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Effective adaptation of viticulture to climate change requires impact and response scenarios. Although climate and production impact scenarios are based on the evaluation of a spatially heterogeneous system, conventional response scenarios do not take into account the variation of the producers-climate interactions. These interactions are often extremely heterogeneous and unevenly distributed in space, leading to errors in the needs and adaptation plans, especially in large areas. Here we develop a novel framework for adaptation that considers the heterogeneity of the responses given by producers to climate, and applies the concept to adaptation of viticulture to climate change in the Mediterranean region. We use future climate scenarios at 0.5 ∘ resolution to estimate the adaptation of viticulture by the end of the 21st century. Results suggest that most of the Mediterranean region may urgently need adaptation plans, leading to potential opportunities. By incorporating spatially explicit information on the diversity of viticulture systems, management practices, and climate vulnerability, this approach may contribute to adaptation policy.

Phase-field models have become a powerful tool to simulate crack propagation. They regularize the fracture discontinuity and smooth the transition between the intact and the damaged regions. Based on the thermodynamic function and a diffusive field, they regularize the variational approach to fracture that generalizes Griffith's theory for brittle fracture. Phase-field models are capable to simulate complex fracture patterns efficiently and straightforwardly. In this paper, we introduce a hybrid phasefield approach to simulate the crack propagation in laboratory-scale and lifescale structures. First, we apply our methodology to the three-point bending test on notched laboratory beams. Second, we simulate the fracture propagation in a life-size structure: the Koyna gravity dam. We account for the pressure load inside the fracture, and we study the effect of the position and number of initial fractures in the upstream face and the value of the Griffith critical energy release, on the fracture propagation under a flood event. The position of the fracture plays an important role in the final fracture pattern and crest displacements, whereas the value of the Griffith critical energy release alters the onset of the fracture propagation. We conclude that phase-field models are a promising computational tool that may be applied to real engineering problems. [ABSTRACT FROM AUTHOR]

High viral tolerance coupled with an extraordinary regulation of the immune response makes bats a great model to study host-pathogen evolution. Although many immune-related gene gains and losses have been previously reported in bats, important gene families such as antimicrobial peptides (AMPs) remain understudied. We built an exhaustive bioinformatic pipeline targeting the major gene families of defensins and cathelicidins to explore AMP diversity and analyze their evolution and distribution across six bat families. A combination of manual and automated procedures identified 29 AMP families across queried species, with α-, β-defensins, and cathelicidins representing around 10% of AMP diversity. Gene duplications were inferred in both α-defensins, which were absent in five species, and three β-defensin gene subfamilies, but cathelicidins did not show significant shifts in gene family size and were absent in Anoura caudifer and the pteropodids. Based on lineage-specific gains and losses, we propose diet and diet-related microbiome evolution may determine the evolution of α- and β-defensins gene families and subfamilies. These results highlight the importance of building species-specific libraries for genome annotation in non-model organisms and shed light on possible drivers responsible for the rapid evolution of AMPs. By focusing on these understudied defenses, we provide a robust framework for explaining bat responses to pathogens., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Castellanos, Moreno-Santillán, Hughes, Paulat, Sipperly, Brown, Martin, Poterewicz, Lim, Russell, Moore, Johnson, Corthals, Ray and Dávalos.)

The intensity and damage potential of earthquakes are linked to the speed at which rupture propagates along sliding crustal faults. Most earthquakes are sub-Rayleigh, with ruptures that are slower than the surface Rayleigh waves. In supershear earthquakes, ruptures are faster than the shear waves, leading to sharp pressure concentrations and larger intensities compared with the more common sub-Rayleigh ones. Despite significant theoretical and experimental advances over the past two decades, the geological and geomechanical controls on rupture speed transitions remain poorly understood. Here we propose that pore fluids play an important role in explaining earthquake rupture speed: the pore pressure may increase sharply at the compressional front during rupture propagation, promoting shear failure ahead of the rupture front and accelerating its propagation into the supershear range. We characterize the transition from sub-Rayleigh to supershear rupture in fluid-saturated rock, and show that the proposed poroelastic weakening mechanism may be a controlling factor for intersonic earthquake ruptures., (© 2023. The Author(s).)

