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With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.

Evidence shows that current adaptation planning approaches are not always successful in generating actionable knowledge to guide implementation on the ground. There remains a persistent disconnect between the production of (physical) climate science and the implementation of practical, local, and context-specific adaptation actions. We argue for a need to incorporate “subaltern” knowledge (i.e., that which is typically labeled local, traditional, or indigenous knowledge) in climate adaptation science and practice. Building on recent comparative assessment studies, we identify limitations of current local adaptation action in its typical application of scientific knowledge and illustrate key pathways through which the subaltern can be integrated to better inform current approaches. We argue that subaltern knowledge can be a critical source of innovation and can help to broaden the adaptation solution space by enhancing both the effectiveness and the social legitimacy of actions.

Multiple cell upsets (MCU) is an issue that has to be dealt with when designing electronics for working in a radiated environment. Furthermore, the constant evolution of ICs integration density causes an increment in the MCUs span. These issues are typical in aviation applications, where, additionally, fault-tolerant (FT) performance is required. FT systems are typically based on a redundancy concept for storing and retrieving healthy information, for example, with a triple modular redundancy (TMR) scheme. The main issue with redundancy is design oversizing. On the other hand, reconfiguration-based techniques allow error scrubbing with a limited overhead. The main drawback here is overhead vulnerability to radiation, which is invalid for FT requirements. This paper proposes a new hybrid architecture that takes advantage of the optimized performance of reconfiguration-based techniques supported on extremely compressed redundant information nonvulnerable to radiation, referred to in this paper as hardwired seed bits (HSB). It also includes different known techniques, such as interleaving, error detection and correction (EDAC) algorithms, etc., for optimizing the final architecture as much as possible. As a result, the proposed approach meets FT requirements thanks to nonvulnerable tiny redundant information combined with an optimized performance through EDAC-based implementation.

The assessment of public adaptation policies, strategies and plans to evaluate progress, effectiveness and long-term sustainability is challenging. The potential to develop an ex-post evaluation linked to outcomes is limited given the lack of policy implementation globally and the uncertainty related to when and how impacts will happen. Ex-ante evaluations, by contrast, seem more feasible when they focus on policy processes, contents and outputs. Yet, proxies that indicate credible outcomes need to be carefully selected. In both cases, how adaptation is integrated in local planning processes, and previous experience by governments seem to be crucial. In this paper we perform an ex-ante evaluation of adaptation planning in 59 cities, identified across a set of 136 coastal cities of over 1 million inhabitants located in developed and developing world regions. We assess 3 major areas: policy and economic credibility, science and technical credibility, and legitimacy. Overall, 53 metrics are used to assess how likely local adaptation policies are to be effective, implemented and sustained in the long-term. This global assessment reveals that current adaptation planning in big global cities has a significant space for improvement and is, overall, unlikely to be effective unless greater effort is invested in financing, regulatory context, monitoring and evaluation, and legitimacy aspects. We also discuss challenges and needs, assuming this sample is re-presentative of current progress of adaptation planning in large cities. “Funding” (#1) is not well accomplished in general as also identified by previous tracking studies ( Aguiar et al., 2018; Dulal, 2019; Simonet & Leseur, 2019; Stults & Woodruff, 2017 ). According to Ford and King (2015, p. 513) , adaptation funding should relate to “the capital costs of interventions and their maintenance over time, and also the associated human resources necessary to successfully identify, implement, monitor, and maintain adaptation efforts, along with costs of funding research projects and programs”. To be credible, adaptation plans should also assign economic resources to implementation and monitoring ( Olazabal, Galarraga, Ford, Lesnikowski, & Sainz de Murieta, 2017 ). In our sample, planning documents tend to omit information regarding budget for the implementation, and when they include it, information is not measure-specific, which inhibits effective resource assignation and implementation. Notably, as discussed later, budgets for monitoring and evaluation activities are never included. Even in cases where funding information is included there is room for improvement. “Plan Clima” in Barcelona, for instance, which scores high (26.6 over 53) compared to the mean (20.4), only includes the budget for citizen climate projects for the annual year of 2018. Montevideo assesses costs and benefits for only 11 strategic adaptation lines, those that had enough information to carry out the economic evaluation and subsequent prioritisation. Woodruff and Stults (2016) conclude that the use of external funding for the creation of plans leads to lower quality plans, probably due to less motivational environments. Many cities in our sample received (total or partial) external funding, either from global institutions like IDB (Panama, Grande Vitoria) or 100 RC (Dakar, Bangkok, Athens), from private foundations (Boston’s plan was partially funded by the Barr Foundation and Sherry and Alan Leventhal Family Foundation, apart from the Commonwealth of Massachusetts Executive Office of Energy and Environmental Affairs), or from national or regional institutions (plans from Lisbon and Porto were partially funded by the European Economic Area Grants; Davao City’s Action Plan was funded by the US Agency for International Development, the World Food Program and UN Habitat). Overall, the Copenhagen Climate Adaptation Plan is a model for funding aspects. The plan clearly specifies the budget for each of the actions proposed, it is funded with own resources and partially secures funding for implementation, mentioning, for example, that “projects launched in 2011 are incorporated into the ordinary budget of the Technical and Environmental Administration. Other project proposals are waiting for funding” (p. 85). All 3 Korean policies examined also provide a detailed budget for the measures proposed, although these do not secure implementation funds. Legislation and regulatory nature (#7, refers to the existing regulatory frameworks and binding nature of adaptation measures) is the lowest ranked indicator in the sample. Adaptation tracking studies in Europe ( Heidrich et al., 2016; Lee, Yang, & Blok, 2020 ) note the important influence of higher-level climate policies on local climate planning. However, our results show that only a few plans claim to be developed in response to any compulsory legislative framework. Exceptions are Los Angeles (complying with federal and state hazard mitigation planning requirements to establish eligibility for funding under the US Federal Emergency Management Agency, FEMA, grant programs), Perth (complying with WALGA's Policy Statement on Climate Change, endorsed by the State Council), Incheon, Ulsan and Busan in Korea (which follow Article 38 of the Enforcement Decree of the Act that stipulates that local governments must establish and implement a detailed implementation plan for climate change adaptation measures). No plan in our sample has stated a legally binding nature, aligning with previous findings in, for example, the US ( Stults & Woodruff, 2017 ).

