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Las devoluciones en caliente en Melilla, una ciudad española ubicada en la frontera terrestre entre Europa y Marruecos, en el norte de África, vulneran la normativa europea de protección de derechos humanos al no contemplar la identificación del migrante que salta la valla que separa ambos territorios, lo que impide reclamar esa decisión administrativa. De esta forma se le priva del derecho a la tutela judicial efectiva, consagrado en la Constitución Española. Tampoco se le permite solicitar asilo o acceder a servicios de intérprete o asistencia letrada junto a la alambrada, y se le devuelve por la vía de hecho a un país (Marruecos) donde ser migrante irregular es un delito. Se obvia así el principio de no devolución a un lugar que no es seguro y, en la mayoría de los casos, la prohibición de las expulsiones colectivas. Este artículo estudia el marco legal de las devoluciones en caliente, en vísperas de la sentencia del Tribunal Europeo de Derechos Humanos de febrero de 2020, que exoneró a España de responsabilidad al poner la seguridad de un Estado por encima de los derechos humanos.

Wind farm implementation is a rapidly growing source of landscape transformation that may alter ecological processes such as predator–prey interactions. We tested the hypothesis that wind farms increase the activity of nest predators and, ultimately, increment ground-nest predation rates. We placed 18 plots in Iberian shrub-steppes (11 at control and seven at wind farm sites), each one comprised nine artificial ground-nests (three quail eggs/nest). Artificial nests were placed during two events: at the beginning (April) and at the end (June) of the breeding season in 2016 (n = 324 artificial nests). We estimated the relative abundance of avian and large mammalian predators in the surroundings of each plot and recorded nest fate after 12 days exposure. We also measured variables at landscape and microhabitat scale that potentially affect predator abundance and nest predation. Wind farm sites contained higher cover of gravel roads and more large mammalian predators. Moreover, the abundance of large mammalian predators increased with surrounding cover of both trees and gravel-roads. Avian predator abundance and nest predation rates did not differ between control and wind farm sites, though nest predation did increase with the surrounding cover of crops and gravel roads. Lastly, nest predation was higher at the end of the breeding season and decreased with moss and lichen cover. Our results support previous evidence on the increase of mammalian predator abundance as the surface area of gravel-roads increases, pointing towards a potential mechanism for wind farms leading to rise ground-nest predation. Future wind energy projects should minimize the development of gravel-roads for wind turbine access or maintenance. This study was supported by Tragsatec—GrupoTragsa (project entitled “Effects of wind farms on Dupont’s lark nest predation”), the European Commission (Life-Ricotí project LIFE15-NAT-ES-000802) and the BBVA Foundation (BBVA-Dron Ricotí project). This paper contributes to project REMEDINAL-3 from CAM.

Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40·0 (30·0 to 53·0). 1397 (66·9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87·5%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64·0%) of 2088 patients were given benzodiazepines for a median of 7·0 days (4·0 to 12·0) and 1481 (70·9%) were given propofol for a median of 7·0 days (4·0 to 11·0). Median Richmond Agitation–Sedation Scale score while on invasive mechanical ventilation was –4 (–5 to –3). 1704 (81·6%) of 2088 patients were comatose for a median of 10·0 days (6·0 to 15·0) and 1147 (54·9%) were delirious for a median of 3·0 days (2·0 to 6·0). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p≤0·04), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p

Over the last decades, several studies have analyzed the collocational preferences of particular sets of near synonyms from a synchronic viewpoint, while their diachronic development has generally been disregarded. The aim of this paper is to partially fill this gap by examining the collocational behavior of the adjectives fragrant, perfumed, and scented, which denote the concept sweet smelling, over the time span 1810–2009. To this purpose, instances of the three near-synonyms and their L5–R5 collocates were extracted from the Corpus of Historical American English (COHA) and then submitted to statistical modeling. Results indicate that, at the beginning of the time span analyzed, the collocational preferences of scented and perfumed are very similar but, over time, scented becomes semantically closer to fragrant, while at the same time taking over some of its functions.

Increasing food security and preventing further loss of biodiversity are two of humanity's most pressing challenges. Yet, efforts to address these challenges often lead to situations of conflict between the interests of agricultural production and those of biodiversity conservation. Here, we focus on conflicts between livestock production and the conservation of wild herbivores, which have received little attention in the scientific literature. We identify four key socio-ecological challenges underlying such conflicts, which we illustrate using a range of case studies. We argue that addressing these challenges will require the implementation of co-management approaches that promote the participation of relevant stakeholders in processes of ecological monitoring, impact assessment, decision-making, and active knowledge sharing.

