased HCU in the 9 months post hospitalization compared to the 9 months prior. Patients had a 47%, 67%, 65%, and 51% increased risk of ED (rate ratio 1.47; 95% CI 1.45-1.49; p < .0001), rehabilitation (rate ratio 1.67; 95% CI 1.61-1.73; p < .0001), office (rate ratio1.65; 95% CI 1.64-1.65; p < .0001), and telemedicine visits (rate ratio 1.5; 95% CI 1.48-1.54; p < .0001), respectively. We also found significantly different rates of HCU for women compared to men (women have higher risk of ED, rehabilitation, and telemedicine visits but a lower risk of inpatient visits, length of stay, and office visits than men) and for patients who received care in the intensive care unit (ICU) vs those who did not (ICU patients had increased risk of ED, inpatient, office, and telemedicine visits and longer length of stay but a lower risk of rehabilitation visits). Outpatient (office) visits were the highest healthcare service utilized post discharge (64.5% increase). Finally, the risk of having an outpatient visit to any of the specialties studied significantly increased post discharge. Interestingly, the risk of requiring a visit to pulmonary medicine was the highest amongst the specialties studied (rate ratio 3.35, 95% CI 3.26-3.45, p < .0001)., Conclusion: HCU was higher after index hospitalization compared to 9 months prior among patients discharged home post-COVID-19 hospitalization. The increases in HCU may be driven by those patients who received care in the ICU., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zaidan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The family-owned dairy goat sector in Andalusia presents great diversity. Taking into account the particularities of their economic strategies, which are focused on generating net value added and a stable long-term remuneration for family labor, this work aims to expand the scarce existing knowledge on the energetic and economic profiles of the different caprine management systems in a context of climate and energy crisis. For this purpose, twenty-one farms, representatives of the four typologies of the Andalusian dairy goat system, were monitored for one year: pastoral systems, grazing systems with high feed supply, indoor systems with associated crops, and indoor systems without associated crops. Technical-economic information was obtained that allowed the calculation of energy and economic indicators. In terms of socialized output, the differences found were due to the energy derived from milk sales, which was clearly lower in pastoral systems. The higher proportion of energy output obtained from manure with respect to edible products (milk and meat) highlights the importance of the former in energetic terms. High values for external inputs are found in the intensive group (111.22 GJ LSU -1 ), while the lowest results correspond to the pastoral group (36.96 GJ LSU -1 ). The main external input is the energy proceeding from purchased feed, which accounts for over 79% of the total external energy input in all four groups. The highest energy efficiency corresponds to the pastoral group, which is also the most efficient one in the use of non-renewable energy to produce milk and meat. Additionally, the level of eco-efficiency is higher in pastoral systems. Common Agricultural Policy funds contribute to increasing the remuneration of family work in pastoral systems, assimilating it to the rest of the systems. Therefore, intensification does not imply an absolute monetary advantage in all cases, while extensification can be remunerative for family-owned dairy farming., Competing Interests: The authors declare no conflicts of interest.

Background: The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening appears promising for antimicrobial stewardship programs. However, a paucity of data remains on the diagnostic performance of culture-based MRSA screen in the intensive care unit (ICU) for pneumonia and bacteremia., Objective: The objective of this study was to compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU and general ward patients., Methods: This multicenter, retrospective study was conducted over a 23-month period. Adult patients with MRSA nasal screening ≤48 hours of collecting a respiratory and/or blood culture with concurrent initiation of anti-MRSA therapy were included. The primary endpoint was to compare the negative predictive value (NPV) associated with culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia., Results: A total of 5106 patients representing the ICU (n = 2515) and general ward (n = 2591) were evaluated. The NPV of the MRSA nares for suspected pneumonia was not significantly different between ICU and general ward patient populations (98.3% and 97.6%, respectively; P = 0.41). The MRSA nares screening tool also had a high NPV for suspected bacteremia in ICU (99.8%) and general ward groups (99.7%) ( P = 0.56). The overall positive MRSA nares rates in the ICU and general ward patient populations were 9.1% and 8.2%, respectively ( P = 0.283). Moreover, MRSA-positive respiratory and blood cultures among ICU patients were 5.8% and 0.8%, respectively., Conclusion and Relevance: Our findings support the routine use of MRSA nasal screening using the culture-based method in ICU patients with pneumonia. Further research on the clinical performance for MRSA bacteremia in the ICU is warranted.

