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This paper estimates feasible water savings for a sample of nine urban water districts in California during the height of the 2012-16 drought, just prior to the implementation of mandatory water use reductions, using household production theory and stochastic frontier analysis. Estimates of feasible savings are compared to mandated reductions and actual reductions in each district. Although the mandated reductions were generally feasible, our results show that they had asymmetric impacts across districts and tended to impose larger burdens on some disadvantaged groups.

Objective: The aim of this study was to analyse whether the association between adherence to the Mediterranean diet and health-related quality of life (HRQoL) is mediated by physical fitness components (i.e., cardiorespiratory fitness, lower-limb strength, upper-limb strength and motor competence) in adolescents. Methods: This is a cross-sectional study including mediation analyses. This study involved 181 adolescents (86 girls) aged 15.8 ± 0.3 years recruited from secondary schools and sport clubs located in Castellon (Spain). Adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. HRQoL was assessed with the KIDSCREEN-10 questionnaire. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Lower-limb strength was assessed through the standing broad jump test. Upper-limb strength was evaluated using a handgrip dynamometer. Motor competence was assessed using the 4 × 10 m shuttle run test. Mediation analyses were performed for each physical fitness component in order to assess its mediating effect on the association between adherence to the Mediterranean diet and HRQoL. Indirect effects (IE) with confidence intervals (CI) not including zero were interpreted as statistically significant. Results: Cardiorespiratory fitness and lower-limb strength had a mediating effect on the positive association between adherence to the Mediterranean diet and HRQoL (IE = 0.11, 95 % CI = 0.01; 0.27 and IE = 0.07, 95 % CI = 0.01; 0.19). Upper-limb strength and motor competence did not act as mediators in the association between adherence to the Mediterranean diet and HRQoL (IE = 0.00, 95 % CI = −0.04; 0.07 and IE = 0.01, 95 % CI = −0.03; 0.07, respectively). Conclusion: Our findings showed that the positive association of adherence to the Mediterranean diet on adolescents' HRQoL was mediated by physical fitness. Educational and public health strategies aiming to improve Spanish adolescents’ HRQoL should focus on diet and physical fitness.

Abstract Background As of 2024, vaccination remains the main mitigation measure against COVID-19, but there are contradictory results on whether people living with HIV (PLWH) are less protected by vaccines than people living without HIV (PLWoH). In this study we compared the risk of SARS-CoV-2 infection and COVID-19 hospitalisation following full vaccination in PLWH and PLWoH. Methods We linked data from the vaccination registry, the COVID-19 surveillance system and from healthcare/pharmacological registries in four Italian regions. We identified PLWH fully vaccinated (14 days post completion of the primary cycle) and matched them at a ratio of 1:4 with PLWoH by week of vaccine administration, age, sex, region of residence and comorbidities. Follow-up started on January 24, 2021, and lasted for a maximum of 234 days. We used the Kaplan-Meier estimator to calculate the cumulative incidence of infection and COVID-19 hospitalisation in both groups, and we compared risks using risk differences and ratios taking PLWoH as the reference group. Results We matched 42,771 PLWH with 171,084 PLWoH. The overall risk of breakthrough infection was similar in both groups with a rate ratio (RR) of 1.10 (95% confidence interval (CI):0.80–1.53). The absolute difference between groups at the end of the study period was 8.28 events per 10,000 person-days in the PLWH group (95%CI:-18.43-40.29). There was a non-significant increase the risk of COVID-19 hospitalisation among PLWH (RR:1.90; 95%CI:0.93–3.32) which corresponds to 6.73 hospitalisations per 10,000 individuals (95%CI: -0.57 to 14.87 per 10,000). Conclusions Our findings suggest PLWH were not at increased risk of breakthrough SARS-CoV-2 infection or COVID-19 hospitalisation following a primary cycle of mRNA vaccination.

Rebate programs are often used in the residential water sector to alleviate market failures that may hamper the adoption of water-efficient technologies. In this paper, we examine whether several rebate programs stimulate or crowd out private investment in indoor and outdoor technologies. To do so, we use a panel of household-level data from a water district in Southern California for the period 2014–2015. Our results indicate that, while all the rebate programs considered in the analysis increase private investment in water-efficient technologies, only outdoor rebate programs generate further private investment in other outdoor technologies.

Migrants who work seasonally in agriculture face living and working conditions that significantly impact their health. Some of these conditions are related to inadequate food access or food preservation and preparation hygiene. This study aimed to explore how migrant and seasonal agricultural farmworkers access food in Spain from the perspective of professionals supporting this population. We conducted a qualitative study in 2021 based on semistructured interviews with 92 social and health service professionals involved in the care of seasonal migrant workers in 4 Spanish provinces. We identified three themes through reflective thematic analysis: (1) Access to food depends on NGOs and institutions, especially after the COVID-19 pandemic; (2) Relevant cultural differences in diet depending on North African or sub-Saharan origin; (3) Seasonal migrant workers frequently suffer from nutritional and other health problems related to food security. The professionals interviewed described the diet of seasonal migrant workers as based on food with little variety, insufficient protein content, and obesogenic products. They also reported a generalized lack of hygiene in food storage and preparation. This study calls for encouraging dietary support strategies to reduce challenges in food accessibility, which would prevent health problems in this population and bring them social justice.

