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Background: The common vole is an agricultural pest and population outbreaks have caused significant crop damage in the agricultural areas of the west-central part of the Iberian Peninsula (Spain) during the last few decades. Thus, monitoring is imperative to gain a comprehensive insight on its spatiotemporal habitat colonization dynamics. This work was performed on a long-term database with the primary objective of establishing an operational framework for understanding the spatial and temporal distribution of the common vole, all of it based on the Getis-Ord statistics., Results: The temporal evolution of the vole abundance index (VAI) was consistent for the three studied habitats, that is, crops, reservoirs and paths. Furthermore, the majority of common vole abundance peaks coincide with summer periods, especially in annual herbaceous crops. The spatial distribution of vole abundance exhibited a non-random pattern, characterized by spatial clustering. Particularly, the areas with higher significance of this clustering were located at the so-called 'Tierra de Campos' county, covering northern Valladolid, southern Palencia and north-eastern Zamora provinces. Periods of major incidence and concentration were 2013-2014, 2016-2017 and 2019. Common vole temporal occupancy patterns demonstrate that colonization occurred simultaneously in alfalfa reservoirs and dispersion paths, both preceding settlement in annual herbaceous crop plots., Conclusion: The geographic information system (GIS)-hotspots-based methodology proposed here can be valuable for stakeholders involved in integrated management of the common vole, serving as a detector of pest-prone areas in both space and time. These hotspots are useful for predicting future surveillance areas that accurately reflect pest colonization patterns. It was found that common vole abundance along dispersal paths acts as a source of dissemination, preceding the risk of colonization in annual herbaceous crop plots. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Presently, there has been a noticeable rise in the consumption of poultry meat within the general population, particularly focusing on poultry sourced from alternative rearing systems as opposed to intensive ones. This study evaluated the impact of incorporating house cricket (Acheta domesticus,AD) larvae meal into the diet of 2 slow-growing chicken strains on their carcass traits and meat quality. A total of 256 one-day-old male chicks were utilized, with 128 belonging to the Red (R) strain and 128 to the Naked Neck (NN) strain. Chicks from each strain were randomly assigned to 16 replicates of 8 chicks each. Eight replicates were allocated to 2 distinct treatments (n=64 chicks/treatment) based on the diet employed: the control treatments for the Red (R-C) and Naked Neck (NN-C) strains were fed soybean meal, while the other 2 treatments were fed AD meal (R-AD and NN-AD). Three different rations were used throughout the growth cycle of the animals, tailored to meet the nutritional needs of the birds. All chickens were slaughtered at 95 d of age, and eight chickens per treatment were randomly chosen to assess carcass traits and meat quality. Near-infrared reflectance spectroscopy (NIRS) was employed to classify meat based on the feed and the chick strain, achieving a correct discrimination of 100% of the samples. The carcass traits exhibited significant alterations due to the inclusion of insect larval meal in the diet, resulting in reduced values across all parameters for chickens consuming AD meal, irrespective of genotype. The pH and cooking losses were generally higher for chicks fed cricket meal, as occurred with moisture. However, protein content was lower in the meat of chicks consuming cricket meal. Fat content showed lower values for NN chickens. There were minimal differences in the fatty acid profile, with lower C18:3n-3 values for chickens fed cricket meal. Therefore, including Acheta domesticus meal in the diets of slow-growing chick strains is a viable alternative to replace soybean meal. It provides meat quality characteristics comparable to those obtained in conventional systems., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Recent clinical studies have shown favorable outcomes for cement augmentation for fixation of trochanteric fracture. We assessed the cost-utility of cement augmentation for fixation of closed unstable trochanteric fractures from the US payer's perspective., Methods: The cost-utility model comprised a decision tree to simulate clinical events over 1 year after the index fixation surgery, and a Markov model to extrapolate clinical events over patients' lifetime, using a cohort of 1,000 patients with demographic and clinical characteristics similar to that of a published randomized controlled trial (age ≥75 years, 83 % female). Model outputs were discounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainty on results., Results: Fixation with augmentation reduced per-patient costs by $754.8 and had similar per-patient QALYs, compared to fixation without augmentation, resulting in an ICER of -$130,765/QALY. The ICER was most sensitive to the utility of revision surgery, mortality risk ratio after the second revision surgery, mortality risk ratio after successful index surgery, and mortality rate in the decision tree model. The probability that fixation with augmentation was cost-effective compared with no augmentation was 63.4 %, 58.2 %, and 56.4 %, given a maximum acceptable ceiling ratio of $50,000, $100,000, and $150,000 per QALY gained, respectively., Conclusion: Fixation with cement augmentation was the dominant strategy, driven mainly by reduced costs. These results may support surgeons in evidence-based clinical decision making and may be informative for policy makers regarding coverage and reimbursement., Competing Interests: Declaration of competing interest Dr Joeris has nothing to disclose; Dr Kabiri reports other from Johnson and Johnson MedTech, during the conduct of the study; Dr Galvain reports other from Johnson and Johnson, during the conduct of the study; Ms Vanderkarr reports other from DePuy Synthes, Inc, during the conduct of the study; Dr Holy reports other from Johnson & Johnson, during the conduct of the study; other from Johnson & Johnson, outside the submitted work; and she is an employee of Johnson & Johnson; Dr Quintana Plaza has nothing to disclose; Dr Schneller has nothing to disclose; Dr Kammerlander reports other from DePuy Synthes, Inc, during the conduct of the study., (Copyright © 2024. Published by Elsevier Ltd.)