Cities across the globe recognise their role in climate mitigation and are acting to reduce carbon emissions. Knowing whether cities set ambitious climate and energy targets is critical for determining their contribution towards the global 1.5 °C target, partly because it helps to identify areas where further action is necessary. This paper presents a comparative analysis of the mitigation targets of 327 European cities, as declared in their local climate plans. The sample encompasses over 25% of the EU population and includes cities of all sizes across all Member States, plus the UK. The study analyses whether the type of plan, city size, membership of climate networks, and its regional location are associated with different levels of mitigation ambition. Results reveal that 78% of the cities have a GHG emissions reduction target. However, with an average target of 47%, European cities are not on track to reach the Paris Agreement: they need to roughly double their ambitions and efforts. Some cities are ambitious, e.g. 25% of our sample (81) aim to reach carbon neutrality, with the earliest target date being 2020.90% of these cities are members of the Climate Alliance and 75% of the Covenant of Mayors. City size is the strongest predictor for carbon neutrality, whilst climate network(s) membership, combining adaptation and mitigation into a single strategy, and local motivation also play a role. The methods, data, results and analysis of this study can serve as a reference and baseline for tracking climate mitigation ambitions across European and global cities. info:eu-repo/semantics/publishedVersion

Background Chronic illnesses are the leading cause of morbidity and mortality and threaten the sustainability of healthcare systems worldwide. There is limited evidence in terms of the best modality and intensity of physical activity for improving cardiorespiratory capacity and quality of life in patients with chronic conditions. The objective of the EfiKroniK study is to estimate the common effect of innovative, individualized and supervised physical exercise, on cardiorespiratory functional capacity and quality of life across people with different chronic conditions. Methods/design This is a multicentre clinical trial with a type I hybrid effectiveness-implementation design, including 370 patients each with one of four different chronic illnesses: solid cancer, blood cancer, chronic obstructive pulmonary disease or schizophrenia. Patients will be randomly divided into two parallel groups, stratified by illness type. Patients in both groups will receive a standard healthy life prescription (PVS, from the Spanish “Prescribe Vida Saludable”) and additionally, the EfiKroniK group will be prescribed a physical exercise programme tailored to each patient in terms of intensity in each session. The primary outcome variables will be cardiorespiratory functional capacity and quality of life. The secondary outcome variables will be signs and symptoms, psychological and social factors and specific laboratory parameters. We will also analyse the dose-response effect of the physical exercise programme. Qualitative variables will describe patients’ perception of the utility and suitability of the EfiKroniK programme, as well as their expectations and satisfaction, identifying barriers to and facilitators of the EfiKroniK implementation process through discussion groups. The study will be carried out on an intention-to-treat basis, comparing changes throughout the 1-year follow-up between groups, adjusting for baseline, by performing mixed-effect analysis of covariance. We will estimate the effect of time on repeated measures in each subject and changes in the EfiKroniK and PVS groups over time. Discussion The study will provide the data necessary to allow us to prescribe physical exercise in a similar way to a drug and as a key part of the treatment of chronic illnesses within our healthcare system. Trial registration NCT03810755. Date and version identifier: October 9, 2020. Version2.0.

Communication Design is a disciplinary territory that is intrinsically linked to technology. The completion of communication design objects depends on proper linkages between project and production technologies. This adequacy has always been important, from the first printed books to the advent of industrialization. One cannot project simply according to the technologies that exist, but it is not possible to project without being aware of their virtualities and limits. This article reviews some consequences of the changes in workflows used in communication design projects as a result of technological changes that have taken place over the last 30 years, namely those resulting from the inclusion of designers in the production chain. Literature review, semi-structured interviews with technical managers of certain production companies and close observation were the methods used to achieve the intended results. They show that technical knowledge allows designers to participate in decision-making and project with full awareness of important aspects of the technologies used to complete projects, and helps them communicate with the actors involved in this process. The ongoing research project, of which this article forms part, intends, on the one hand, to show that technology influences ways of seeing and making, that is, it builds a culture that neither looms large, nor submits itself to the project culture; on the other hand, it seeks to provide scientific support to the professional experience of those who teach, because teaching what we know is clearly limited.