Constitutive activity of the immune surveillance system detects and kills cancerous cells, although many cancers have developed strategies to avoid detection and to resist their destruction. Cancer immunotherapy entails the manipulation of components of the endogenous immune system as targeted approaches to control and destroy cancer cells. Since one of the major limitations for the antitumor activity of immune cells is the immunosuppressive tumor microenvironment (TME), boosting the immune system to overcome the inhibition provided by the TME is a critical component of oncotherapeutics. In this article, we discuss the main effects of the TME on the metabolism and function of immune cells, and review emerging strategies to potentiate immune cell metabolism to promote antitumor effects either as monotherapeutics or in combination with conventional chemotherapy to optimize cancer management., Intramural Research Programs of the National Institutes of Health, National Cancer Institute and National Heart, Lung, and Blood Institute. JT is supported by the Ministry of Science and Innovation (MICINN) of Spain (grants RYC2018-026050-I and PID2019-105665RA-I00)

The New Jersey Pediatric Residency Advocacy Collaborative (NJPRAC) is a statewide collaborative with faculty leads from each of the 10 New Jersey pediatric residency programs. The 2 major goals of the collaborative were to build community partnerships between pediatric residency programs and local organizations and develop a core advocacy curriculum. In this article, we focus on how the NJPRAC built community partnerships with Family Success Centers (FSCs) across the state over the course of a 2-year period. FSCs are located within every county in the state and fall under the New Jersey Department of Children and Families, providing resources and supports for families in crisis, with a focus on child abuse prevention services. Amid this growing partnership, the coronavirus disease 2019 (COVID-19) pandemic forced the NJPRAC to swiftly pivot its partnership and develop innovative programs to support families during the COVID-19 pandemic. As FSC leadership communicated families’ concerns to the collaborative, we initiated the Virtual House Call webinar, which incorporated pediatricians, community leaders, and allied health professionals to answer COVID-19 questions. These webinars quickly expanded into weekly interprofessional series, with experts in mental health, law, nutrition, and dentistry partnering with pediatricians from various subspecialties. Key to the webinars’ success was responding in real time to audience questions, collaborating with the FSC leadership on content, and garnering the support from the local New Jersey Chapter, American Academy of Pediatrics and the national American Academy of Pediatrics. A key challenge remains to meaningfully incorporate pediatric trainees into community partnerships. The NJPRAC plans to continue the Virtual House Call series with continuous input from the FSCs and participating families.

[EN]: The next reform ofthe EU Common Agricultural Policy (CAP) for the period 2021-2027 (currently extended to 2023-2030) requires the approval by the European Commission of a Strategic Plan with environmental objectives for each Member State. Here we use the best available scientific evidence on the relationships between agricultural practices and biodiversity to delineate specific recommendations for the development of the Spanish Strategic Plan. Scientific evidence shows that Spain should (1) identify clear regional biodiversity targets and the landscape-level measures needed to achieve them; (2) define ambitious and complementary criteria across the three environmental instruments (enhanced conditionality, eco-schemes, and agri-environmental and climate measures) of the CAP’s Green Architecture, especially in simple and complex landscapes; (3) ensure that other CAP instruments (areas of nature constraints, organic farming and protection of endangered livestock breeds and crop varieties) really support biodiversity; (4) improve farmers’ knowledge and adjust measures to real world constraints; and (5) invest in biodiversity and ecosystem service monitoring in order to evaluate how the Plan achieves regional and national targets andto improve measures if targets are not met. We conclude that direct assessments of environmental objectives are technically and economi- cally feasible, can be attractive to farmers, and are socially fair and of great interest for improving the environmental effectiveness of CAP measures. The explicit and rigorous association of assessments and monitoring, relating specific environmental indicators to regional objectives, should be the main criterion for the approval of the Strategic Plan in an environmentally-focused CAP2023-2030., [ES]: La reforma de la Política Agraria Común (PAC) para el periodo 2021-2027 (extendido en la actualidad a 2023-2030) exige que la Comisión Europea apruebe un Plan Estratégico por cada Estado Miembro con claros objetivos ambientales. En este trabajo desarrollamos recomendaciones específicas para la elaboración del Plan Estratégico para los sistemas agrícolas españoles, basadas en la mejor evidencia científica disponible sobre las relaciones entre la gestión agrícola y los componentes de la biodiversidad. La evidencia científica muestra que España debe 1) identificar objetivos regionales claros relativos a la biodiversidad de los medios agrarios y las medidas a nivel paisajístico necesarias para alcanzarlas; 2) definir criterios ambiciosos y complementarios para los tres instrumentos ambientales (condicionalidad extendida, eco-esquemas y medidas agroambientales y climáticas) de la Arquitectura Verde de la PAC, especialmente en paisajes sencillos y complejos; 3) garantizar que otros instrumentos de la PAC (zonas desfavorecidas, agricultura ecológica y protección de razas ganaderas y variedades de cultivos en peligro de extinción) favorecen realmente la diversidad biológica; 4) mejorar el conocimiento de los agricultores y ajustar las medidas a las limitaciones del mundo real; y 5) invertir en seguimiento de la biodiversidad y sus servicios ecosistémicos asociados con el fin de evaluar si el Plan alcanza los objetivos regionales y nacionales y mejorarlos adaptativamente si no lo consigue. Concluimos que la evaluación directa de los objetivos ambientales es técnica y económicamente viable, puede ser atractiva para los agricultores, es socialmente justa y de gran utilidad en la mejora de la efectividad de las medidas de la PAC. Una combinación rigurosa de seguimiento y evaluación de medidas y objetivos adaptados regionalmente mediante indicadores ambientales directos y claros debería ser el criterio que guíe la aprobación del Plan Estratégico para una PAC 2023-2030 centrada en el medio ambiente y orientada a la conservación de la biodiversidad.