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the digestive tract usually characterized by diarrhea, rectal bleeding, and abdominal pain. IBD includes Crohn's disease and ulcerative colitis as the main entities. IBD is a debilitating condition that can lead to life-threatening complications, involving possible malignancy and surgery. The available therapies aim to achieve long-term remission and prevent disease progression. Biologics are bioengineered therapeutic drugs that mainly target proteins. Although they have revolutionized the treatment of IBD, their potential therapeutic benefits are limited due to large interindividual variability in clinical response in terms of efficacy and toxicity, resulting in high rates of long-term therapeutic failure. It is therefore important to find biomarkers that provide tailor-made treatment strategies that allow for patient stratification to maximize treatment benefits and minimize adverse events. Pharmacogenetics has the potential to optimize biologics selection in IBD by identifying genetic variants, specifically single nucleotide polymorphisms (SNPs), which are the underlying factors associated with an individual's drug response. This review analyzes the current knowledge of genetic variants associated with biological agent response (infliximab, adalimumab, ustekinumab, and vedolizumab) in IBD. An online literature search in various databases was conducted. After applying the inclusion and exclusion criteria, 28 reports from the 1685 results were employed for the review. The most significant SNPs potentially useful as predictive biomarkers of treatment response are linked to immunity, cytokine production, and immunorecognition.

Background: The common vole has invaded the agroecosystems of northwestern Spain, where outbreaks cause important crop damage and management costs. Little is yet known about the factors causing or modulating vole fluctuations. Here, we used 11 years of vole abundance monitoring data in 40 sites to study density-dependence and weather influence on vole dynamics. Our objective was to identify the population dynamics structure and determine whether there is direct or delayed density-dependence. An evaluation of climatic variables followed, to determine whether they influenced vole population peaks., Results: First- and second-order outbreak dynamics were detected at 7 and 33 study sites, respectively, together with second-order variability in periodicity (2-3 to 4-5-year cycles). Vole population growth was explained by previous year abundance (mainly numbers in summer and spring) at 21 of the sites (52.5%), by weather variables at 11 sites (27.5%; precipitation or temperature in six and five sites, respectively), and by a combination of previous abundance and weather variables in eight sites (20%)., Conclusions: We detected variability in vole spatiotemporal abundance dynamics, which differs in cyclicity and period. We also found regional variation in the relative importance of previous abundances and weather as factors modulating vole fluctuations. Most vole populations were cyclical, with variable periodicity across the region. Our study is a first step towards the development of predictive modeling, by disclosing relevant factors that might trigger vole outbreaks. It improves decision-making processes within integrated management dealing with mitigation of the agricultural impacts caused by voles. © 2023 Society of Chemical Industry., (© 2023 Society of Chemical Industry.)