IntroductionData on the increase in mortality during the COVID-19 pandemic based on individuals' socioeconomic positions are limited. This study examines this increase in mortality in Spain during the epidemic waves of 2020 and 2021.MethodsWe calculated the overall and cause-specific mortality rates during the 2017–2019 pre-pandemic period and four epidemic periods in 2020 and 2021 (first, second, third-fourth, and fifth-sixth waves). Mortality rates were analyzed based on educational levels (low, medium, and high) and across various age groups (25–64, 65–74, and 75+). The increase in mortality during each epidemic period compared to the pre-pandemic period was estimated using mortality rate ratios (MRR) derived from Poisson regression models.ResultsAn inverse educational gradient in overall mortality was observed across all periods; however, this pattern was not consistent for COVID-19 mortality in some age groups. Among those aged 75 years and older, highly educated individuals showed higher COVID-19 mortality during the first wave. In the 25–64 age group, individuals with low education experienced the highest overall mortality increase, while those with high education had the lowest increase. The MRRs were 1.21 and 1.06 during the first wave and 1.12 and 0.97 during the last epidemic period. In the 65–74 age group, highly educated individuals showed the highest overall mortality increase during the first wave, whereas medium-educated individuals had the highest increase during the subsequent epidemic periods. Among those aged 75 and older, highly educated individuals exhibited the highest overall mortality increase while the individuals with low education showed the lowest overall mortality increment, except during the last epidemic period.ConclusionThe varying educational patterns of COVID-19 mortality across different age groups contributed to the disparities of findings in increased overall mortality by education levels during the COVID-19 pandemic.

BackgroundThe time-varying reproduction number R is a critical variable for situational awareness during infectious disease outbreaks; however, delays between infection and reporting of cases hinder its accurate estimation in real-time. A number of nowcasting methods, leveraging available information on data consolidation delays, have been proposed to mitigate this problem.MethodsIn this work, we retrospectively validate the use of a nowcasting algorithm during 18 months of the COVID-19 pandemic in Italy by quantitatively assessing its performance against standard methods for the estimation of R.ResultsNowcasting significantly reduced the median lag in the estimation of R from 13 to 8 days, while concurrently enhancing accuracy. Furthermore, it allowed the detection of periods of epidemic growth with a lead of between 6 and 23 days.ConclusionsNowcasting augments epidemic awareness, empowering better informed public health responses.

Introduction: The formation of bacterial biofilms on knee arthroplasty implants can have catastrophic consequences. The aim of this study was to analyze the effectiveness of the bioelectric effect in the elimination of bacterial biofilms on cultivated knee arthroplasty implants.Methods: A novel device was designed to deliver a bioelectric effect on the surface of knee arthroplasty implants. 4-femoral prosthetic implants were cultivated with a staphylococcus aureus inoculum for 15 days. The components were divided into four different groups: A (not treated), B (normal saline 20-minutes), C (bioelectric effect 10-minutes), D (bioelectric effect 20-minutes). The implants were sonicated, and the detached colonies were quantified as the number of colony-forming unit (CFUs). The implants were sterilised and the process was repeated in a standardized manner four more times, to obtain a total of five samples per group.Results: The number of the CFUs after a 10-minute exposure to the bioelectric effect was of 208.2 ± 240.4, compared with 6,041.6 ± 2010.7 CFUs in group A, representing a decrease of 96.5% ± 4.3 (p = 0.004). And a diminution of 91.8% ± 7.9 compared with 2,051.0 ± 1,364.0 CFUs in group B (p = 0.109). The number of bacterial colonies after a 20-minute exposure to the bioelectric effect was 70 ± 126.7 CFUs, representing a decrease of 98.9% ± 1.9 (p = 0.000) compared with group A. And a decrease of 97.8% ± 3.0 (p = 0.019) compared with group B.Conclusions: The bioelectric effect was effective in the elimination of bacterial biofilm from knee arthroplasty implants. This method could be used in the future as part of conventional surgical procedures.

El artículo analiza el impacto de los comentarios en redes sociales sobre el rendimiento de las acciones de los bancos en el mercado de valores de EE.UU. Se empleó inteligencia artificial para monitorear y extraer comentarios en tiempo real, y se utilizó el procesamiento de lenguaje natural para calcular el sentimiento de cada comentario. Los comentarios se clasificaron como positivos o negativos y se agregaron, por hora, para cada banco durante el período observado. Los resultados mostraron que tanto los comentarios positivos como los negativos tienen un efecto significativo en el rendimiento de las acciones, con un impacto asimétrico más pronunciado en el caso de los comentarios negativos. Este estudio contribuye a la comprensión de cómo la interacción en redes sociales puede influir en el valor de mercado de las empresas y destaca la importancia para las compañías que cotizan en bolsa de monitorear y gestionar la percepción en línea.