Global cervical cancer incidence and mortality have remained a major public health problem. Depending on the quality and coverage of preventive programs, and the capacity of health care systems, different screening tests are used, with the Pap smear being the most widely implemented. Several difficulties have been reported in accessing timely detection, causing late cervical cancer diagnosis. Trying to close these gaps, new screening devices have been developed in recent years; however, there is a lack of knowledge about whether or not women perspective has been included in the design process and technological development of these devices. This scoping review aimed to describe and synthesize scientific literature on women's critical experiences with Pap smears to prospectively contribute to the design, development, and scale-up of cervical cancer screening devices. The electronic databases Web of Science, Scopus, PubMed, PsycINFO and SciELO were searched for relevant studies published between 2012 and 2021; finally, 18 qualitative studies were included. Experiences were classified into four categories: fear and embarrassment, speculum pain and discomfort, outcome distress and health service barriers. Critical experiences before, during, and after the test were analyzed in turn. In particular, during the test, women reported pain associated with the use of the speculum. The acceptability of new screening devices will largely depend on comfort during the test and timely delivery of results. This review provides a useful qualitative synthesis, not only to advance the design of novel devices but also for future implementation research in cervical screening services., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Study Objective: Thromboelastography (TEG) offers a more dynamic assessment of hemostasis over activated partial thromboplastin time (aPTT). However, the clinical utility of TEG in monitoring bivalirudin during extracorporeal membrane oxygenation (ECMO) remains unknown. The purpose of this study was to evaluate the correlation between aPTT and TEG in adult ECMO patients anticoagulated with bivalirudin., Design: Multicenter, retrospective, cohort study conducted over a 2-year period., Setting: Two academic university medical centers (Banner University Medical Center) in Phoenix and Tucson, AZ., Patients: Adult patients requiring ECMO and bivalirudin therapy with ≥1 corresponding standard TEG and aPTT plasma samples drawn ≤4 h of each other were included. The primary endpoint was to determine the correlation coefficient between the standard TEG reaction (R) time and bivalirudin aPTT serum concentrations., Measurements and Main Results: A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r = 0.41; p < 0.001). Overall, 502 (59.2%) concurrent assessments of TEG R time and aPTT values showed agreement on whether they were sub-, supra-, or therapeutic according to the institution's classification for bivalirudin. The 42.2% (n = 271/642) discordant TEG R times among "therapeutic" aPTT were almost equally distributed between subtherapeutic and supratherapeutic categories., Conclusions: Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients., (© 2023 Pharmacotherapy Publications, Inc.)

Ecuador is the third largest cacao exporter in the world. Up to 10 % of Ecuador's cacao production is grown in the Amazon region, mostly under conventional (CA) and organic (OA) agroforestry systems. Despite the importance of cacao in this area, no previous studies on its environmental impact and economic viability have yet been carried out. The main objective of this research is to fill this gap and, more specifically, perform a comparative analysis between CA and OA systems. For this purpose, primary information was gathered from 90 farms (44 conventional and 46 organic ones) that implement land management practices. The environmental performance of cacao production was assessed using a life cycle analysis methodology, with a cradle-to-farm gate approach. Up to twelve impact categories and five environmental and monetary efficiency indicators were estimated based on three functional units (1 kg of cacao, 1 kg of output sold, and 1 ha). Additionally, an economic viability analysis was performed, focused on profitability. The results show that organic management allows to reduce the environmental impact in all the analyzed categories, except for the land footprint, and improved the environmental and economic efficiency of agroforestry systems. The economic analysis shows no statistically significant differences between CA and OA profitability (net margin), which can be improved by selling co-products. Despite the low environmental impact of both types of system, economic profitability is certainly one of the weaknesses of cacao production in the Ecuadorian Amazon region. This study contributes to develop technical, production-related and political actions that could improve the economic cacao production situation without jeopardizing the environmental benefit obtained by these systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The identification of risk factors for COVID-19 adverse course in autoimmune rheumatic diseases (ARDs) is of the utmost importance when approaching patient management; however, data are scarce in relation to the Latin American population. The objective of this study was to determine predictors of hospitalization for COVID-19 patients from an ARD community cohort., Methods: A real setting longitudinal study (March to November 2020) in an ARD community cohort was carried out. Potential predictors of hospitalization for COVID-19 examined included (1) sociodemographic variables (age, gender, education, tobacco use, socioeconomic status, and co-inhabitants), (2) comorbidities, (3) time to COVID-19 diagnosis, and (4) ARD's features: clinical (disease type, disease duration, activity), treatment [corticosteroids use/doses, use of synthetic DMARDs (cDMARDs, tsDMARDs, and bDMARDs)], treatment schedule and non-adherence, and the Multidimensional Health Assessment Questionnaire (MDHAQ). Univariable and multivariable regression analysis were conducted; OR and 95% CI (p < 0.05) were determined., Results: One thousand and one hundred forty-eight patients with ARDs were included; 154 had COVID-19; of these 139 (90.3%) were women, aged 52.5 (13.7) years; 33.1% had hypertension and 61.0% an affected organ by ARD. Infection was detected 8.4 (10.1) days after symptoms started; there were 33 hospitalized patients (rate 21.4%). Predictors of hospitalization by multivariable analysis were age (OR: 1.06; CI: 1.01-1.10; p: 0.01), comorbidities: hypertension (OR: 3.95; 95% CI: 1.40-10.95, p: 0.01) and neoplasm (OR: 9.0; 95% CI: 1.6-52.3; p: 0.01), number of organs involved by ARD (OR: 2.26; 95% CI: 1.16-4.41; p: 0.02), and infection diagnosis delay (OR: 1.36; 95% CI: 1.03-1.80; p: 0.01)., Conclusions: In our ARD patients with COVID-19, older age, comorbidities (neoplasm and hypertension), and a delay in COVID-19 diagnosis were predictors of hospitalization. The only ARD-associated predictor feature was the number of organs involved. Key Points • Patients with ARD and COVID-19 have an adverse course in comparison to the general population. • Previous predictors of COVID-19 hospitalization, including known risk factors (such as older age and comorbidities) and systemic manifestations, should be taken into account in the management of these patients. • Delayed diagnosis of COVID-19 impacts negatively on prognosis. • Availability of diagnostic tests is of utmost importance., (© 2021. International League of Associations for Rheumatology (ILAR).)