Sustainable poultry meat production involves the use of slow-growing chick strains and the utilization of new protein sources as an alternative to the current monopoly of soybean meal. In this scenario, a study was conducted to assess the effect of replacing soybean meal with domestic cricket (Acheta domesticus) meal on the developing cycle of slow-growing chicks. To this end, a total of 128 one-day-old male chicks (Colorield) were randomly assigned into 16 experimental units, each consisting of 8 chicks, which in turn were grouped into 2 groups fed isoproteic and isoenergetic diets in which the protein source differed: the control group (C) fed soybean meal and the Acheta group (AD) fed Acheta domesticus insect meal as the main protein source. Chicks were slaughtered at 95 d of age. Three different diets (F1, F2 and F3) were used for each experimental group according to the nutritional needs of the birds during their growth. The F1 diet (1-29 d) resulted in higher feed and water intake and higher body weight gain for group C, but a lower feed conversion rate. On the contrary, during F2 (29-60 d) no differences in productive performances were observed between the 2 groups, except for a higher water intake for group C. Finally, during the period corresponding to diet F3 (60-95 d) there were only differences in feed intake, which was higher for the AD group. In conclusion, the substitution of soybean meal for Acheta domesticus meal caused a decrease in feed intake during the first month and consequently a lower body weight. During the first 4 weeks of life of the chicks, a partial replacement of soybean meal may be recommended, since high inclusions of A. domesticus meal in this period seem to be detrimental in young chicks. Given the absence of relevant differences in productive performances between both groups, it could be concluded that the use of A. domesticus cricket meal can be a potential protein alternative to soybean meal., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The characterization of quality brand meat products, such as "Chorizo Zamorano" dry fermented sausages, involves a wide range of data which makes it necessary to use alternative statistical methodologies. In this study, the feasibility of the Categorical Principal Components Analysis as a multivariate non-linear technique for the characterization of "Chorizo Zamorano" was assessed. The data analyzed were those of eight commercial brands covered by the quality mark over an eight-year period (2013-2020) and included parameters of the physicochemical composition and organoleptic properties of the product. The results showed that "Chorizo Zamorano" has an average moisture content (28.28%), high protein (38.38%) and fat (51.05%) contents, and a very low carbohydrate concentration (1.52%). Results showed that the fat and protein content and the sensory parameters related to external and internal odor appeared to be the studied variables with the greatest influence on the classification of the products according to their quality.

Smoking and substance use during pregnancy are major preventable causes of mortality and morbidity, having a bidirectional and deleterious relationship with the mental health of the mother and child. As part of the WOMAP (Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to describe the prevalence of co-occurring mental illness and substance use problems, diagnoses and severity of those considered at risk and rates of treatment.A screening of 2,014 pregnant women was done using the AC-OK scale and they were asked about their smoking habits and services use for mental health/substance abuse. Of these, 170 women were considered at risk of co-occurring mental illness and substance use problems (≥ 2 positive responses to the AC-OK-Mental Health subscale, ≥ 1 positive response to the AC-OK-Substance Abuse subscale and/or smoking more than once a month and no use of specialized services) and were assessed with a more extensive battery of measures (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Posttraumatic stress disorder [PTSD] Checklist for DSM-5 [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] and Fagerström).In the last year, 614 women (30.5%) smoked tobacco (42.5% daily) and 9.8% were positive for both substance use and mental illness per the AC-OK. Only 11.1% of them received specific treatment in the previous three months while another 13.6% were scheduled to attend services in the following month. From the subsample assessed in depth, 62(36.5%) endorsed at least moderate depression, 35(20.6%) endorsed at least moderate anxiety, 32(18.8%) endorsed PTSD on the PCL, and 37 out of 88 alcohol users scored above the threshold in AUDIT (≥ 3). In conclusion, high prevalence and low treatment rates suggest that effective detection mechanisms should be integrated into usual care, allowing for early interventions.

Background: A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective., Methods: The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses., Results: The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%., Conclusions: Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available., Level of Evidence: Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H225 )., (Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Surgical site infection constitutes a serious complication in the healing process of bone fractures and has been associated with increases in medical resource use and healthcare costs. This study evaluates the economic impact of surgical site infection in tibial fractures in a Spanish cohort. It is a retrospective, single-centre, comparative cohort study of patients with tibial fractures with longitudinal follow-up for up to 18 months post-surgery. Included patients (n = 325) were adults, with tibial fracture, either isolated or polyfracture, or polytrauma with an Injury Severity Score >15. Patients had been surgically treated within 30 days of the tibial fracture by external or internal fixation, or external followed by internal fixation. Most patients (84.9%) had an American Society of Anaesthesiology score of 1-2. 20% of the patients had one open tibial fracture, 12.3% had polytrauma, and 20% had multiple fractures. Most patients were treated with a nail (41.8%) or a plate (33.8%). 56 patients (17.2%) developed surgical site infection. Patients with infection had significantly higher hospital length of stay (34.9 vs 12.0 days; p<0.001; +191%), readmissions (1.21 vs 0.25; p<0.001; +380%) and mean operating theatre time (499 vs 219 min; p<0.001; +128%) than patients without infection. Mean length of stay in intensive care did not significantly increase with infection (2.8 vs 1.7 days; p = 0.25). Total in-hospital costs for patients with infection increased from €7,607 to €17,538 (p<0.001; +131%). Overall, infections were associated with significantly increased healthcare resource use and costs. Preventive strategies to avoid infections could lead to substantial cost savings., Competing Interests: TG, JND, JQP, EE and CM are employees of Johnson & Johnson. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2022 Barrés-Carsí 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.)