We review two cases of adolescents with orbital cellulitis, sinusitis and SARS- CoV-2 infection presenting to emergency departments within a 24 hour period. SARS-CoV-2 samples obtained within 24 hours were positive, supporting prior infection despite relatively limited early symptoms of COVID-19. Unusual clinical and radiographic characteristics included hemorrhagic abscess with blood of varying age in the first, intracranial epidural abscess in the second, radiographic signal consistent with hemorrhagic or thrombotic phenomena, retro-maxillary antral fat changes, and meningeal enhancement or extension in both cases. Radiographic findings thereby mimic fungal infection, although final cultures and ancillary investigation for allergic and invasive fungal disease have remained negative. These cases highlight two unusual orbital presentations of cellulitis occurring in the context of SARS-CoV-2 co-infection.

Background/aim The Fistula Risk Score (FRS), as other risk scores, is a validated model predicting the development of a clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). We evaluated risk factors related with CR-POPF and correlated four predictive scores with the likelihood of developing CR-POPF in our cohort. Patients and methods The records of 107 patients who underwent PD from 2007 to 2015 were obtained from a prospectively maintained database and reviewed. CR-POPFs were categorized by the International Study Group of Pancreatic Fistula (ISGPF) standards. Firstly, a univariate and multivariate analysis of risk factors related to CR-PPOPF was performed, and then the data were correlated with FRS, Wellner's, Robert's and Yamamoto's scores. Results In total, 30 patients developed a CR-POPF. On multivariate analysis, abdominal thickness (OR=1.02, p=0.010), Wirsung's duct diameter (OR=0.57, p=0.029), pancreatic consistency (OR=3.18, p=0.011) and histological diagnosis of the lesion (OR=1.65, p=0.012) represented independent predictive factors of CR-POPF. FRS (R2=0.596, p=0.001), Wellner's score (R2=0.285, p=0.005) and Roberts' score (R2=0.385, p=0.002) correlated with the likelihood of developing CR-POPF. Conclusion Abdominal thickness, Wirsung's duct diameter, pancreatic consistency and histological diagnosis were independent predictive factors of CR-POPF. Predictive scores reflected the likelihood of CR-POPF, FRS being the score with the highest predictive value.

A fasting mimetic diet blunts inflammation, and intermittent fasting has shown ameliorative effects in obese asthmatics. To examine whether canonical inflammatory pathways linked with asthma are modulated by fasting, we designed a pilot study in mild asthmatic subjects to assess the effect of fasting on the NLRP3 inflammasome, Th2 cell activation, and airway epithelial cell cytokine production. Subjects with documented reversible airway obstruction and stable mild asthma were recruited into this study in which pulmonary function testing (PFT) and PBMCextraction was performed 24 h after fasting, with repeated PFT testing and blood draw 2.5 h after refeeding. PFTs were not changed by a prolonged fast. However, steroid-naive mild asthmatics showed fasting-dependent blunting of the NLRP3 inflammasome. Furthermore, PBMCs from these fasted asthmatics cocultured with human epithelial cells resulted in blunting of house dust mite–induced epithelial cell cytokine production and reduced CD4+ T cell Th2 activation compared with refed samples. This pilot study shows that prolonged fasting blunts the NLRP3 inflammasome and Th2 cell activation in steroid-naive asthmatics as well as diminishes airway epithelial cell cytokine production. This identifies a potential role for nutrient level–dependent regulation of inflammation in asthma. Our findings support the evaluation of this concept in a larger study as well as the potential development of caloric restriction interventions for the treatment of asthma.

Background Assessment using entrustable professional activities (EPAs) is currently under study as a joint effort of the American Board of Pediatrics and program director community. However, limited evidence exists for the feasibility of EPA-based assessment in pediatrics. Aim Among pediatric residency programs that implemented EPA-based assessment over 3 academic years (2015-16, 2016-17, 2017-18), determine how often programs were “unable to assess” a resident on a given EPA. Methods 23 programs reported clinical competency committee (CCC) determined EPA supervision level assignments for all residents in their program for a subset of 5-6 of the 17 general pediatrics EPAs biannually (Fall and Spring), except interns who were only assessed at the end of the academic year (Spring). They indicated “unable to assess” whenever applicable. Results Across the 5 data collection cycles, there were 29,643 opportunities to assign an EPA supervision level to 1987 residents from all three post-graduate years. Of these, 4140 assignments (14%) were deemed “unable to assess.” Across all EPAs, this determination was made less often in mid-year reports than year-end reports (p=.005). Post-graduate year 3 (PGY3) residents and PGY2 residents had significantly lower frequencies of “unable to assess” assignments when compared with PGY1 residents (Figure). EPAs with the lowest rates of “unable to assess” included: EPA 4 (patients with acute, common dx) at 0.4%, EPAs 10 (initial resuscitation/stabilization) and 16 (handovers) at 0.9%, EPA 11 (manage information) at 4%, and EPA 13 (practice management) at 5%. EPAs with the highest rates of “unable to assess” included EPA 8 (transition to adult care) at 43%, EPA 17 (procedures) at 27%, EPA 14 (quality improvement) at 20%, and EPAs 12 (make referrals) and 9 (behavioral and mental health) at 14%. Conclusions “Unable to assess” assignments are related to the given EPA, training year, and timing of assessment within the academic year. CCCs may be less likely to assign EPA supervision levels at timepoints viewed as higher stakes, such as transition from one training year to the next. Future work should explore this further and consider the etiology behind high levels of inability to assess some EPAs in particular.