Abstract Background Migrant seasonal agricultural workers face conditions of material vulnerability such as inadequate housing difficulties prevent access to running water supplies. The purpose of this study is to explore the perceptions of professionals involved in the care and support of seasonal migrant agricultural workers, as it relates to water access and water consumption and their impact on these workers’ health, in a context of COVID-19 pandemic. Methods: A qualitative exploratory and descriptive study was conducted in 2021 as part of a larger research project, based on 63 personal semi-structured interviews with professionals who provided support to seasonal migrant agricultural workers in three Spanish autonomous regions. COREQ checklist was used for reporting. The interviews were recorded, transcribed, and imported into ATLAS.ti-9 for an inductive thematic analysis. Results: The results have been structured into two main themes: (1) Accessing and obtaining water; and (2) Health problems related to water consumption. Seasonal migrant agricultural workers experience barriers to obtaining safe water for hygiene, cleaning, food preparation and drinking. The implementation of regulations to reduce COVID-19 transmission resulted in improved hygiene levels in the migrants’ quarters, including access to safe drinking water. Conclusion: This study suggests that water insecurity experienced by migrant seasonal agricultural workers in Spain results from their poor living conditions and causes health problems related to a lack of hygiene and the use of unsafe water. Sustainable solutions are needed beyond the pandemic in order to provide migrant workers with adequate living conditions and ensure their water needs are fulfilled.

In recent years, large language models (LLMs) have been employed significantly in different domains of computing education. Nevertheless, these models have been focused on essential adherence to their integration as coding assistants in computing education. However, attention has been switched to thoroughly examining and analyzing LLM behavior, particularly in computing education for programming tasks such as code generation, code explanation, and programming error message explanation. Therefore, it becomes imperative to understand their behavior to examine potential pitfalls. This article addresses this gap systematically and details how different LLM-based coding chatbots, such as ChatGPT, Codex, Copilot, and others, react to various coding inputs within computing education. To achieve this objective, we collected and analyzed articles from 2021 to 2024, and 72 studies were thoroughly examined. These objectives include investigating the existing limitations and challenges associated with utilizing these systems for coding tasks, assessing their responses to prompts containing coding syntax, examining the impact of their output on student learning, and evaluating their performance as debugging tools. The findings of this review highlight that it is premature to incorporate these systems into computing education due to their limitations that may limit their effectiveness as comprehensive coding assistants for computer science students. These limitations include issues with handling prompts containing code snippets, potential negative impacts on student learning, limited debugging capabilities, and other ineffectiveness. The finding also reports multiple research directions that can be considered in future research related to LLMs in computing education.