Hormonal treatments used in the artificial insemination (AI) of sheep can cause several physiological problems that can affect negatively fertility and animal health; however, AI protocols based on the detection of natural estrus offer a more sustainable option and can achieve high fertility. In this study, an AI protocol at natural estrus in organic Churra sheep was performed. In the first phase (AI protocol development), 125 ewes were exocervically inseminated, and their fertility was assessed based on the following factors: number of AI, physiological state, body condition, estrus detection-AI interval, and vaginal fluids in cervix. That protocol was repeated for six consecutive years. In all individuals, fertilities based on the timing of insemination after estrus detection were very high. Lactating ewes produced better results than did dry ewes, which was probably because of the better feeding of the former. In addition, double insemination increased the fertility of ewes whose estrus was detected within 16 h of onset. Body condition and amount of vaginal fluid were correlated with fertility. Exocervical inseminations at natural estrus can produce acceptable fertility and prolificity in Churra ewes.

Environmental factors affect daily milk production in dairy animals. The aim of this study was to quantify the effects of environmental factors, specifically mean temperature (°C), relative humidity (%), temperature-humidity index (THI), solar radiation (°), pluvial precipitation (mm) and lunar calendar (full moon, waxing quarter, waning quarter, new moon), on milk production (kg/d). The analysis was based on 96,195 morning and evening milking records documented on 109 consecutive days, from 869 Lacaune ewes. Ewes were housed in groups of 174 individuals. The analysis was performed in two independent procedures, a Pearson correlation analysis and a multivariate analysis of the ewe's interrelationships, which was based on the total variance estimate and a Varimax-rotated factorial analysis. Milk yield (kg/d) was significantly (p < 0.05) negatively correlated with mean temperature (-0.24), relative humidity (-0.16), THI (-0.24), and radiation (-0.18), which suggests that the higher these environmental factors, the lower the milk yield. Lunar calendar had a significant (p < 0.01) effect on milk production yield; specifically, yields were higher on the full moon and new moon (2.25 ± 0.05 kg/day) than they were on the crescent or waning moon (2.17 ± 0.05 kg/day). In conclusion, ewes that had been exposed to higher mean temperature, relative humidity, THI and solar radiation had the lowest milk yield, and milk yields are highest on full and new moons. The results of this work may be helpful in making predictions for milk production in Lacaune ewes in the Mediterranean region throughout the year., (© 2022. The Author(s) under exclusive licence to International Society of Biometeorology.)

Background: The common vole (Microtus arvalis) is a very destructive agricultural pest. Particularly in Europe, its monitoring is essential not only for adequate management and outbreak forecasting, but also for accurately determining the vole's impact on affected fields. In this study, several alternatives for estimating the damage to alfalfa fields by voles through unmanned vehicle systems (UASs) and multispectral cameras are presented. Currently, both the farmers and agencies involved in the integrated pest management (IPM) programs of voles do not have sufficiently precise methods for accurate assessments of the real impact to crops., Results: Overall, the four multispectral classification methods presented showed similar performances. However, the normalized difference vegetation index (NDVI)-based segmentation exhibited the most accurate and reliable appraisal of the affected areas. Nevertheless, it must be noted that the simplest method, which was based on an automatic classification, provided results similar to those obtained by more complex methods. In addition, a significant direct relationship was found between the number of active burrows and damage to the alfalfa canopy., Conclusion: Unmanned vehicle systems, combined with multispectral imagery classification, are an effective and easily transferable methodology for the assessment and monitoring of common vole damage to agricultural plots. This combination of methods facilitates decision-making processes for IPM control strategies against this pest. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Insect larval meal is an increasingly common protein source in poultry systems. In this study, the effect of replacing soybean meal with Tenebrio molitor larval meal on the performance of slow-growing chickens was assessed. A total of 128 one-day-old chickens ( Colorield ) were randomly divided into a control group (C) ( n = 64), fed with soybean meal, and an experimental group (TM) ( n = 64), fed with T. molitor larvae meal. The chicks were slaughtered after 95 days. Three different isoenergetic and isoproteic diets (F1, F2 and F3) were used for each group. The F1 diet resulted in higher body weight gain and higher feed and water intakes in group C, but a lower feed conversion ratio. Contrarily, diets F2 and F3 did not produce differences in the studied parameters between the two groups, except for body weight gain in the case of diet F2, which was highest in group C. Therefore, weight gain and feed and water intakes were significantly higher in group C, but there were no differences in feed conversion ratio or live weight. In conclusion, the total replacement of soybean meal with T. molitor larvae meal resulted in a reduction in feed intake and a consequent reduction in weight. During this period, partial rather than total substitution may be recommended.