The aim was to evaluate the effects of judo combat on the athletes’ postural control (PC) and physiological loading before, during and after a simulated match. Seventeen under-20 regional and national level athletes completed one modified 7-min match. At baseline, during the combat (3rd and 7th minutes) and 2-min post-match centre of pressure (CoP) parameters were assessed. Heart rate (HR), blood lactate (BLa) and rating of perceived exertion (RPE) and local RPE (LRPE) were collected. Significant increments were observed in CoP mean positioning and velocity at 3rd and 7th minutes, but the CoP deviation in both axes was unaffected. HR and BLa were elevated at 3rd and 7th minutes, and they remained elevated 2-min post-match. However, CoP returned to baseline 2-min post-match. RPE was elevated at 3rd and 7th minutes and the greatest effort was displayed in the Deltoid and Quadriceps. Thus, one simulated judo match stimulates a significant metabolic response and balance is degraded, with the greatest effects on the anterior–posterior axis and it recovers to baseline level after 2 min of passive rest. The physiological load cannot be regarded as a potential predictor variable of CoP. Overall, a judo match predominantly affects the upper body than the other body parts.

Objective To describe the clinical and electromyographic characteristics of blepharospasm caused by selective involvement of the pars pretarsalis of the orbicularis oculi muscle. Methods Clinical assessment and simultaneous electromyographic recordings from levator palpebrae superioris and pars orbitaria and pretarsalis of orbicularis oculi muscles were performed in patients with blepharospasm and primary failure to botulinum toxin injections. Patients with selective abnormal electromyographic activity of the pars pretarsalis of the orbicularis oculi muscle were identified and treated with selective pretarsal injections of botulinum toxin. Results We found 24 patients with pretarsal blepharospasm confirmed by the electromyographic assessment. All of them were functionally blind. Three clinical-electromyographic patterns were identified: (a) Impairment of eyelid opening; (b) Increased blinking; (c) Spasms of eye closure combined with varying degrees of excessive blinking and impairment of eye-opening. Pretarsal injections of botulinum toxin induced a significant improvement in all patients and 50 % regained normal or near-normal vision. The clinical improvement was sustained after repeated pretarsal injections. Conclusions Pretarsal blepharospasm can be suspected on clinical grounds and it can be confirmed by electromyographic recordings. Significance Recognition of this type of blepharospasm is important because of its excellent response to botulinum toxin injections applied into the pretarsal part of the orbicularis oculi muscle.

Farmland bird populations have strongly declined across Europe over the last decades due to agriculture intensification, despite successive reforms of EU’s Common Agricultural Policy (CAP). In parallel, CAP has led to a reduction of fallow land, a critical habitat for biodiversity in agroecosystems. Fallow land in Spain, a country harboring the largest European populations of many endangered farmland birds, has decreased by 1.1 million ha in 15 years. The significant positive relationship between yearly change rates of the Spanish Farmland and Cereal Bird Indices (FBI and CBI) and fallow surface change highlights the adequacy of fallow land cover as an indicator of the state of farmland bird communities at country level. Moreover, the strong and positive association between the reduction in abundance of the fallow specialist little bustard and fallow surface suggests a potential causal link between these two factors. These results highlight the need for a new CAP that guarantees the maintenance of fallow land in European agroecosystems if farmland bird populations are to be conserved.

L-DOPA is the main pharmacological therapy for Parkinson's disease. However, long-term exposure to L-DOPA induces involuntary movements termed dyskinesia. Clinical trials show that dyskinesia is attenuated by metabotropic glutamate receptor type 5 (mGluR5) antagonists. Further, the onset of dyskinesia is delayed by nicotine and mGluR5 expression is lower in smokers than in non-smokers. However, the mechanisms by which mGluR5 modulates dyskinesia and how mGluR5 and nicotine interact have not been established. To address these issues, we studied the role of mGluR5 in D1R-containing neurons in dyskinesia and examined whether nicotine reduces dyskinesia via mGluR5. In the aphakia mouse model of Parkinson's disease, we selectively knocked down mGluR5 in D1R-containing neurons (aphakia-mGluR5KD-D1). We found that genetic downregulation of mGluR5 decreased dyskinesia in aphakia mice. Although chronic nicotine increased the therapeutic effect of L-DOPA in both aphakia and aphakia-mGluR5KD-D1 mice, it caused a robust reduction in dyskinesia only in aphakia, and not in aphakia-mGluR5KD-D1 mice. Downregulating mGluR5 or nicotine treatment after L-DOPA decreased ERK and histone 3 activation, and FosB expression. Combining nicotine and mGluR5 knockdown did not have an added antidyskinetic effect, indicating that the effect of nicotine might be mediated by downregulation of mGluR5 expression. Treatment of aphakia-mGluR5KD-D1 mice with a negative allosteric modulator did not further modify dyskinesia, suggesting that mGluR5 in non-D1R-containing neurons does not play a role in its development. In conclusion, this work suggests that mGluR5 antagonists reduce dyskinesia by mainly affecting D1R-containing neurons and that the effect of nicotine on dyskinetic signs in aphakia mice is likely via mGluR5., This work was supported by grants from the Spanish Ministerios de Economía y Competitividad and of Sanidad Política Social e Igualdad, ISCIII: SAF2016-78207-R, CIBERNED ref. CB06/05/0055, PNSD 2016/33, and PCIN 2015-098; and Foundation Ramon Areces and Secretaria de Ciencia Tecnología e Innovación de la Ciudad de Mexico (037-2016) to RM.