RESUMEN Introducción. La Organización Mundial de la Salud considera la violencia de género como un grave problema de salud pública. Una de cada cuatro mujeres entre 15 y 49 años ha sufrido violencia de género a lo largo de su vida desde los 15 años, esto conlleva graves consecuencias para la salud no solo de las mujeres sino también de sus hijas e hijos. Desde la Organización Sanitaria Integrada Bilbao-Basurto y la Universidad del País Vasco existe el compromiso de dar respuesta a este importante problema a través de la implementación de la Guía de Buenas Prácticas: El maltrato contra las mujeres: cribado, identificación y respuesta inicial. Objetivo. Reflexionar acerca del proceso de implementación en los ámbitos asistencial y académico de la guía de buenas prácticas clínicas sobre “El maltrato contra las mujeres de la Registered Nurses’ Association of Ontario RNAO: cribado, identificación y respuesta inicial. Temas de reflexión. En este artículo se abordarán dos temas de reflexión: 1) Descripción de la metodología de implementación. 2) Descripción de cada una de las fases, tanto en el ámbito clínico como académico. Conclusiones. La Guía de Buenas prácticas “El maltrato contra las mujeres de la RNAO: cribado, identificación y respuesta inicial”, presenta una herramienta útil para la implementación de buenas prácticas en los sistemas sanitarios que ayudan a la lucha contra la violencia de género. Las enfermeras y otros profesionales de la salud se encuentran en una posición privilegiada para ayudar a las mujeres que sufren abuso/violencia de su pareja íntima. Palabras clave: Violencia de Género; Centros de Salud; Enfermeras y Enfermeros; Personal de Salud; Guía de Práctica Clínica ABSTRACT Introduction. The World Health Organization considers gender-based violence to be a severe public health problem. One in four women between 15 and 49 years of age has suffered gender-based violence in her lifetime since the age of 15. It has severe consequences for the health not only of women but also of their children. The Bilbao-Basurto Integrated Health Organization and the University of the Basque Country are committed to responding to this critical problem through the implementation of the Good Practice Guide: Abuse against Women: Screening, identification, and initial response. Objective. To reflect on the process of implementation of the good clinical practice guide on “Abuse against women in the RNAO: screening, identification and initial response”. Reflection topics. This article will address two topics for reflection: 1) Description of the implementation methodology. 2) Description of each of the phases, both clinically and academically. Conclusions. The RNAO Good Practice Guide: “RNAO Woman Abuse: Screening, identification and initial response”, presents a useful tool for implementing exemplary practices in health systems that help in the fight against gender-based violence. Nurses and other health professionals are in a privileged position to assist women in the fight agains t gender-based violence. Keywords: Gender-Based Violence; Community Health Centers; Nurses; Health Personnel; Practice Guideline RESUMO Introdução. A Organização Mundial da Saúde considera a violência de gênero um grave problema de saúde pública. Uma em cada quatro mulheres entre 15 e 49 anos de idade sofreu violência de gênero durante a vida, desde os 15 anos. Ela tem sérias consequências para a saúde não apenas das mulheres, mas também de seus filhos. A Organização Integrada de Saúde de Bilbao-Basurto e a Universidade do País Basco estão comprometidas em responder a esse importante problema por meio da implementação do Guia de Boas Práticas: Abuso contra mulheres: triagem, identificação e resposta inicial. Objetivo. Refletir sobre o processo de implementação do guia de boas práticas clínicas sobre “Abuso de mulheres na RNAO: triagem, identificação e resposta inicial”. Temas para reflexão. Este artigo abordará dois tópicos para reflexão: 1) Descrição da metodologia de implementação. 2) Descrição de cada uma das fases, tanto em ambientes clínicos quanto acadêmicos. Conclusões. O Guia de Boas Práticas da RNAO: “RNAO Woman Abuse: Screening, Identification and Initial Response” (Abuso de mulheres na RNAO: triagem, identificação e resposta inicial), apresenta uma ferramenta útil para a implementação de boas práticas nos sistemas de saúde para auxiliar na luta contra a violência de gênero. Os enfermeiros e outros profissionais de saúde estão em uma posição única para ajudar as mulheres na luta contra a violência de gênero. Palavras-chave: Violência de Gênero; Centros de Saúde; Enfermeiras e Enfermeiros; Pessoal de Saúde; Guia de Prática Clínica

Resumen: Introducción: La insuficiencia ovárica prematura (POI) conlleva importante morbilidad, causando infertilidad, disfunción sexual, disminución de la densidad ósea, riesgo cardiovascular, alteraciones emocionales y mortalidad precoz. Objetivo: Conocer la incidencia y el manejo actual de la POI en supervivientes a un tumor sólido en la infancia y/o adolescencia en nuestro medio. Material y métodos: Estudio observacional multicéntrico. Mujeres entre 12 y 18 años con diagnóstico de tumor sólido y criterios clínicos y/o analíticos de POI. El riesgo se estima según los criterios «The Pediatric Initiative Network of the Oncofertility Consortium». Resultados: Incidencia de 1,5 (30 casos de POI). Edad media 14 ± 2,09. Los tumores sólidos que más se asociaron a la POI fueron: sarcoma de Ewing, tumores cerebrales y germinales. El 83% de los casos no realizó preservación previa al tratamiento. Un 63% no referían menarquia al diagnóstico de la POI. El 97% cumplían criterios de alto riesgo de toxicidad gonadal, a pesar de ello el 47% no realizó ninguna vigilancia previa al diagnóstico. La mediana de tiempo tras el diagnóstico y la aparición del evento es de 43,5 y 29,5 meses tras finalizar tratamiento. Las curvas de Kaplan-Meier, muestran que al 30% de los casos, aparecen en los 2 años tras el diagnóstico y las mujeres con estadio puberal 1 desarrollan insuficiencia más tardíamente que aquellas con estadio 5. Conclusiones: El seguimiento de mujeres en riesgo de la POI, es susceptible de mejora. Las herramientas actuales facilitan conocer el riesgo al planificar los tratamientos del tumor y realizar vigilancia, educación, diagnóstico precoz, preservación e instauración de tratamiento sustitutivo. Todo ello, supondría importantes mejoras en salud. Abstract: Introduction: Primary ovarian insufficiency (POI) carries significant morbidity, causing infertility, sexual disfunction, decreased bone density, cardiovascular risk, emotional distress and early mortality. Objective: To know the incidence and current management of POI in childhood/adolescent solid tumour survivors. Material and methods: We conducted a multicentre observational study. It included female patients aged 12 to 18 years with a diagnosis of solid tumour and meeting clinical or biochemical criteria for POI. The risk was estimated based on the criteria of the Pediatric Initiative Network of the Oncofertility Consortium. Results: We found an incidence of 1.5 (30 cases of POI): The median age at the time of the event was 14 years (standard deviation, 2.09). The solid tumours associated most frequently with POI were Ewing sarcoma and brain and germ cell tumours. Eighty-three percent of patients did not undergo fertility preservation. Sixty-three percent reported not having undergone menarche at the time of ovarian failure. Ninety-seven percent were at high risk of gonadal toxicity, yet 47% were not monitored before the diagnosis. The median time elapsed to the occurrence of the event was 43.5 months after diagnosis and 29.5 months after completing treatment. The Kaplan-Meier curves showed that approximately 30% of POI cases developed within 2 years of diagnosis and that women at Tanner stage 1 developed insufficiency later than women at Tanner stage 5. Conclusions: There is room for improvement in the followup of women at risk of POI in Spain. The tools currently available facilitate risk assessment at the time of treatment planning and allow the implementation of monitoring, education, early diagnosis, fertility preservation, and replacement therapy as needed. All of this would achieve significant improvement in health outcomes.