Since 2007, the non-indigenous calanoid copepod Pseudodiaptomus marinus Sato, 1913 has been increasingly recorded in numerous European sites, spreading at an unexpectedly fast pace over a short time-span. This species presents specific biological and behavioural traits which make it of particular interest for ecological and applied research topics. On 29–30 January 2018, 29 scientists from nine European Countries established the EUROBUS (Towards a EURopean OBservatory of the nonindigenous calanoid copepod Pseudodiaptomus marinUS) Working Group (WG). This WG aimed at creating a European network of institutions and researchers working on the various aspects of the biology and ecology of P. marinus, with an open forum where sharing experience and know-how among WG participants. This brought to an updated distribution map of P. marinus in European waters, as well as to the identification of priority research lines and potential joint initiatives under the WGEUROBUS umbrella. This contribution, stemming from the experts participating at the WG, represents the manifesto of the current and future initiatives developed within WGEUROBUS. info:eu-repo/semantics/publishedVersion

This chapter offers a critical reflection on the results of a global urban adaptation tracking study on 136 coastal cities around the world that builds a reference baseline of what is happening on the ground. It discusses adaptation planning progress in this set of the world’s largest coastal cities in relation to the emergence of a new climate urbanism. The chapter reflects on the limited policy progress in public sector climate adaptation worldwide and highlights the need for new ways to do adaptation, including new arenas, new data, new partnerships and new tools. The emergence of climate urbanism necessitates a new adaptation agenda that is more diverse and inclusive.

Chest compressions during cardiopulmonary resuscitation (CPR) generate cardiac output during cardiac arrest. Their quality performance is key to achieving the return of spontaneous circulation. Serious thoracic injuries (STIs) are common during CPR, and they can change the shape and mechanics of the thorax. Little is known about their hemodynamic effects, so a review of this emerging concept is necessary. The Campbell diagram (CD) is a theoretical framework that integrates the lung and chest wall pressure-volume curves, allowing us to assess the consequences of STIs on respiratory mechanics and hemodynamics. STIs produce a decrease in the compliance of the chest wall and lung. The representation of STIs on the CD shows a decrease in the intrathoracic negative pressure and a functional residual capacity decrease during the thoracic decompression, leading to a venous return impairment. The thorax with STIs is more vulnerable to the adverse hemodynamic effects of leaning, hyperventilation, and left ventricular outflow tract obstruction during CPR. A better understanding of the effects of STIs during CPR, and the study of avoidable injuries, can help to improve the effectiveness of chest compressions and the survival in cardiac arrest.

Background: Primary immune thrombocytopenia (ITP) is an immune-mediated acquired disorder characterized by impaired production and increased destruction of platelets with an elevated risk of bleeding. At present, diagnosis of primary ITP still remains one of exclusion with a need to discard other causes of isolated thrombocytopenia, in the absence of robust and accurate clinical and laboratory diagnostic criteria. For the diagnosis of ITP, a bone marrow (BM) study may be useful to differentiate between ITP and other diseases, such as myelodysplastic syndromes (MDS). Next generation flow (NGF) has emerged as a potential useful tool in these settings. Aim: In this study (FCR-PTI-2017-01) we prospectively evaluated the potential utility of NGF analysis of BM and peripheral blood (PB) for more accurate diagnosis of ITP vs MDS. Methods: 62 patients presenting with isolated thrombocytopenia and classified as ITP (n=20), MDS (n= 11) or inconclusive, i.e. unclassifiable, (n= 25) by BM cytomorphology, were studied. PB (n=47) and BM (n=62) analysis by NGF was blindly performed in parallel for the ITP, MDS and unclassifiable patient groups using the EuroFlow 8-colour AML/MDS classification antibody panel followed by automated analysis against pre-existing flow cytometry databases of normal healthy donor PB and BM immunophenotypic profiles. NGF BM and PB results were then compared with the BM cytomorphological diagnosis. In parallel, epidemiological data from patients were recorded in an electronic case report form (eCRF) and analyzed afterwards. Results: By cytomorphology, expert hematologists were able to conclude an ITP or MDS diagnosis in only 31 cases (55.3%). 62 BM and 48 PB samples with isolated thrombocytopenia were evaluated by NGF. Our 62 patients were allocated in 4 immunophenotypic groups attending to different BM variables observed: maturation blockades, abnormal antigen expression and cross lineage markers. Thus, we observed normal phenotype cases (n=10), isolated (unilineage) alterations (n=24), mild multilineage (>1) alterations (n=20) and severe multilineage (MDS-like) phenotypes (n=8). Cytomorphology diagnosed our cases as ITP, MDS or unclassifiable with a median number of alterations observed by BM NGF of 4 (IQR, 3-6), 2 (IQR, 1-6) and 4 (IQR, 3-5) respectively. For ITP cytomorphology group, NGF demonstrated numerous BM alterations being monocytic alterations (n=17, 94%) the most frequent finding observed. MDS presumed cases were also associated with monocytic alterations (50%) with a frequent decrease in neutrophil precursors (40%). On the contrary, when cytomorphology was not capable to establish a diagnosis, NGF showed a mixture of alterations with no clear predominance of none of them (table 1). Similarly to our work with BM NGF, we looked into a potential correlation of cytomorphology with PB NGF phenotypes. Thus, we observed a median number of alterations of 4 (IQR, 3-5), 4 (IQR, 2-4) and 4 (IQR, 3-5) in ITP, MDS and inconclusive cytomorphology groups. Increased platelet size and upregulated CD41, CD61 and CD63 glycoprotein (GP) expression were the most characteristic findings of ITP cohort. MDS subtype depicted an increased platelet size and overexpression of CD41. Downregulation of GP was restricted to patients with MDS-like phenotypes. (table 2). Nearly statistical significant differences at significance level of 90% were observed between cytomorphology and BM NGF results (p=0.179) (table 3), between platelet score and BM NGF findings (p=0.118) and also, among morphology, BM NGF and platelet score (p=0.179). Nevertheless, cytomorphology and PB NGF showed no statistical differences between them (p=0.206) (table 4). Conclusions: Limitations of BM cytomorphology when facing an isolated thrombocytopenia were demonstrated here. However, normal or unilineage BM NGF alterations may lead us to an ITP diagnosis while mild or severe multilineage BM phenotypes may correlate good with MDS. PB platelet GP expression allowed us to classify our patients in six groups (Gonzalez-Lopez/Matarraz platelet score) which may help ITP diagnosis when this score is low. Comparison of BM cytomorphology, BM NGF and PB NGF techniques at diagnosis showed statistically nearly comparable results (p=0.179), with a bigger amount of patients needed to confirm this trend. All these NGF findings may lead us to better address ITP at diagnosis. Figure 1 Figure 1. Disclosures Gonzalez-Lopez: Novartis: Other: Advisoryboard and speakers honoraria, Research Funding; Amgen: Other: Advisory board and speakers honoraria, Research Funding; Sobi: Other: Advisory board honoraria; Grifols: Other: Advisory board honoraria.