For children with brainstem encephalitis or encephalomyelitis, clinicians should look for enterovirus and not limit testing to cerebrospinal fluid., We conducted an observational study from January 2016 through January 2017 of patients admitted to a reference pediatric hospital in Madrid, Spain, for neurologic symptoms and enterovirus infection. Among the 30 patients, the most common signs and symptoms were fever, lethargy, myoclonic jerks, and ataxia. Real-time PCR detected enterovirus in the cerebrospinal fluid of 8 patients, nasopharyngeal aspirate in 17, and anal swab samples of 5. The enterovirus was genotyped for 25 of 30 patients; enterovirus A71 was the most common serotype (21/25) and the only serotype detected in patients with brainstem encephalitis or encephalomyelitis. Treatment was intravenous immunoglobulins for 21 patients and corticosteroids for 17. Admission to the pediatric intensive care unit was required for 14 patients. All patients survived. At admission, among patients with the most severe disease, leukocytes were elevated. For children with brainstem encephalitis or encephalomyelitis, clinicians should look for enterovirus and not limit testing to cerebrospinal fluid.

Chronic neurotoxicity caused by lithium salts can be reversible or irreversible and may appear after years of treatment, even at serum levels considered within the usual therapeutic range. The authors present the case of a patient with bipolar disorder who developed dementia at the age of 54 after being treated with lithium carbonate at therapeutic levels for 4 years. Nevertheless, lithium treatment was continued. At age 56, the patient presented with an acute encephalopathy caused by toxic lithium levels, which resolved only after lithium carbonate was discontinued. Full recovery from the dementia, which had started 2 years earlier, occurred only after cessation of lithium. The authors conclude that when patients treated with lithium develop subacute cognitive impairment, the possibility of lithium toxicity should be considered, even if the serum levels are considered within the therapeutic range. A long duration of neurotoxicity associated with lithium treatment does not necessarily indicate an irreversible prognosis.

Objective Our objective is to use the area of the motor evoked potential (MEP) as a diagnostic tool for intraoperative radicular injury. Methods We analyzed the intraoperative neurophysiological monitoring data and clinical outcomes of 203 patients treated for dorsolumbar spine deformity. The decrease in amplitude was compared with the reduction in the MEP area. Results In 11 cases, new intraoperative injuries occurred, nine of them were lumbar radiculopathies. Our new criteria, a decrease MEP area of 70%, yielded a sensitivity and specificity of 1, since it detected all the radicular injuries, with no false positive cases. Using a 70% amplitude decrease criteria, we obtained a sensitivity of 0,89 and a specificity of 0,99. A lower threshold (65% amplitude reduction) yielded a higher number of false positives, whereas a higher threshold (75 and 80%) gave rise to a higher number of false negatives. Conclusions The measurement of the MEP area gave evidence to be more reliable and accurate than the measurement of the amplitude reduction in order to assess and detect intraoperative radicular injuries. Significance The criterion of decrease of the MEP area has a higher reliability and accuracy in the detection of intraoperative radicular lesions than the amplitude reduction.

Progressive resistance exercise (PRE) can have a positive effect in individuals with Parkinson’s disease (PD). However, the effect of PRE may vary with the clinical subtype of PD. To date, no study has assessed the effects of PRE in the different subtypes of PD. AIM: The aim of the present study was to assess the effects of PRE in PD patients with akinesia and rigidity (AR-subtype). DESIGN: A randomized controlled trial was conducted. SETTING: Outpatients clinics of the Bierzo Parkinson Association (Ponferrada, Spain) and the Asturias Parkinson Association (Oviedo, Spain). POPULATION: Twenty-eight patients with AR-subtype PD were randomized into an Experimental Group (EG, N.=13) and Control Group (CG, N.=15). METHODS: Static posturography (Centre of Pressure -CoP- parameters), gait (the Ten-Meter Walk Test [TMWT]), freezing of gait (the Freezing of Gait Questionnaire [FOG-Q]), the motor portion of the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and patient-perceived quality of life (the 39-item Parkinson’s disease Questionnaire [PDQ39]), were assessed at pre-test, post-test, and re-test. Ratings of perceived exertion (RPE) (Borg >6-20 Scale) were recorded at the end of each PRE training session. RESULTS: The EG displayed significant ameliorations in Length (CoP parameters) from pre- to post-test (P=0.048), in speed of fast rhythm walking (TMWT) from pre- to post-test (P=0.000), and from pre- to re-test (P=0.027), and in the PDQ39 Score from pre- to post-test (P=0.024). No significant differences were detected in Area or Speed (CoP parameters), speed of preferred rhythm walking (TMWT), FOG-Q scores, or the motor portion of the MDS-UPDRS scores. The EG reported a mean RPE of 9.95 (between “very light” and “fairly light”) for the whole training program. CONCLUSIONS: These findings provide support for the use of PRE training in the rehabilitation of individuals with AR-subtype PD, as it can improve static posturography, gait, and quality of life. Furthermore, RPE scores showed that individuals with AR-subtype PD consider that PRE training require only light efforts. CLINICAL REHABILITATION IMPACT: The PRE training can be a helpful and fruitful rehabilitation tool for AR-subtype PD patients. Sin financiación 2.208 JCR (2017) Q1, 15/65 Rehabilitation 0.754 SJR (2017) Q1, 31/125 Rehabilitation; Q2, 53/201 Physical Therapy, Sports Therapy and Rehabilitation No data IDR 2017 UEM