Introduction: Primary ovarian insufficiency (POI) carries significant morbidity, causing infertility, sexual disfunction, decreased bone density, cardiovascular risk, emotional distress and early mortality. Objective: To know the incidence and current management of POI in childhood/adolescent solid tumour survivors. Material and methods: We conducted a multicentre observational study. It included female patients aged 12–18 years with a diagnosis of solid tumour and meeting clinical or biochemical criteria for POI. The risk was estimated based on the criteria of the Pediatric Initiative Network of the Oncofertility Consortium. Results: We found an incidence of 1.5 (30 cases of POI): The median age at the time of the event was 14 years (standard deviation, 2.09). The solid tumours associated most frequently with POI were Ewing sarcoma and brain and germ cell tumours. Eighty-three percent of patients did not undergo fertility preservation. Sixty-three percent reported not having undergone menarche at the time of ovarian failure. Ninety-seven percent were at high risk of gonadal toxicity, yet 47% were not monitored before the diagnosis. The median time elapsed to the occurrence of the event was 43.5 months after diagnosis and 29.5 months after completing treatment. The Kaplan-Meier curves showed that approximately 30% of POI cases developed within 2 years of diagnosis and that women at Tanner stage 1 developed insufficiency later than women at Tanner stage 5. Conclusions: There is room for improvement in the follow-up of women at risk of POI in Spain. The tools currently available facilitate risk assessment at the time of treatment planning and allow the implementation of monitoring, education, early diagnosis, fertility preservation, and replacement therapy as needed. All of this would achieve significant improvement in health outcomes. Resumen: Introducción: La insuficiencia ovárica prematura (POI) conlleva importante morbilidad, causando infertilidad, disfunción sexual, disminución de la densidad ósea, riesgo cardiovascular, alteraciones emocionales y mortalidad precoz. Objetivo: Conocer la incidencia y manejo actual de POI en supervivientes a un tumor sólido en la infancia y / o adolescencia en nuestro medio. Material y métodos: Estudio observacional multicéntrico. Mujeres entre 12 y 18 años con diagnóstico de tumor sólido y criterios clínicos y/o analíticos de POI. El riesgo se estima según los criterios” The Pediatric Initiative Network of the Oncofertility Consortium”. Resultados: Incidencia de 1.5 (30 casos de POI). Mediana de edad 14 ± 2,09. Los tumores sólidos que más se asociaron a POI fueron: sarcoma de Ewing, tumores cerebrales y germinales. El 83% de los casos no realizó preservación previa al tratamiento. Un 63% no referían menarquia al diagnóstico de POI. 97% cumplían criterios de alto riesgo de toxicidad gonadal, a pesar de ello el 47% no realizó ninguna vigilancia previa al diagnóstico. La mediana de tiempo tras el diagnóstico y la aparición del evento es de 43,5 y 29,5 meses tras finalizar tratamiento. Las curvas de Kaplan- Meier, muestran que a el 30% de los casos, aparecen en los dos años tras el diagnóstico y las mujeres con estadio puberal 1 desarrollan insuficiencia más tardíamente que aquellas con estadio 5. Conclusiones: El seguimiento de mujeres en riesgo de POI, es susceptible de mejora. Las herramientas actuales facilitan conocer el riesgo al planificar los tratamientos del tumor y realizar vigilancia, educación, diagnóstico precoz, preservación e instauración de tratamiento sustitutivo. Todo ello, supondría importantes mejoras en salud.

Metabolism is a challenging subject for bioscience students due to the intrinsic complexity of the metabolic network, as well as that of the overlapping mechanisms of metabolic regulation. Collaborative learning based on a problem-based learning approach can help students to successfully learn and understand metabolism. In the present article, we propose a selection of exercises, problems, and cases aimed to focus students' attention on the scientific work made by Sir Hans Krebs and his collaborators to elucidate four main metabolic cycles, as well as on the study of these cycles, their regulation, and their metabolic integration. The objectives, the tools, and the implementation of this proposal are described, and the results obtained during its first implementation with volunteer students enrolled in two courses on metabolic regulation at our university are presented and discussed. These volunteer students signed a learning contract and were randomly distributed in small groups (3-4 students each). Application of this collaborative learning activity to our classrooms has been very satisfactory, as evidenced by an improvement in the volunteers' academic performance and a very positive perception by most of them, who declared to be "very satisfied" or "satisfied" with their experience and felt that they had learned more.