Introduction: The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database., Methods: CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010-2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery., Results: 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)-84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156)., Conclusions: Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need., (© 2022. The Author(s).)

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FE NO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis., (Copyright © 2021 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FE NO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis., (Copyright © 2021 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Six cows managed under extensive grazing conditions were used to study the effect of moving the animals to a higher grazing density on the circadian rhythms of temperature (T), heart rate (HR), and activity (ACT), which were recorded by implantable bio-loggers. Cows were maintained at a density of 1.5 livestock units per hectare (LSUs/ha; low density, LD) until they were moved to a grazing area at 128 LSUs/ha (high density, HD). Animals were implanted subcutaneously with a T, HR, and ACT bio-logger, which was programmed to record data at 5-min intervals. For each animal, cosinor rhythmometry (the study of circadian rhythms by fitting a sine wave to a time series) was applied to the data recorded over 5 days in LD and HD. Mean Midline Estimating Statistic of Rhythm (MESOR; the average value around which the variable oscillates), amplitude (difference between the peak and the mean value of a wave), and acrophase (timing of peak activity) were calculated and evaluated statistically. Differences between mean day and nighttime values, and mean LD and HD values were calculated. Cows presented cosinor curves that fit a 24-h rhythm ( p < 0.001) in T, HR, and ACT at both densities. MESOR (T: 37.98 vs. 38.02°C; HR: 69.12 vs. 65.91 bpm; ACT: 49.39 vs. 40.41 mg, for LD and HD, respectively) and amplitude (T: 0.28 vs. 0.28°C; HR: 4.12 vs. 3.14 bpm; ACT: 18.14 vs. 11.28 mg, respectively) did not differ significantly between the two densities; however, significant ( p < 0.05) differences between densities occurred in the acrophase of the three variables; specifically, the T acrophase was 2 h later at HD (22:45 h) than LD (20:45 h), and HR (LD: 19:51; HD: 16:49 h) and ACT acrophases 3 and 2 h earlier at HD than LD (LD: 14:47; HD: 12:49 h), respectively. T and ACT differed significantly ( p < 0.01) between daytime (mean ± SE; 37.92 ± 0.19°C, 40.39 ± 4.74 mg) and nighttime (38.14 ± 0.17°C, 29.93 ± 5.66 mg). In conclusion, our study suggests that a high animal grazing density might exacerbate the social competence for valuable resources for animals, resulting in shifting the circadian rhythmicity of temperature, heart rate, and activity of the cows, advancing or delaying their acrophases., 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 © 2021 Palacios, Plaza and Abecia.)

Currently, there are very few studies in the dairy sheep sector associating milk quality and indicators regarding carbon footprint and their link to grazing levels. For 1 year, monthly milk samples and records related to environmental emissions and management systems were collected through surveys from 17 dairy sheep farms in the region of Castilla y León (Spain), in order to relate this information to the use of natural pastures under free grazing. Indicators were constructed on the collected data and subjected to a multivariate statistical procedure that involved a factor analysis, a cluster analysis and a population canonical analysis. By applying multivariate statistical techniques on milk quality and carbon footprint indicators, it was possible to identify the management system of the farms. From an environmental point of view, farms with a higher grazing level (cluster 4) were more sustainable, as they had the lowest carbon footprint (lower CO 2 , N 2 O and CO 2 equivalent emissions per sheep and year) and the lowest energy consumption levels, which were gradually lower than those of farms in cluster 3; both indicators were much lower than those of farms in clusters 1 and 2. The milk quality of cluster 1 and 2 farms was significantly lower in terms of total protein and fat content, dry extract, omega-3 fatty acid levels and α-tocopherol content than farms in clusters 3 and 4, which had higher accessibility to grazing resources. In sum, the higher the use of natural resources, the lower the external inputs the farms required and the lower environmental impact and energy costs they have.