Audio recording systems coupled with automated song recognition are commonly being used for monitoring wildlife. Recorders usually differ in cost and effectiveness, and their performance may vary with source distance, wind speed and acoustic source direction, among other factors. We here assess the cost-effectiveness of five audio systems considering such factors as distance and singing direction. We developed field tests using playback of Dupont's Lark Chersophilus duponti songs from nine fixed locations at distances of 1 to 256m, played towards or away from the recorders' position. We selected this species because its very characteristic song should be easily identified by automated signal recognition software. Field tests were carried out during March 2016 in level dwarf-shrub steppe (mean height < 40cm) in NE Spain. We found large differences in effectiveness between recorders. The number of songs detected by an automated signal recognition algorithm significantly decreased with distance and when playback was angled away from the recorder position, a factor never previously tested. Finally, we give the design of a cost-effective Autonomous Recording Unit, based upon the most effective recorder. We recommend researchers working with acoustic recorders to evaluate the performance of several devices before making a selection for long-term monitoring programmes, and to consider such factors such as singing direction in their analyses. —perez-Granados, C., Bota, G., Giralt, D., Albarracin, J. & Traba, J. (2019). Cost-effectiveness assessment of five audio recording systems for wildlife monitoring: differences between recording distances and singing direction. Ardeola, 66: 311-325.

The goal of this study was to specify symptoms frequently neglected in concussion. Health care professionals correctly identified 75% of concussion symptoms, whereas children and caregivers both only correctly identified 31%. Most people correctly identified headache and ataxia, but many missed photophobia, paresthesias, anxiety and depression. This study demonstrates the general lack of knowledge regarding specific signs and symptoms of concussion.

There is growing concern about the effect of livestock on wild ungulate populations, particularly in arid ecosystems, where waterholes are an extremely scarce resource, around which animals tend to gather, primarily in the dry season. This situation is worrying in South American deserts, where guanaco is the native species that often shares trophic and water resources with livestock from local communities, even inside protected areas. We assess through general linear modeling (GLM) the use of waterholes by guanaco and two introduced species, free-ranging cattle and feral donkeys, during the summer-wet and winter-dry seasons, in an arid, water-limited region in northwestern Argentina. Waterholes were more intensively used in the dry than the wet season by all three herbivores. However, introduced ungulates did not use all of the waterholes, whereas guanaco used them all with equal intensity, which points to an apparent absence of interference probably due to the low density of the introduced species. Nevertheless these results could mask negative effects regarding the risk of parasite transmission, the under-use of one of the waterholes, and the risk related to increasing livestock density in a near future. Therefore, it would be advisable to make long-term monitoring to prevent potentially negative effects on guanacos. Fil: Acebes, Pablo. Universidad Autónoma de Madrid; España Fil: Malo, Juan E.. Universidad Autónoma de Madrid; España Fil: Ovejero Aguilar, Ramiro Jose Antonio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Investigaciones de las Zonas Áridas. Provincia de Mendoza. Instituto Argentino de Investigaciones de las Zonas Áridas. Universidad Nacional de Cuyo. Instituto Argentino de Investigaciones de las Zonas Áridas; Argentina Fil: Traba, Juan. Universidad Autónoma de Madrid; España

The aim of this study was to assess whether supervised slackline training reduces the risk of falls in people with Parkinson's disease (PD).Twenty-two patients with idiopathic PD were randomized into experimental (EG, N = 11) and control (CG, N = 11) groups. Center of Pressure (CoP), Freezing of Gait (FOG), and Falls Efficacy Scale (FES) were assessed at pre-test, post-test and re-test. Rate perceived exertion (RPE, Borg's 6-20 scale) and local muscle perceived exertion (LRPE) were also assessed at the end of the training sessions.The EG group showed significant improvements in FOG and FES scores from pre-test to post-test. Both decreased at re-test, though they did not return to pre-test levels. No significant differences were detected in CoP parameters. Analysis of RPE and LRPE scores revealed that slackline was associated with minimal fatigue and involved the major lower limb and lumbar muscles.These findings suggest that slacklining is a simple, safe, and challenging training and rehabilitation tool for PD patients. It could be introduced into their physical activity routine to reduce the risk of falls and improve confidence related to fear of falling. Implications for Rehabilitation Individuals with Parkinson's disease (PD) are twice as likely to have falls compared to patients with other neurological conditions. This study support slackline as a simple, safe, and challenging training and rehabilitation tool for people with PD, which reduce their risk of falls and improve confidence related to fear of falling. Slackline in people with PD yields a low tiredness or fatigue impact and involves the major lower limb and lumbar muscles.