Abstract The near-surface temperature in Mediterranean climate-type regions has increased overall similarly or more rapidly than the global mean rates. Although these regions have comparable climate characteristics and are located at similar latitudes, recent warming acceleration is most pronounced in the Mediterranean Basin. Here, we investigate the contributions of several climate drivers to regional warming anomalies. We consider greenhouse gases, aerosols, solar irradiance, land–atmosphere interactions, and natural climate variability modes. Our results highlight the dominant role of anthropogenic greenhouse gas radiative forcing in all Mediterranean climate-type regions, particularly those in the northern hemisphere. In the Mediterranean Basin, the recent warming acceleration is largely due to the combined effect of declining aerosols and a negative trend in near-surface soil moisture. While land-atmosphere feedbacks are also important in other locations (e.g., California and Southern Africa), this synergy is unique in the Mediterranean Basin. These two regional climate drivers have natural and anthropogenic components of equivalent importance. Such feedbacks are not fully resolved in the current regional climate projections.

Background: The aim of our study was to test the hypothesis that the community contact tracing strategy of testing contacts in households immediately instead of at the end of quarantine had an impact on the transmission of SARS-CoV-2 in schools in Reggio Emilia Province. Methods: We analysed surveillance data on notification of COVID-19 cases in schools between 1 September 2020 and 4 April 2021. We have applied a mediation analysis that allows for interaction between the intervention (before/after period) and the mediator. Results: Median tracing delay decreased from 7 to 3.1 days and the percentage of the known infection source increased from 34–54.8% (incident rate ratio-IRR 1.61 1.40–1.86). Implementation of prompt contact tracing was associated with a 10% decrease in the number of secondary cases (excess relative risk –0.1 95% CI –0.35–0.15). Knowing the source of infection of the index case led to a decrease in secondary transmission (IRR 0.75 95% CI 0.63–0.91) while the decrease in tracing delay was associated with decreased risk of secondary cases (1/IRR 0.97 95% CI 0.94–1.01 per one day of delay). The direct effect of the intervention accounted for the 29% decrease in the number of secondary cases (excess relative risk –0.29 95%–0.61 to 0.03). Conclusions: Prompt contact testing in the community reduces the time of contact tracing and increases the ability to identify the source of infection in school outbreaks. Although there are strong reasons for thinking it is a causal link, observed differences can be also due to differences in the force of infection and to other control measures put in place. Funding: This project was carried out with the technical and financial support of the Italian Ministry of Health – CCM 2020 and Ricerca Corrente Annual Program 2023.

Objective: To compare anxiety and acute stress levels among nursing students who joined the labour market during the first wave of the COVID-19 pandemic and those who did not. Methods: A cross-sectional, multicentre descriptive study across three Spanish public universities. A total of 216 nursing students participated in our study. Data collection was carried through an online questionnaire, that included variables on conditions for entering the labour market, the Zung Anxiety Self-Assessment Scale and the Stanford Acute Stress Reaction Questionnaire. We performed univariate and multivariate analyses. Results: Overall, 42.6% (n=92) of the students entered the labour market during the first wave of the COVID-19 pandemic. The global anxiety score was x?=36.31 (SD=5.71) and the stress score was x?=82.39 (SD=30.84). Lower anxiety levels were observed among those who joined the labour market (x?=35.67; SD=5.78) as compared to those who did not (x?=36.73; SD=5.67). Overall 92.4% of the students were acutely stressed. Acute stress was higher among those who did not work (x?=84.35; SD=32.38) and significantly in women. Conclusions: Nursing students were able to cope with stress in situations such as the COVID-19 pandemic. A healthy worker effect could not be ruled out. Stress and anxiety among nursing students should be considered by clinical practice preceptors and at the time students first enter the labour market.

Epidemic Intelligence activities depend significantly on analysts’ ability to locate and aggregate heterogeneous and complex information promptly. The level of novelty of the targeted information is a challenge. The earlier events of interest are located the larger the benefit: more accurate and timely warnings can be made available by the analysts. In this work, the role of Natural Language Processing technologies is investigated. In particular, transformer-based encoding of Web documents (such as newspaper articles as well as epidemic bulletins) for the automatic recognition of events and relevant epidemic information is adopted and evaluated. The resulting framework is configured as a domain-specific meta-search methodology and as a possible basis for a novel generation of Web search environments supporting the Epidemic Intelligence analyst.