Background: Evidence suggests that supportive male engagement in health care services, including family planning, remains low in many countries, despite known benefits for female partners. In 2017-2018, the United States Agency for International Development Transform: Primary Health Care Project conducted a participatory gender analysis, collecting relevant data to better understand Ethiopian men's lack of support for the uptake of family planning services., Methods: Qualitative data were collected through 96 unique participatory group discussions with community members via a semistructured discussion guide and participatory activity; data were disaggregated by sex, age, and marital status. In-depth interviews (91) conducted with service providers, health system managers, and health extension workers used semistructured guides. Discussants and interviewees were selected purposefully, drawn from 16 rural woredas in four project regions: Amhara; Oromia; Tigray; and Southern Nations, Nationalities, and Peoples' Region. Data collectors took notes and transcribed audio recordings. The research team deductively and inductively coded transcripts to develop preliminary findings later validated by key technical project staff and stakeholders., Results: Findings reinforce existing knowledge on the dominant role of men in health care-related decision making in rural Ethiopia, although such decision making is not always unilateral in practice. Barriers at the societal level impede men's support for family planning; these include norms, values, and beliefs around childbearing; religious beliefs rooted in scriptural narratives; and perceived adverse health impacts of family planning. Lack of efforts to engage men in health care facilities, as well as the perception that health care facilities do not meet men's needs, highlight systems-level barriers to men's use of family planning services., Conclusions: Findings indicate several opportunities for stakeholders to increase men's support for family planning in rural Ethiopia, including systems-wide approaches to shape decision making, social and behavior change communication efforts, and additional research and assessment of men's experiences in accessing health care services., (© 2022. The Author(s).)

Climate change adaptation choices defined by local communities reflect individual risk perception and contextual factors. This study examines how local contextual environmental factors contribute to individual choices for adapting to water scarcity in three locations in central Spain. The study evaluates citizens' choices by audience segmentation and explore the role of geographical location in segments' engagement with adaptation and adaptation measure preference. The results of the analysis of the effect of local experience support the findings of other studies that suggest that local experience is linked to risk perception but does not necessarily drive adaptive behaviour. The results suggest that respondents from most degraded areas show a higher local risk perception, but do not show homogeneous commitment to adaptation. The results also indicate differences over adaptation measure preferences across locations. Respondents of less degraded areas have a lower risk perception and show individualistic responses as compared to respondents in water stressed communities. These results highlight the relevance of local experience-driven risk perception in support to adaptation actions. Spain exemplifies many countries in southern Europe and North Africa, where drought is already a challenge to society and it is affecting an increasing number of people., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In this study we focused on urban bird diversity across Mexico, a megadiverse country, with a special focus on the relative role of urban greenspaces and heavily-built sites. We considered a country-wide approach, including 24 different sized Mexican cities. Our aims were to describe the urban bird diversity in focal cities and further assess the relationships between it and the biogeographic region where cities are located, their size, elevation, and annual rainfall. Additionally, we evaluated differences in the functional composition of bird communities in both studied urban scenarios (i.e., urban greenspaces, heavily-built sites). Our results confirm that urban greenspaces are home to a large proportion of species when contrasted with heavily-built sites. While total species richness and species richness of greenspaces were related with the cities' biogeographic region -with higher species richness in the Neotropical region and Transition Zone-, the relationship did not hold true in heavily-built sites. We found that annual rainfall was negatively related to bird richness in heavily-built sites, suggesting that species from arid systems can be more tolerant to urbanization. Regarding the bird functional group assessment, results show a clear differentiation between the functional groups of greenspaces and those of heavily-built sites, with granivores and omnivores associated with the latter and a highly diverse array of functional groups associated with urban greenspaces., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2020. Published by Elsevier B.V.)