We modelled the distribution of two vulnerable steppe birds, Otis tarda and Tetrax tetrax, in the Western Palearctic and projected their suitability up to the year 2080. We performed two types of models for each species: one that included environmental and geographic variables (space-included model) and a second one that only included environmental variables (space-excluded model). Our assumption was that ignoring geographic variables in the modelling procedure may result in inaccurate forecasting of species distributions. On the other hand, the inclusion of geographic variables may generate an artificial constraint on future projections. Our results show that space-included models performed better than space-excluded models. While distribution of suitable areas for T. tetrax in the future was approximately the same as at present in the space-included model, the space-excluded model predicted a pronounced geographic change of suitable areas for this species. In the case of O. tarda, the space-included model showed that many areas of current presence shifted to low or medium suitability in the future, whereas a northward expansion of intermediate suitable areas was predicted by the space-excluded one. According to the best models, current distribution of these species can restrict future distribution, probably due to dispersal constraints and site fidelity. Species ranges would be expected to shift gradually over the studied time period and, therefore, we consider it unlikely that most of the current distribution of these species in southern Europe will disappear in less than one hundred years. Therefore, populations currently occupying suitable areas should be a priority for conservation policies. Our results also show that climate-only models may have low explanatory power, and could benefit from adjustments using information on other environmental variables and biological traits; if the latter are not available, including the geographic predictor may improve the reliability of predicted results., AE has a contract funded by the project 1098/2014 (Organismo Autónomo Parques Nacionales, Spain). This paper is a contribution to CGL2009-13029/BOS of the Spanish Ministry of Science, as well as to the REMEDINAL 3 (S2013/MAE-2719) network of the CAM. This work was partly supported by the Project CGL2009/11316/BOS (Spanish Ministry of Science and FEDER).

Introduction of domestic ungulates may lead to interspecific competition with native herbivores, particularly if the species involved are of similar size and share similar foraging strategies due to a scarcity of trophic resources. This interaction has not been investigated in South American deserts in which guanaco (Lama guanicoe), the larger South American wild camelid and the most widely-distributed ungulate, co-occurs with several introduced ungulates (e.g. cattle, donkeys, sheep or red deer). We studied the occurrence and abundance patterns of guanacos, donkeys and cattle in desert areas of Argentina by dung sampling. Analyses of co-occurrence show no relationship in land use between guanaco and livestock when geographical effects are removed. Distribution and abundance models of the guanaco are strongly associated with sparse plant cover, rocky substrata and human-influence variables, guanacos appearing in areas furthest from villages. Nevertheless, while guanaco distribution is weakly related to feral livestock presence, their abundance is negatively associated with donkey presence. In contrast, livestock species appear closely associated with each other, being centred on areas of densest and most productive vegetation. These results are relevant for the management of extensive arid areas of South America, where guanacos co-occur with feral donkeys and frequently conflicts with humans activities.

Summary. This study describes the climatic factors determining the distribution of two sympatric steppe birds, the little and the great bustards, on a Western Palearctic scale. We used the European Bird Census Council breeding bird atlas, recording presence/absence for 50×50 km UTM squares. Climate data were extracted from a 10′ latitude × longitude global compilation. Linear and quadratic terms were included to account for non-linear responses. A model-averaging approach was performed to determine the weight and effect of those variables describing the climatic preferences for each species. Although both showed a preference for drier areas in Europe, our results suggest that the great bustard's climate niche is mainly defined by variables related to primary production (e.g. rainfall, soil moisture), with temperature-related variables being less influential. These results contrast with those for the little bustard, whose climate niche seems to be defined by both temperature and precipitation-related varia...

The introduction and naturalization of alien species represents a serious threat to many natural protected areas. One such case of worldwide concern is the impact of feral livestock on arid ecosystems. Damage suffered by Echinopsis (¼Trichocereus) terscheckii dominating the landscape of rocky slopes was surveyed in seven locations within the IschigualastoeTalampaya World Heritage Site (Argentina) by measuring the frequency, position on the plant and extent of damage. At the same time we employed transects to estimate the abundance of autochtonous and feral large herbivores (Lama guanicoe, Bos taurus, Equus asinus) from their dung. Our results show relatively high damage levels (40e77% of individuals damaged, more than 5 dm 3 removed by plant in some sites), particularly within 0.50e1.75 m above the ground, showing herbivores to be the main responsible for them. We also found significant differences between sites in variables measuring damage level and in the intensity of use by the two feral livestock species but not by guanacos. The frequency of damaged cacti below 1.75 m (but not above) was significantly positively correlated among locations with the frequencies of cattle and donkey dung, and the damage suffered by individual cacti was also correlated with donkey and cattle dung in their surroundings after correcting for spatial effects. However, all correlations were non-significant in the case of guanacos. We conclude that the continued presence of feral livestock, particularly donkeys, leads to damages to columnar cacti with potential effects on their populations and the physiognomy of this protected landscape.