Introducción: La terapia transfusional no está libre de riesgos, siendo los pacientes hemato- oncológicos los mayores transfundidos, por ello la necesidad de la hemovigilancia. El objetivo del presente estudio fue identificar las características transfusionales y la hemovigilancia de los pacientes pediátricos con cáncer en el Instituto SOLCA-Cuenca, enero-diciembre 2021. Método: Se realizó un estudio descriptivo con todos los pacientes menores de 18 años que requirieron transfusiones y todas las hemotransfusiones realizadas en SOLCA-Cuenca 2021. Los datos fueron recolectados en un formulario previamente validado y se analizaron en el programa SPSS v25.0, presentándose como frecuencias, porcentajes, media y desviación estándar. Resultados: Se estudiaron 73 pacientes y 620 transfusiones, predominando: adolescentes (45.2 %), de sexo masculino (63 %), mestizos (98.6 %), urbanos (76.7%), grupo ORH+ (83.5 %). Con leucemia linfoblástica aguda células B (49.3 %) y quimioterapia de inducción (41.1 %). El 58.9 % tenían antecedente transfusional y 4.1 % reacción previa (urticaria). La media transfusional por paciente fue 8,49 y, 7,1% fueron premedicadas con esteroides; se transfundieron principalmente concentrados eritrocitarios (49%) por anemia (95.4 %) a 9,32ml/kg (media) en 121 a 180 minutos (56.9 %). Del 3.1 % de reacciones evidenciadas, el 100% fueron inmediatas, no infecciosas (urticaria 84.2 %), definitivas y se trataron con medicamentos (84.2 % esteroide); el 79 % de reacciones fueron leves; fueron secundarias a concentrados eritrocitarios (47.4 %), aféresis (47.4 %) y; evidenciadas en pacientes con leucemia linfoblástica aguda células B (31.5 %). Conclusiones: Los pacientes con leucemia linfoblástica aguda células B requirieron más transfusiones sanguíneas, principalmente concentrados eritrocitarios; mientras las reacciones transfusionales se asociaron frecuentemente a concentrados eritrocitarios y aféresis.

AbstractIn assisted ambulation, the user’s psychological comfort has a significant impact not only on acceptability of mobility aids but also on overall gait performance. Specifically, in the case of rollators, negative states such as distress may result in balance loss, inefficient manoeuvres, and an increased risk of falling. This paper presents a pilot study to investigate the effect of distress on rollator assisted navigation. To achieve this goal, a novel test protocol is proposed to assess distress while walking with a rollator, using the Self-Assessment Manikin (SAM) questionnaire. First, the participant completes a standardised visual stress induction test and fills in a SAM questionnaire on the dimensions of arousal and valence, to establish personal benchmarks. Then, they complete a course consisting of four navigation tasks with different levels of difficulty that affect the rollator manoeuvrability, filling in a SAM questionnaire after each task. An experiment including 25 healthy volunteers has been completed. Our preliminary results show that stressors like uneven or sloping surfaces increase perceived stress, whereas the shape of the trajectory does not significantly affect stress. The ultimate purpose of this work is to validate a performance-oriented protocol to investigate the dynamics of stress response in assisted walk and to train automatic stress detection systems.

This paper estimates feasible water savings for a sample of nine urban water districts in California during the height of the 2012-16 drought, just prior to the implementation of mandatory water use reductions, using household production theory and stochastic frontier analysis. Estimates of feasible savings are compared to mandated reductions and actual reductions in each district. Although the mandated reductions were generally feasible, our results show that they had asymmetric impacts across districts and tended to impose larger burdens on some disadvantaged groups.

Amphibian and reptile diversity from Isla Santay (Durán, Ecuador) has been underestimated due to the lack of monitoring throughout the island. Historically, this island has also been affected by anthropic landscape changes which limit the occurrence of certain species and favors the dispersion of opportunistic or more tolerant species. Such species dynamics tend to be more evident on islands, since their isolation limits species’ mobility. We present an updated checklist of the herpetofauna of Isla Santay Durán, Ecuador, and report for the first time the occurrence of two introduced species, Anolis sagrei Duméril & Bibron, 1837, Brown Anole, and Hemydactylus frenatus Duméril & Bibron, 1836.

Objectives: During 2022, Omicron became the dominant SARS-CoV-2 variant in Europe. This study aims to assess the impact of such variant on severe disease from SARS-CoV-2 compared with the Delta variant in Italy. Methods: Using surveillance data, we assessed the risk of developing severe COVID-19 with Omicron infection compared with Delta in individuals aged ≥12 years using a multilevel negative binomial model adjusting for sex, age, vaccination status, occupation, previous infection, weekly incidence, and geographical area. We also analyzed the interaction between the sequenced variant, age, and vaccination status. Results: We included 21,645 cases of SARS-CoV-2 infection where genome sequencing found Delta (10,728) or Omicron (10,917), diagnosed from November 15, 2021 to February 01, 2022. Overall, 3,021 cases developed severe COVID-19. We found that Omicron cases had a reduced risk of severe COVID-19 compared with Delta cases (incidence rate ratio [IRR] = 0.77; 95% confidence interval [CI]: 0.70-0.86). The largest difference was observed in cases aged 40-59 (IRR = 0.66; 95% CI: 0.55-0.79), while no protective effect was found in those aged 12-39 (IRR = 1.03; 95% CI: 0.79-1.33). Vaccination was associated with a lower risk of developing severe COVID-19 in both variants. Conclusion: The Omicron variant is associated with a lower risk of severe COVID-19 compared to infection with the Delta variant, but the degree of protection varies with age.