The Modern period in Europe is marked by the introduction of deep agricultural changes. In the Basque Country (northern Spain), the implantation of an intensive crop rotation was made possible by the expansion of agricultural liming, although the extent and implications of this practice have not been previously explored in depth. The present paper proposes a multidisciplinary approach to this question, based on the combined analysis of archival sources, toponymy, visual prospection focused on the presence of limekilns, and agricultural soil coring in four local contexts of the Atlantic Basque Country. The results show, for the first time, evidence of concurrent and widespread liming in this territory at the edge of the 18th century, with strong implications for the model of agricultural management in the communities involved. The spreading of mineral fertilisation reflects an intensification in the forms of agricultural management, in the framework of a new relationship between land and labour that emerged after the introduction of American crops. Continuous liming for more than 200 years exerted a deep impact in the analysed soils, with interesting socio-economic and ecological implications that are representative of the potential short-term effects that changing relationship between humans and their socio-ecological environment may produce in agricultural soils.

Strontium, carbon, and nitrogen isotopes of human bone and tooth remains have been used to reconstruct residential mobility and diet of early medieval populations at Las Gobas from the sixth to eleventh centuries. Most non-local individuals correspond to the tenth to eleventh centuries and were mostly women and infants. This residential mobility coincided with the formation of Lano village and the abandonment of artificial cave settlement. Carbon and nitrogen isotope ratios of bone collagen indicate an omnivorous homogenous diet based on terrestrial plant resources, with few animal-derived proteins from livestock. Millet consumption was restricted to an earlier period of time (seventh to ninth centuries); and in later periods (tenth to eleventh centuries), mainly C3 plants such as wheat and barley were consumed. In general, there were no dietary differences between individuals according to sex or age. Sex-related dietary differences have only been observed in the tenth to eleventh centuries, when females consumed a more vegetarian diet and less animal protein. The higher δ 15N values in infants reflect the weaning effect, while the differences in δ 15N values between young adult men and young adult women can be explained as a physiological factor related to pregnancy or different origins. In a comparison with contemporaneous medieval populations in the northern Iberian Peninsula, both δ 13C and δ 15N values suggest similar foodstuff resources and diet among Christian and Muslim populations.

espanolDesde la puesta en circulacion de Una Imagen, el mediometraje rodado por Harun Farocki en el estudio fotografico de Playboy en Munich, las interpretaciones que han ido apareciendo sobre este filme son diversas. Al considerar la perspectiva de genero, este ensayo propone un modo distinto de recorrer sus imagenes, indagando sobre cuestiones como la creacion del imaginario sexual masculino y heterosexual y la negacion del «hecho mujer» en las representaciones sexuales, el analisis de las relaciones de poder entre sexos, o la sexualizacion de la industria. Finalmente, recordando dos casos celebres del ambito audiovisual, el cine de Chantal Akerman, y de Femme Productions con Candida Royalle a la cabeza, se observa el potencial de una industria erotica o pornografica donde las mujeres puedan inventar su propia historia, el cuerpo, el deseo, la identidad. EnglishSince the entry into circulation of An Imagen, the medium-length film shot by Harun Farocki at the Playboy photographic studio in Munich, the interpretations that have been appearing on this film are diverse. In considering the gender perspective, this essay proposes a different way of traversing its images, investigating questions such as the creation of the male and heterosexual sexual imaginary and the denial of the «woman fact» in sexual representations, the analysis of relations of power between sexes, or the sexualization of the industry. Finally, recalling two famous cases in the audiovisual field, Chantal Akerman’s cinema, and Femme Productions with Candida Royalle as the main leader, we observe the potential of an erotic or pornographic industry where women can invent their own history, body, desire, identity.

The Paris Agreement requires measurement of the progress made on adaptation. Tracking the progress made by governments through analysis of policies provides insight into the goals and means to achieve adaptation targets. Here we show the current state-of-the-art in public adaptation planning affecting 136 of the largest coastal port urban agglomerations, covering 68 countries. We identify 226 adaptation policies: 88 at national level, 57 at regional/state level and 81 at city/metropolitan level. This set of adaptation policies can be considered the latest, most up-to-date database of governmental and public-led adaptations. Our analyses show that (1) in one half of cases, there is no evidence of policy implementation, (2) in almost 85% of cases, planned adaptation actions are not driven by present or future climatic impacts or risks, and (3) formal adaptation planning is relatively recent and is concentrated in more developed areas and countries. This study is part of the project CLIC (Are cities prepared for climate change? http://clic.bc3research.org/) supported by AXA Research Fund (Grant Agreement No. 4771) and the Spanish Ministry of Economy and Competitiveness (MINECO) (Grant Agreement No. IJCI-2016-28835). KV and RS acknowledge the support of the European Union programme Erasmus+.