Analyzing coexistence of exotic and native ungulates in arid areas is important from both a theoretical and a species conservation perspective. We assess the habitat use patterns and possible interference between guanaco (Lama guanicoe) and feral livestock (donkey and cattle) in arid environments of South America. To determine habitat use and niche overlap between exotic and native ungulate species, ten sites with different habitats and six natural waterholes were selected. Plots (20 at each site, ten around each waterhole) were randomly set up and characterized by environmental variables and relative use by cattle, donkey and guanaco through faecal pellet counts. Aggregation, niche breadth and niche overlap of the three herbivores were analyzed at habitat level (mesoscale). A direct redundancy analysis was used to examine the relationships between abundance of herbivore faeces and environmental variables at microscale. Mesoscale analyses showed (i) an extensive use of the area by all three species, with guanaco having the highest niche breadth followed by donkey and cattle and (ii) a large, broad guanaco–donkey and donkey–cattle habitat overlap. However, results at a finer scale showed high spatial aggregation of feral livestock species and an independent use of territory by guanacos. This study is the first to provide information about habitat partitioning between guanacos and feral livestock in the hyper-arid Monte Desert biome and points to an apparent lack of negative effects on the native ungulate.

This study presents an assessment, resulting from consultation with experts in steppe-bird conservation (scientists, officers and conservationists) using the Delphi method, of a broad range of agri-environmental measures (AEMs) which have been applied in agricultural areas in Spain, with particular reference to four threatened steppe bird species. The measures which experts have valued most highly relate to the maintenance of fallow land, the prohibition of agrochemicals and the suspension of certain agricultural practices when the species are nesting. Other AEMs which have frequently been mentioned as beneficial for steppe birds, including the maintenance of straw-mulched fallows and the abandonment of farmland, were rejected by the experts. The assessment showed a high degree of consensus between experts, although differences between the four studied species were detected. Delphi assessment indicated that different birds need different AEMs. In addition, expert evaluation showed that different AEMs can cause the same effect on the target species, which could generate an over-implementation of measures. Finally, we evaluated the financial implementation of the AEMs selected by the Delphi using a Special Protection Area for birds (SPA) in the Madrid region as a case study. All the hypothetical scenarios used yielded assumable costs, oscillating between 1 and 2 times the current AEMs expenditure. In conclusion, in extensive agrarian systems with already high conservation merits, the implementation of AEMS could be improved using species-specific assessments, thus avoiding over-implementation and improving the fit between costs and benefits for conservation.

Introduction We have done almost 1000 thryoidectomies and parathryoidectomies during the last three years, monitoring 2000 RLN, multiple methods we used during the monitoring to ensure the integrity of the RLN. Methods Monitoring EMG activity, MEP with transcraneal stimulation, transcutaneus vagus stimulation, on the neck and direct recurrent nerve stimulation by the surgeon using a laryngeal electrode placed in the endotracheal tube. Results In our experience the best method, to ensure RLN safety; is direct observation of EMG activity. In all the cases there was an increase of EMG activity (double or triple amplitude) when the surgeon was nearby the nerves, including superior laryngeal nerve (SLN), or pulling the thryroid gland, so warning the surgeon and stopping the dissection for a while or changing the field, lead to stop or decrease the EMG activity. Stimulation of the RLN, SLN or vagus nerve confirms the integrity of the nerve or the suffering to stop or delay surgery. A latency delay in RLN response was seen sometimes, directly relationated to RLN compromise. Conclusion In none of our cases a nerve lesion was seen, so we can say our method is working well, better than only RLN identification by stimulation or direct surgeon identification, so we think our experience can improve RLN monitoring, also superior laryngeal nerve, leading to a superior control of the nerves in this type of surgery always controversy about the effectiveness of monitoring recurrent laryngeal nerves.

Resumen Hemos realizado una revision del contenido de porfirinas en una clase peculiar de calculos renales. Estos son negros como el carbon y presentan un espectro infrarrojo (EIR) similar al conocido como “materia organica”, el cual no indica la clase de sustancia a la que corresponde. Otros tipos de calculus renales, principalmente de pequeno tamano y eliminados espontaneamente, pueden tener un compuesto oscuro o negro de forma difusa o aislada y presentan un espectro de IR similar al de “material organica”. Despues de observar que la hemoglobina presentaba un espectro de IR de “materia organica”, estudiamos, por cromatografia en capa fina, un metodo sensible para la determinacion de porfirinas, la presencia de porfirinas en diversos tipos de calculos renales negros y oscuros, ya que las porfirinas son los precursores del grupo hemo. Este trabajo ha puesto de manifiesto dos tipos de porfirinas: la coproporfirina, en pacientes que padecen hepatopatias, y la uroporfirina y heptacarboxilporfirina en pacientes con algun tipo de porfiria o bien con fracaso renal cronico.

Title Hemorragia vitrea bilateral asociada a hemorragia pontomesencefalica: un caso extremo de sindrome de Terson.