This study investigated the influence of the production system (conventional vs. organic), the grass consumption level and the ageing period (7 and 14 days) on beef quality. Three groups of samples from Limousin × Avileña calves were analysed: F100, formed by animals fed 100% on forage; F74, formed by animals fed on an average amount of forage of 74%; and F35, formed by animals fed on straw fodder (35%) and concentrate (65%). The results showed that the higher the grass content, the lower the fat oxidation and the higher the n-3 content, but also the higher the SFA level, the initial Warner-Bratzler shear force (WBSF), and the more residue it leaves on chewing. As for the effect of production system, organic samples showed higher intramuscular fat content and lower moisture and MUFA content. These samples were darker and showed lower values for flavour quality. Among the organic samples, F100 had higher n-3 and CLA content and higher values for colour, hardness, odour and flavour quality. Increased ageing time may improve the sensory characteristics of the meat, especially in the case of the F100 samples. The results pointed out that F100 samples aged at least 14 days showed the best physico-chemical, nutritional and sensory characteristics.

This paper proposes a novel end-to-end learning model, called skip-connected covariance (SCCov) network, for remote sensing scene classification (RSSC). The innovative contribution of this paper is to embed two novel modules into the traditional convolutional neural network (CNN) model, i.e., skip connections and covariance pooling. The advantages of newly developed SCCov are twofold. First, by means of the skip connections, the multi-resolution feature maps produced by the CNN are combined together, which provides important benefits to address the presence of large-scale variance in RSSC data sets. Second, by using covariance pooling, we can fully exploit the second-order information contained in such multi-resolution feature maps. This allows the CNN to achieve more representative feature learning when dealing with RSSC problems. Experimental results, conducted using three large-scale benchmark data sets, demonstrate that our newly proposed SCCov network exhibits very competitive or superior classification performance when compared with the current state-of-the-art RSSC techniques, using a much lower amount of parameters. Specifically, our SCCov only needs 10% of the parameters used by its counterparts.

Background: Diagnostic tests for fecal incontinence have been improved over time. This study aims to evaluate the role of Three-dimensional endoanal ultrasound (3D-EUS) and the Starck's score in the assessment and treatment of obstetric sphincter injuries., Methods: A prospective observational study was performed including primiparous women who were evaluated at 20 wk of pregnancy and 3 mo after childbirth. Sphincter defects were classified according to the Starck's and Obstetrical Anal Sphincter Injuries classifications. Patients also completed the Fecal Incontinence Quality of Life and the Wexner questionnaires before and after childbirth., Results: Sphincter defects were detected in 45% of the 56 women included, although 85% had an uneventful delivery. Most defects were found isolated to the external anal sphincter except for two cases, classified by a Starck's score >8. Fecal Incontinence Quality of Life and Wexner questionnaires showed a rate of symptomatic patients of around 46%. We observed that 30% of patients with sphincter injuries remained asymptomatic., Conclusions: The 3D-EUS is a useful test in assessing sphincter defects after childbirth. This method makes it possible to detect small sphincter defects that otherwise would have gone unnoticed, as 30% of patients with sphincter injuries were asymptomatic. In addition, both the 3D-EUS and the Starck's score were valuable in establishing an algorithm for the treatment of obstetric sphincter injuries., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth., Methods: a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS., Results: a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8)., Conclusions: AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.

Purpose: Rates of nonadherence to asthma treatment in Spain are between 24% and 76%, which results in poor disease control and increased health care costs. The main objective of this multidisciplinary consensus was to investigate the opinions of health professionals and patients regarding adherence to inhaled therapy in Spain. The results will help to identify the causes of nonadherence and to establish strategies to detect and correct the problem., Methods: This research was conducted by using a modified Delphi method organized into 2 rounds and involving a panel of 64 physicians, 16 nurses, and 10 community pharmacists. In addition, 70 patients with asthma completed a simplified 1-round survey, based on the Delphi questionnaire. The items proposed to reach a consensus included topics such as impact and causes of nonadherence, as well as strategies to improve adherence to treatment., Findings: Expert panelists reached a consensus on ~80% of the items proposed. They agreed that the lack of control in asthma has an important economic impact. The causes of nonadherence with more agreement were the patients' beliefs about treatment and the complexity of the inhalation devices. Panelists agreed that the most important strategies to improve adherence were modification of patients' beliefs, training of professionals in the management of adherence, and personalization of interventions. Most patients only agreed with items that referred to strategies to improve adherence., Implications: Although the problems, impact, causes, and interventions regarding nonadherence to asthma treatment are known, adequate monitoring of adherence to treatment is not performed. A multidisciplinary and personalized approach is necessary to control and improve adherence., (Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.)