Organizations that develop work in neighborhoods with complex social problems can benefit from collaboration with communication designers. This paper presents a study of a co-design project, developed with young people from Rego Neighborhood, in Lisbon, with the purpose of creating the image for an event called “Festival Passa Sabi – Geracao RG”. The preparation of the festival consisted of a set of meetings that involved IPAV workers, residents, former residents and the young people that we considered to have good leadership skills and responsibility. The graphic images and medias were created in close collaboration between the designers and young leaders. The responsible work carried out by the young leaders involved allowed them to acquire skills so that in the future they could lead other similar projects, building bridges between different communities. We therefore believe that this study may help other designers who work in the social field.

After the Paris Agreement that put stronger emphasis on the development of climate change adaptation policies and on the definition of financing mechanisms, there is a patent need to track whether actual planning efforts are proving sufficient. This entails the development of assessment methods and metrics as plans are drafted and actions implemented. To this end, this paper explores the concept of credibility as a critical issue in climate policy and develops an Adaptation Policy Credibility (APC) conceptual and operational assessment framework for helping to allocate public funding and private investments, and for implementing and catalysing climate policy. Through a pilot testing in four early-adopting cities (Copenhagen, Durban, Quito and Vancouver), a clear potential for large-n tracking and assessment exercises of local climate adaptation plans is envisaged. The APC approach might also be useful to guide individual cities that aim to improve their adaptation planning and policy-making processes. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor and Francis Group. This work was supported by the European Commission [653522];Eusko Jaurlaritza [POS_2016_1_0089];Spanish Ministry of Economy and Competitiveness (MINECO) [FPDI-2013-16631,IJCI-2016-28835]; This study has received funding from the European Union?s Horizon 2020 research and innovation programme under grant agreement no. 653522 (RESIN - Climate Resilient Cities and Infrastructures project). MO acknowledges funding from the Spanish Ministry of Economy and Competitiveness (MINECO) (FPDI-2013-16631 and IJCI-2016-28835). ESM?s Postdoctoral Fellowship is supported by the Basque Government (POS_2016_1_0089)

// Jesus Vallejo-Diaz 1 , Manuel Olazabal-Moran 1 , Ariel E. Cariaga-Martinez 1 , Maria J. Pajares 2, 4, 5 , Juana M. Flores 3 , Ruben Pio 2, 4, 6 , Luis M. Montuenga 2, 4, 5 , Ana Clara Carrera 1 1 Department of Immunology and Oncology, Centro Nacional de Biotecnologia (CNB-CSIC), Universidad Autonoma de Madrid, Cantoblanco, Madrid 2 Program in Solid Tumors and Biomarkers, Center for Applied Medical Research (CIMA), Pamplona, Spain 3 Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Spain 4 Navarra Health Research Institute (IDISNA), University of Navarra, Pamplona, Spain 5 Department of Histology and Pathology, School of Medicine, University of Navarra, Pamplona, Spain 6 Department of Biochemistry and Genetics, School of Science, University of Navarra, Pamplona, Spain Correspondence to: Ana Clara Carrera, email: acarrera@cnb.csic.es Keywords: lung cancer, SQCC, PIK3R2, targeted therapy, PI3K pathway Received: March 02, 2016 Accepted: October 21, 2016 Published: November 08, 2016 ABSTRACT Oncogenic mutations in the PI3K/AKT pathway are present in nearly half of human tumors. Nonetheless, inhibitory compounds of the pathway often induce pathway rebound and tumor resistance. We find that lung squamous cell carcinoma (SQCC), which accounts for ~20% of lung cancer, exhibits increased expression of the PI3K subunit PIK3R2 , which is at low expression levels in normal tissues. We tested a new approach to interfere with PI3K/AKT pathway activation in lung SQCC. We generated tumor xenografts of SQCC cell lines and examined the consequences of targeting PIK3R2 expression. In tumors with high PIK3R2 expression, and independently of PIK3CA, KRAS , or PTEN mutations, PIK3R2 depletion induced lung SQCC xenograft regression without triggering PI3K/AKT pathway rebound. These results validate the use PIK3R2 interfering tools for the treatment of lung squamous cell carcinoma.

Resumen Objetivo Valorar si el adelgazamiento del segmento uterino inferior puede aumentar el riesgo de complicaciones obstetricas. Y determinar cual es el metodo de eleccion para su correcta medicion. Material y metodo Revision bibliografica de la literatura y exposicion de un caso clinico. Resultados, caso clinico Presentamos el caso de una gestante con una degeneracion quistica de la cicatriz uterina que durante la gestacion se resuelve: se produce el parto a termino y sin complicaciones obstetricas ni neonatales. Comentario, discusion y revision de la literatura La ecografia se valora como una tecnica facil, reproducible y con una metodologia ya definida a la hora de valorar una cicatriz anterior. Aun asi, no disponemos de una tecnica estandarizada para la medicion del segmento uterino inferior. La mayoria de los autores y algunas sociedadesestan de acuerdo en que faltan estudios homogeneos y un punto de corte definitivo. A pesar de los estudios publicados, no hay datos que indiquen que la dehiscencia de la cicatriz uterina requiere reparacion para su adecuada cicatrizacion. Conclusiones El mejor metodo diagnostico es la histerosonografia. La medicion del segmento uterino inferior en el tercer trimestre podria ser util para decidir la via de parto. No se puede determinar un punto de corte para predecir el riesgo de rotura uterina o dehiscencia de cicatriz uterina. Se requieren mas estudios para establecer una tecnica adecuada y un punto de corte mediante el cual se pueda clasificar a las pacientes y tomar decisiones respecto a la via de parto. El punto de corte mas definido en los estudios para el segmento uterino inferior es 3.5-3.2. El factor mas importante de las pruebas de imagen es valorar si son capaces o no de predecir las complicaciones obstetricas que pueden suceder, el riesgo de afectacion materna o fetal y la opcion de la via vaginal. Faltan estudios para tomar decisiones clinicas conforme a estos resultados.