Background: Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be extremely difficult to treat. As far as we know, no cases of staghorn calculi in en-bloc kidney transplant have been published so far., Case Presentation: A 27-year-old woman presented to the Emergency Department because of asthenia, adynamia and weight loss associated with lower urinary tract symptoms and subfebrile temperature. Ten years before, she had undergone an en-bloc kidney transplant because of end-stage renal disease secondary to perinatal asphyxia syndrome. One kidney was implanted capo-volta in the right iliac fossa and the other one in the right flank. NCCT scan showed incomplete staghorn calculi in the iliac fossa transplanted kidney. Besides, severe dilation of the native and the right flank transplanted kidney, due to two ureteral stones of 6 and 7 mm impacted in the uretero-ureteral anastomosis, was found. After hospital admission and under ceftriaxone prophylaxis, an attempt to perform primary RIRS following our COVID protocol was carried out. Nevertheless, we ended up placing a JJ stent because once the guidewire passed through the ureteral stones, purulent material came out from the ureteral orifice. She stayed 9 days in-hospital for management of postobstructive polyuria and was discharged with oral antibiotics. Three weeks afterward, we removed the stent and performed flexible ureteroscopy and holmium laser lithotripsy of the ureteral stones. In the same procedure, we performed Mini-ECIRS (21 French) previous ultrasound-guided upper pole puncture. Postoperative NCCT scan showed neither residual fragments nor operative complications., Conclusion: This is the first clinical case reporting Mini-ECIRS in a patient with an en-bloc kidney transplant. This endourological approach seems to be a feasible, safe and effective approach to treat stones in this anatomically challenging condition., Competing Interests: Competing interestsNo competing financial interests exist., (© The Author(s) 2021.)

This paper suggests how climate change may transform vineyards. We consider changes in agro-climatic indicators derived from climatic variables as drivers for adaptation needs. We use two climate scenarios, GCM GFL-ESM2M and HadGEM2-ES, with 0.5° spatial resolution and daily time step forced by two emission scenarios, RCP2.6 and 6.0, to estimate the transition of potential vineyards in the major grape production world areas by the late 21st century. We present and discuss changes in three impact indicators - one drought indicator and two temperature ones - aimed at exploring the benefits of transition-based policies. The drought indicator provides insights to prepare adaptation for extreme events in probabilistic terms. The temperature indicators offer information on the transition towards suitable zones of production. Future projections suggest a lack of water to maintain current levels of production in all regions of the world. Furthermore, thermal suitability of grapevine may be greatly affected in China and the Mediterranean region. Nevertheless, the possibility of quality wines is not altered within the regions with adequate suitability. Lastly, a portfolio of strategies to adapt to the future climate is presented., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction: In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies., Methods: We conducted a cross-sectional survey of 210 households in a rural region of northwestern Ecuador. The households were sampled with two-stage cluster sampling and represent an estimated 20% of the households in the region. We used two structured, pretested questionnaires. The first questionnaire collected demographic and economic household data, expenditure data on the past ordinary illness, and presented our definition of perceived emergency. The second recorded the number of emergency events, symptoms, further case description, healthcare-seeking behavior, and health expenditure, which was defined as being catastrophic when it exceeded 40% of a household's ability to pay., Results: The response rate was 85% with a total of 74 reported emergency events during the past year (90/1,000 inhabitants). We further analyzed the most recent event in each household (n=54). Private, for-profit providers, including traditional healers, were chosen by 57.4% (95% confidence interval [CI] [44-71%]). Public providers treated one third of the cases. The mean health expenditure per event was $305.30 United States dollars (USD), compared to $135.80 USD for the past ordinary illnesses. Catastrophic health expenditure was found in 24.4% of households., Conclusion: Our findings suggest that the provision of free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in the organization of public emergency departments and improved financial protection for emergency patients may improve the situation., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Hydraulic fracture trajectories in rocks and other materials are highly affected by spatial heterogeneity in their mechanical properties. Understanding the complexity and structure of fluid-driven fractures and their deviation from the predictions of homogenized theories is a practical problem in engineering and geoscience. We conduct a Monte Carlo simulation study to characterize the influence of heterogeneous mechanical properties on the trajectories of hydraulic fractures propagating in elastic media. We generate a large number of random fields of mechanical properties and simulate pressure-driven fracture propagation using a phase-field model. We model the mechanical response of the material as that of an elastic isotropic material with heterogeneous Young modulus and Griffith energy release rate, assuming that fractures propagate in the toughness-dominated regime. Our study shows that the variance and the spatial covariance of the mechanical properties are controlling factors in the tortuousness of the fracture paths. We characterize the deviation of fracture paths from the homogenous case statistically, and conclude that the maximum deviation grows linearly with the distance from the injection point. Additionally, fracture path deviations seem to be normally distributed, suggesting that fracture propagation in the toughness-dominated regime may be described as a random walk.

This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.