Introduction: The gradual aging of the population results in increased incidence of osteoporotic bone fractures. In a good quality bone, the fixation with the usual methods is adequate, but not in osteoporotic bone, in which consolidation delays and other complications are common, with failure rates for screws up to 25%., Objective: To test fibronectin loaded hydroxyapatite as a complementary treatment for osteoporotic fractures., Material and Methods: This study was performed in a vivo model; 42 female osteoporotic adult rabbits 4-5kg (White New Zealand) were used. Two groups (hydroxyapatite and fibronectin loaded hydroxyapatite) and a control group were tested. 3 time points 24h, 48h and 5days were studied. Defects were created in both femurs, in one of them, a cannulated screw (4mm) and a biocompatible material were placed; in the other femur a screw was inserted without supplemented material forming the control group. Osteoporosis was induced from models already known throughout administration of steroids. Samples were analyzed histologically and through imaging (micro Ct)., Results: Basal levels of BMD are observed below to normal when compared to other studies (0.25/0.3 instead of 0.4). Global and dependent of time analysis of samples, show no significant differences for samples analyzed. However, an important trend was noted for variables that define the trabecular bone microarchitecture. Indices that define trabecular microarchitecture in the comparative analysis found to have statistical differences (p<0.01)., Discussion: Osteosynthesis in an osteoporotic bone is a challenge for the surgeon, due to a reduced bone mineral density and different bone architecture. The main finding was the verification of the hypothesis that the trabecular bone parameters increases with our augmentation material in weak rabbit bone quality. Also, the histological analyses of samples show an increase of non inflammatory cells in protein samples (OHAp-Fn) from the first 24hours., Conclusion: An early response of rabbit osteroporotic bone to a complementary treatment with fibronectin loaded hydroxyapatite has been observed. This response is reflected in greater values for indices that define the trabecular bone microarchitecture, thickness and separation, a greater non-inflammatory cellularity after only 24hours and an increased amount of connective tissue observed at 48hours., (© 2016 Elsevier Ltd. All rights reserved.)

Purpose: To date, non-invasive prenatal diagnosis (NIPD) of monogenic disorders has been limited to cases with a paternal origin. This work shows a validation study of the Droplet Digital PCR (ddPCR) technology for analysis of both paternally and maternally inherited fetal alleles. For the purpose, single nucleotide polymorphisms (SNPs) were studied with the only intention to mimic monogenic disorders., Methods: NIPD SNP genotyping was performed by ddPCR in 55 maternal plasma samples. In 19 out of 55 cases, inheritance of the paternal allele was determined by presence/absence criteria. In the remaining 36, determination of the maternally inherited fetal allele was performed by relative mutation dosage (RMD) analysis., Results: ddPCR exhibited 100% accuracy for detection of paternal alleles. For diagnosis of fetal alleles with maternal origin by RMD analysis, the technology showed an accuracy of 96%. Twenty-nine out of 36 were correctly diagnosed. There was one FP and six maternal plasma samples that could not be diagnosed., Discussion: In this study, ddPCR has shown to be capable to detect both paternal and maternal fetal alleles in maternal plasma. This represents a step forward towards the introduction of NIPD for all pregnancies independently of the parental origin of the disease.

A 12-year-old boy presented to our emergency department complaining of pain and functional limitation on his right ankle after an indirect trauma. Plain radiographs were taken identifying a type II epiphysiolysis of the distal tibia and a proximal fibula fracture. An open reduction and internal fixation was performed without transyndesmal fixation. Maisonneuve fractures are an uncommon injury in the pediatric population. This fracture pattern has not been described by the Dias-Tachdjian classification. It is important to bear in mind that, based on the need for osteosynthesis for the epiphysiolysis, the treatment of these fractures in children usually differs from that in the adults as no transyndesmal screw fixation is required.