ICT is being rapidly introduced into development evaluation. Evaluators need to keep abreast of these important evolutions in the field in order to stay current and continue shaping the future of development work through their practice. ICT is helping to resolve some age-old issues that evaluators face, especially in terms of time, resources and data quality constraints. At the same time, the introduction of ICTs into evaluation brings a series of new ethical, political and methodological challenges that evaluators need to address. The article also weighs the potential opportunities for ICT to strengthen equity and empowerment-focused evaluation against concerns that these new technologies could result in more ‘extractive’ approaches whereby it becomes easier for international agencies and donors to collect information remotely thereby reducing the ability of local communities and civil society to participate in the development dialogue.

Transformative change for urban sustainability and resilience calls for the use of new governance approaches that take into account the complexity of urban systems and associated stakeholder knowledge and perceptions. This raises the need to explore the cognitive dimension in the management of urban resilience and transformation. The article presents a Fuzzy Cognitive Mapping approach to develop plausible policy scenarios that support the decarbonisation of the urban energy system of the city of Bilbao, Basque Country. Scenario results indicate that a combination of local institutional and social action may be most conducive for stimulating effective and sustainable transformation of Bilbao's urban energy system. We address the properties of the resulting cognitive network, with a focus on the role of the energy system's connectivity which is found to present conflicting potential for resilience and transformation.

In this paper we are going to present the case of a patient with major depression with psychotic features and a chronic-course catatonic syndrome that was resistant to psychopharmacological treatment. Treatment was started with electroconvulsive therapy and benzodiazepines, and, after an initial favourable response, it subsequently became refractory. It was decided to treat it with intravenous ketamine infusions, which is among the available therapeutic options for the treatment of resistant depression. The glutamatergic effect of ketamine is responsible for its rapid-onset therapeutic action. As an oral maintenance pharmacological treatment, it was decided to use drugs with similar pharmacological mechanisms of action (lithium, lamotrigine, clozapine, TCA). The chronic nature of the catatonic syndrome creates changes in neurotransmission patterns, which become structural patterns that are difficult to modify. Chronic depression is a neurotoxic condition and damages the microvasculature of the brain, as evidenced in white matter lesions which are irreversible. An early detection and correct treatment of catatonic syndromes continues to be a priority in our clinical practice.

This paper addresses the importance of the cognitive dimension in urban sustainability transition policy practice. Many and diverse actors with contrasting interests interact in urban sustainability transitions. Their perceptions and values impact the potential uptake of transition strategies in urban systems. It is thus important to understand how actors view themselves involved in such processes. A case study on low carbon transitions for the city of Bilbao (Basque Country) is presented to explore the barriers and opportunities for an energy transition using Q methodology. Results suggest that stakeholders' motivation and perceived capacity for change are mainly related to four main discourses: follower, visionary, pragmatist and sceptic. Results also indicate that information exchange, communication and participation in decision-making processes, bridging visionaries and pragmatists with decision-makers, are key for bringing about effective transition processes. This study contributes to identifying attitudes of actors who can negotiate urban low-carbon transitions and stresses the need to build a common shared cognitive vision of whether and how sustainable urban transformation can take place.

Social awareness in contemporary graphic design should involve new approaches in university education curricula. This paper analyses the process and results of a graphic design project called “Festival da Ponte” (“Bridge Festival”), an annual event to disseminate the social intervention programme “O Nosso Km2” (“Our Km2”). The “O Nosso Km2” project was designed to encourage active citizenship, improving the residents’ well-being, and to promote local companies and organisations and find solutions for identified problems. It started as a Calouste Gulbenkian Foundation initiative. It is a programme that deals with the intercultural and intergenerational conflicts and social problems in the area surrounding the Foundation’s headquarters. The festival organizers presented the project to our communication design master’s students and explained its origins and objectives, as well the collaboration that was expected from them. The students were also encouraged by the teacher to work on the project intensely, and they became very interested in getting to know the social context through dialogue and relationships with the people involved. Several initiatives were then developed, organizing creative activities with the residents. This project was a pedagogical contribution for the students, and potentially key for some specific fields. Firstly, it further developed essential ethical and social awareness in graphic design. But it also further developed critical faculties, attention to the specific contexts, and improved communication abilities based on the limits inherent to graphic designers’ work: budgets, the client’s expectations, the audience’s characteristics and deadlines.

Decision-making for climate change adaptation requires an integrated and cross-sectoral approach to adequately capture the complexity of interconnected systems. More meaningful decisions can be taken in an arena where different agents provide knowledge of specific domains. This paper uses a semi-quantitative method based on cognitive mapping to demonstrate how new knowledge emerges when combining knowledge from diverse agents. For the case of heatwaves in the city of Madrid (Spain) we elicit knowledge about climatic impacts across urban sectors and potential adaptation options. Knowledge is elicited in individual interviews and then aggregated using fuzzy cognitive maps. We observe that the individual maps vary considerably in size and structure and find evidence of diverse and even contradictory perceptions. There is no super-stakeholder , who theoretically could provide full knowledge about mechanisms operating in this urban system: the maximum percentage of the final aggregated map explained by a single individual is 26% in terms of concepts and 13% in terms of connections. We illustrate how the emergence of new knowledge can be sustained by combining scientific and policy expertise. Our approach supports knowledge co-production and allows to account for the interconnectedness of urban sectors under climatic impacts in view of formulating more robust adaptation strategies. © 2018 The Authors