To determine the effectiveness of a peer tutorial strategy in the school achievement of English to high school students, whose mother tongue is not English, we made a comparison of two groups; in one, peer tutoring was carried out through the support of high average students and compared with the results of a group that did not receive the intervention. The tutors were 121 students who scored higher than 80 points in the initial exam and accepted to participate in the program. The group of tutees was formed by those who obtained scores lower than 65 and accepted to be tutored (101 formed the experimental group and 112 the control group). The peer tutoring was done in the classroom with the monitoring of the teacher, lasted 11 weeks, and focused on taking class notes and comparing them, giving feedback and clarifying doubts for 30 minutes after the teacher's explanation. The results of the midterm exam and final exam were analyzed through the Student's t-test, showing significant differences in the group that was tutored compared to the low-performing students who did not receive the intervention. The procedure was effective, finding that the use of peer support can improve school performance. It is necessary to monitor the profile of the tutors and systematize the tutorial strategy.

ObjectiveTo determine changes in incretins, systemic inflammation, intestinal permeability and microbiome modifications 12 months after metabolic RYGB (mRYGB) in patients with type 2 diabetes (T2D) and their relationship with metabolic improvement.Materials and methodsProspective single-center non-randomized controlled study, including patients with class II-III obesity and T2D undergoing mRYGB. At baseline and one year after surgery we performed body composition measurements, biochemical analysis, a meal tolerance test (MTT) and lipid test (LT) with determination of the area under the curve (AUC) for insulin, C-peptide, GLP-1, GLP-2, and fasting determinations of succinate, zonulin, IL-6 and study of gut microbiota.ResultsThirteen patients aged 52.6 ± 6.5 years, BMI 39.3 ± 1.4 kg/m2, HbA1c 7.62 ± 1.5% were evaluated. After mRYGB, zonulin decreased and an increase in AUC after MTT was observed for GLP-1 (pre 9371 ± 5973 vs post 15788 ± 8021 pM, P

Objectives Despite growing evidence suggesting increased COVID-19 mortality among people from ethnic minorities, little is known about milder forms of SARS-CoV-2 infection. We sought to explore the association between ethnic background and the probability of testing, testing positive, hospitalisation, COVID-19 mortality and vaccination uptake.Design A multistate cohort analysis. Participants were followed between 8 April 2020 and 30 September 2021.Setting The UK Biobank, which stores medical data on around half a million people who were recruited between 2006 and 2010.Participants 405 541 subjects were eligible for analysis, limited to UK Biobank participants living in England. 23 891 (6%) of participants were non-white.Primary and secondary outcome measures The associations between ethnic background and testing, testing positive, hospitalisation and COVID-19 mortality were studied using multistate survival analyses. The association with single and double-dose vaccination was also modelled. Multistate models adjusted for age, sex and socioeconomic deprivation were fitted to estimate adjusted HRs (aHR) for each of the multistate transitions.Results 18 172 (4.5%) individuals tested positive, 3285 (0.8%) tested negative and then positive, 1490 (6.9% of those tested positive) were hospitalised, and 129 (0.6%) tested positive at the moment of hospital admission (ie, direct hospitalisation). Finally, 662 (17.4%) died after admission. Compared with white participants, Asian participants had an increased risk of negative to positive transition (aHR 1.24 (95% CI 1.02 to 1.52)), testing positive (95% CI 1.44 (1.33 to 1.55)) and direct hospitalisation (1.61 (95% CI 1.28 to 2.03)). Black participants had an increased risk of hospitalisation following a positive test (1.71 (95% CI 1.29 to 2.27)) and direct hospitalisation (1.90 (95% CI 1.51 to 2.39)). Although not the case for Asians (aHR 1.00 (95% CI 0.98 to 1.02)), black participants had a reduced vaccination probability (0.63 (95% CI 0.62 to 0.65)). In contrast, Chinese participants had a reduced risk of testing negative (aHR 0.64 (95% CI 0.57 to 0.73)), of testing positive (0.40 (95% CI 0.28 to 0.57)) and of vaccination (0.78 (95% CI 0.74 to 0.83)).Conclusions We identified inequities in testing, vaccination and COVID-19 outcomes according to ethnicity in England. Compared with whites, Asian participants had increased risks of infection and admission, and black participants had almost double hospitalisation risk, and a 40% lower vaccine uptake.