Since the discovery of the presence of fetal DNA in maternal blood, non-invasive fetal sex determination has been the test most widely translated into clinical practice. To date there is no agreement between the different laboratories performing such tests in relation to which is the best protocol. As a consequence there are almost as many protocols as laboratories offering the service, using different methodologies and thus obtaining different diagnostic accuracies. By the end of 2007, after a validation study performed in 316 maternal samples collected between the 5th and 12th week of gestation, the fetal sex determination was incorporated into clinical practice in our Service. The test is performed in the first trimester of pregnancy, and it is offered as part of the genetic counseling process for couples at risk of X-linked disorders. As a general rule and in order to avoid misdiagnosis, two samples at different gestational ages are tested per patient. The analysis is performed by the study of the SRY gene by RT-PCR. Two hundred and twenty six pregnancies have been tested so far in these 5 years. Neither false positives nor false negatives diagnoses have been registered, thus giving a diagnostic accuracy of 100%.

Polyamines are molecules involved in cell growth and differentiation and are produced by bacterial metabolism. However, their production and effects by the microbiota selected by fructooligosaccharides consumption are controversial. In this study, we investigated the influence of supplementation of fructooligosaccharides on the cecal polyamine production by the microflora selected, and its effect on gut maturation in newborn piglets. Twenty piglets were fed a control formula (n = 10) or a formula supplemented with fructooligosaccharides (8 g/l) (n = 10) for 13 days. Colony-forming unit's count of cecal content was done in different media. Several intestinal development parameters were measured as well as the polyamine concentration in the cecal mucosa and cecal content. A dose-dependent study on in vitro polyamine production by fructooligosaccharides addition to the isolated cecal content was performed. Bifidogenic activity of fructooligosaccharides increased polyamine concentration in the cecal content, mainly putrescine, with no beneficial effect on gut maturation. Bifidobacterium spp. were able to produce polyamines, but they were not the most significant bacterial producer of polyamines in the cecum of piglets fed fructooligosaccharides. Bifidogenic activity of fructooligosaccharides did not lead to an increase in gut maturation in piglets of 15 days of age although polyamines were increased in the cecal content.

Objective: Polyamines are essential for many cell functions, and they form part of the composition of maternal milk; despite this, their addition to infant formulas is currently under evaluation. The aim of the present study was to evaluate the effects of milk formulas designed to resemble sow milk supplemented with polyamines at maternal physiologic milk doses on the gut maturation of early-weaned piglets., Methods: We fed 30 newborn piglets with maternal milk (n=10), a control milk formula (n=10), or a milk formula supplemented with polyamines (5 nmol/mL of spermine and 20 nmol/mL of spermidine, n=10) for 13 d (day 2 after birth through day 15). Several growth and intestinal development parameters were measured., Results: The piglets fed the formula containing polyamine at physiologic doses showed significantly increased crypt depth in the small intestine compared with those fed with the control formula. Villus length was correlated to crypt depth. Although there were no differences in the disaccharidase activities between the animals fed the two formulas, alkaline phosphatase and gamma-glutamyl transferase activities tended to be higher in the jejunum of those fed the polyamine-supplemented diet. Dietary polyamines did not significantly modify the gut mucosal concentrations of putrescine, spermine, or spermidine., Conclusion: Milk formulas supplemented with polyamines at maternal milk physiologic doses slightly enhanced gut growth and maturation in neonatal piglets.

Hyperspectral imaging is a new remote sensing technique that generates hundreds of images, corresponding to different wavelength channels, for the same area on the surface of the Earth. Supervised classification of hyperspectral image data sets is a challenging problem due to the limited availability of training samples (which are very difficult and costly to obtain in practice) and the extremely high dimensionality of the data. In this paper, we explore the use of multi-channel morphological profiles for feature extraction prior to classification of remotely sensed hyperspectral data sets using support vector machines (SVMs). In order to introduce multi-channel morphological transformations, which rely on ordering of pixel vectors in multidimensional space, several vector ordering strategies are investigated. A reduced implementation which builds the multi-channel morphological profile based on the first components resulting from a dimensional reduction transformation applied to the input data is also proposed. Our experimental results, conducted using three representative hyperspectral data sets collected by NASA's Airborne Visible-Infrared Imaging Spectrometer (AVIRIS) sensor and the German Digital Airborne Imaging Spectrometer (DAIS 7915), reveal that multi-channel morphological profiles can improve single-channel morphological profiles in the task of extracting relevant features for classification of hyperspectral data using small training sets.