This chapter aims to provide up-to-date quantitative estimates of the costs and benefits related to adaptation strategies for different sectors in Europe. This is done by critically evaluating modeling frameworks and contexts applied to adaptation and by describing new developments achieved in sectoral assessment models (water, agriculture, ecosystems, and health). Robust methodologies have been applied to deal with uncertainty and an advanced discussion is included on the challenges learnt to better address the upscaling issue from bottom-up adaptation processes. Costs and benefits are explored with respect to present and future climate scenarios, different socioeconomic development pathways and different adaptation strategies. In all models, the Shared Socioeconomic Pathways 2 (“middle of the road”), 3 (“fragmented world”), and 5 (“market-driven development”) are considered for comparative assessment as well as the climate scenarios according to remote concentration pathway 4.5 (average climate change) and 8.5 (high climate change) at 2050 (also see Chapter 2: Storylines and Pathways for Adaptation in Europe).

La maloclusión de clase III es la más compleja de diagnosticar y tratar, durante el crecimiento constituye uno de los retos más difíciles con los que se puede encontrar el ortodoncista ya sea en dentición decidua, mixta temprana, mixta tardía o permanente. El objetivo del tratamiento de la maloclusión de clase III en dentición decidua, es lograr un ambiente favorable para un mejor desarrollo dentofacial por ello esta maloclusión debe ser tratada a penas se diagnostica. En el presente artículo se presenta el reporte de un caso, de una paciente de 5 años con 6 meses, con una maloclusión esquelética clase III, resalte negativo, overbite 80%, patrón normodivergente.

The concept of urban resilience has so far been related mainly to climate change adaptation and disaster management perspectives. Here we aim to broaden the discussion by showing how the framework of urban resilience should be related to wider sustainability challenges, including i) climate change and natural hazard threats, ii) unsustainable urban metabolism patterns and iii) increasing social inequalities in cities. Using three case studies (flood risk management in the Dutch polders, urban–rural teleconnections driving the Bolivian quinoa market, and spatial diversity in the adaptive capacity of Kampala slums),(1) we draw out significant insights related to scales and sustainability, which will push urban resilience research forward. The key “move” is to consider both spatial and temporal interactions, in order to shift from the mainstreaming of the resilience-building paradigm toward a critical understanding and management of resilience trade-offs. While urban resilience emerges not necessarily as a normatively positive concept anymore, we argue that addressing multi-scale and temporal aspects of urban resilience will allow greater understanding of global sustainability challenges.

Background Proton pump inhibitors (PPIs) are commonly used to treat gastrointestinal diseases. Incidence of hypersensitivity reactions to PPIs has risen, likely because of increased consumption. Their diagnosis is difficult, with skin tests (STs) presenting low sensitivity, making it necessary to perform drug provocation tests (DPTs). The value of in vitro tests for the diagnosis of immediate reaction to PPI is unclear. Objective To analyze the diagnostic value of the basophil activation test (BAT) in a group of patients diagnosed with immediate allergy to omeprazole. Methods The study included 42 patients with confirmed immediate allergic reactions to omeprazole confirmed by positive ST results or DPT results and 22 age- and sex-matched subjects tolerant to PPIs. BAT was performed with omeprazole, pantoprazole, and lansoprazole using CD63 and CD203c as activation markers. Results ST sensitivity was 66.7% with a specificity of 100%. BAT using CD63 with a stimulation index of more than 2 as positive revealed a sensitivity of 73.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 66.7%. BAT was positive in 57.1% of patients with negative ST result, and thus by combining ST and BAT we can correctly diagnose 85.7% of patients with immediate allergy to omeprazole. Conclusion BAT represents a complementary tool for inclusion in the allergological workup for patients allergic to omeprazole. When combined with ST, it can be of value to guide the clinician as to whether to perform a DPT.

Azken urteotan, Gipuzkoan, listeriosiaren intzidentziaren igoera esanguratsua atzeman da. Arrisku-taldeen artean, haurdun dauden emakumeak aurkitzen dira. Transmisio-bide ohikoena helduetan, kutsatutako elikagaien bidezkoa da, eta fetuaren eta jaioberrien kasuan, berriz, transmisio bertikala (plazenta edo erditze-kanalean zehar). Kasuen erregistroa Ingurumen Ikerkuntza eta Osasun Publikoko teknikariek egin dute eta laginen azterketa molekularra Donostia Ospitaleko Mikrobiologia Zerbitzuan eta Mikrobiologia Zentro Nazionalean egin dira, PFGE teknika erabiliz andui ezberdinakisolatzeko. Aldi berean, Gipuzkoan izandako azken urteotako listeriosi kasuen bilaketa klinikoa eginez, zehaztu ahal izan da zein izan den haurdun eta jaioberrien kasuen ezaugarri eta bilakaera. 2008-2014 urte bitartean, Gipuzkoan 73 kasu berri jakinarazi ziren, eta horietatik 52, 2012-2014 urte bitartean. Urte horietako kasuen informazio kliniko eta mikrobiologikoak aztertu dira lan honetan. 2013. urtean, 22 kasurekin, azken 10 urteetako intzidentzia hirukoiztu zen. Urte horretan, haurdun eta jaioberriak arrisku-taldeen % 50 izan ziren (9 kasu).Haurdunaren infekzioa detektatzea zaila izan liteke, sintoma inespezifikoak eragiten ditu-eta (digestio-aparatuarekin lotutako sintomak eta sukarra), baina umekiarengan ondorio kaltegarriak izan ditzake (abortu septikoa, goiztiartasuna). Lan honetan aztertutako kasu gehienetan haurdunak sukarrarekin agertu ziren eta kasu gehienetan erditze goiztiarra gertatu zen. Kasuen banaketa eta ezaugarriak ezberdinak izan dira urte batetik bestera. 2012ko kasuek banaketa topografiko zehatz bat izan zuten eta 2014ko kasuak, ordea, elikagai konkretu bati loturikoak izan dira. Lortutako datuen arabera, eta behaketa horren ostean infekzio-bide nagusia elikagai kutsatuen bidezkoa dela ohartuta, prebentzio-neurriak areagotu behar direla atzeman dugu, eta, horretarako, elikagaien inguruko heziketa egokia eta lehen mailako prebentzio-neurriak azaltzen ditugu.

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis.

Objectives To compare the efficacy and safety of innovator infliximab (INX) and CT-P13, an INX biosimilar, in active rheumatoid arthritis patients with inadequate response to methotrexate (MTX) treatment. Methods Phase III randomised, double-blind, multicentre, multinational, parallel-group study. Patients with active disease despite MTX (12.5–25 mg/week) were randomised to receive 3 mg/kg of CT-P13 (n=302) or INX (n=304) with MTX and folic acid. The primary endpoint was the American College of Rheumatology 20% (ACR20) response at week 30. Therapeutic equivalence of clinical response according to ACR20 criteria was concluded if the 95% CI for the treatment difference was within ±15%. Secondary endpoints included ACR response criteria, European League Against Rheumatism (EULAR) response criteria, change in Disease Activity Score 28 (DAS28), Medical Outcomes Study Short-Form Health Survey (SF-36), Simplified Disease Activity Index, Clinical Disease Activity Index, as well as pharmacokinetic (PK) and pharmacodynamic (PD) parameters, safety and immunogenicity. Results At week 30, ACR20 responses were 60.9% for CT-P13 and 58.6% for INX (95% CI −6% to 10%) in the intention-to-treat population. The proportions in CT-P13 and INX groups achieving good or moderate EULAR responses (C reactive protein (CRP)) at week 30 were 85.8% and 87.1%, respectively. Low disease activity or remission according to DAS28–CRP, ACR–EULAR remission rates, ACR50/ACR70 responses and all other PK and PD endpoints were highly similar at week 30. Incidence of drug-related adverse events (35.2% vs 35.9%) and detection of antidrug antibodies (48.4% vs 48.2%) were highly similar for CT-P13 and INX, respectively. Conclusions CT-P13 demonstrated equivalent efficacy to INX at week 30, with a comparable PK profile and immunogenicity. CT-P13 was well tolerated, with a safety profile comparable with that of INX. ClinicalTrials.gov Identifier NCT01217086

International audience; Globally, efforts are underway to reduce anthropogenic greenhouse gas emissions and to adapt to climate change impacts at the local level. However, there is a poor understanding of the relationship between city strategies on climate change mitigation and adaptation and the relevant policies at national and European level. This paper describes a comparative study and evaluation of cross-national policy. It reports the findings of studying the climate change strategies or plans from 200 European cities from Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Italy, Netherlands, Spain and the United Kingdom. The study highlights the shared responsibility of global, European, national, regional and city policies. An interpretation and illustration of the influences from international and national networks and policy makers in stimulating the development of local strategies and actions is proposed. It was found that there is no archetypical way of planning for climate change, and multiple interests and motivations are inevitable. Our research warrants the need for a multi-scale approach to climate policy in the future, mainly ensuring sufficient capacity and resource to enable local authorities to plan and respond to their specific climate change agenda for maximising the management potentials for translating environmental challenges into opportunities. © 2015 Elsevier Ltd.

Traditional top-down and technocratic approaches seem to be insufficient to tackle the many conflicts related to the sustainable use of natural resources. At the same time, reductionist and mono-disciplinary approaches lack the capacity to capture the complex interactions within evolving socio-ecological systems. Coastal zone management is an area that provides a clear example of such difficulties. In this paper we explore the scope of a participatory integrated assessment process, known as Social Multi-Criteria Evaluation (SMCE), in the context of Integrated Coastal Zone Management (ICZM). Through a two-year collaborative research process, between an interdisciplinary group of researchers and a diverse group of stakeholders in the Urdaibai Estuary (a Biosphere Reserve in the Basque Country, Northern Spain), we show that improving the integration of diverse expertise and values can lead, through a mutual learning process, to the definition of relevant policy options and sound decisions in the face of complexity, value conflict and unavoidable uncertainty.

An integrated methodology has been designed to assist sustainable decision-making processes managed by spatial planners and developers in public authorities and the private sector. It emphasises public participation at early stages of spatial planning for the integration of sustainability criteria. It also acts as an integrated decision-support system for use at the plans and programmes approval stages to validate and complement strategic environmental assessment. A toolbox using state-of-the-art planning and geographic information system-based methods is complemented by five modules – conceptual models, system indicators, multi-criteria analysis, database management and geographic information system framework – which may be integrated in stakeholder participation tools throughout the implementation process. The approach therefore facilitates coherent responses to the following questions: What is the best way to design an integrated sustainable planning system? What is the best method to integrate sustainability criteria at early stages of planning? How can sustainability yardsticks successfully integrate environmental, social and economical aspects? Finally, how can stakeholder interest and participation in the planning process be stimulated? A scenario-based case-study of spatial planning in urban and peri-urban areas of Vitoria-Gasteiz, the capital of the Basque autonomous region in Spain, is chosen to report on the system validation.