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Abstract Objective Zika virus (ZIKV) infection in pregnancy can cause brain and eye abnormalities and neurodevelopmental sequelae. In the absence of medical countermeasures, behavioral interventions were recommended to prevent mosquito bites and sexual transmission of ZIKV. This report uses data from the Zika en Embarazadas y Niños (ZEN) prospective cohort study in Colombia to describe the knowledge, attitudes, and behaviors (KAB) related to ZIKV prevention in male partners compared to those of their pregnant partners at study enrollment during February 2017–2018. Results Most male partners reported wearing protective clothing such as long pants (97.6%) and long sleeves (72.8%), as well as covering ankles and feet (89.1%) to prevent ZIKV infection. When comparing the preventive behavior of condom use between male and pregnant partners, 26 pairs (10.0%) both responded that they performed the behavior. Overall, 25.1% of male partners and 18.9% of pregnant people reported any condom use during the three months before enrolling in ZEN. When comparing other preventive behaviors between male and pregnant partners, the behavior which was most frequently reported by both partners was wearing long pants (85.4%), and the least frequently reported by both partners was using condoms after finding out about a partner’s pregnancy (3.4%).

Abstract Background Limited diagnostic capabilities, resources and health worker skills have deterred the advancement of birth defects surveillance systems in most low- and middle-income countries (LMICs). Empowering health workers to identify and diagnose major external birth defects (BDs) is crucial to establishing effective hospital-based BD surveillance. Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration BD Surveillance System consists of three diagnostic levels: (1) surveillance midwives, (2) MU-JHU clinical team, and (3) U.S. Centers for Disease Control and Prevention (CDC) birth defects subject matter experts (SMEs) who provide confirmatory diagnosis. The diagnostic concordance of major external BDs by surveillance midwives or MU-JHU clinical team with CDC birth defects SMEs were estimated. Methods Study staff went through a series of trainings, including birth defects identification and confirmation, before surveillance activities were implemented. To assess the diagnostic concordance, we analyzed surveillance data from 2015 to 2021 for major external BDs: anencephaly, iniencephaly, encephalocele, spina bifida, craniorachischisis, microcephaly, anophthalmia/microphthalmia, anotia/microtia, cleft palate alone, cleft lip alone, cleft lip with cleft palate, imperforate anus, hypospadias, talipes equinovarus, limb reduction, gastroschisis, and omphalocele. Positive predictive value (PPV) as the proportion of BDs diagnosed by surveillance midwives or MU-JHU clinical team that were confirmed by CDC birth defects SMEs was computed. PPVs between 2015 and 2018 and 2019–2021 were compared to assess the accuracy of case diagnosis over time. Results Of the 204,332 infants examined during 2015–2021, 870 infants had a BD. Among the 1,245 BDs identified, 1,232 (99.0%) were confirmed by CDC birth defects SMEs. For surveillance midwives, PPV for 7 of 17 BDs was > 80%. For the MU-JHU clinical team, PPV for 13 of 17 BDs was > 80%. Among surveillance midwives, PPV improved significantly from 2015 to 2018 to 2019–2021, for microcephaly (+ 50.0%), cleft lip with cleft palate (+ 17.0%), imperforate anus (+ 30.0%), and talipes equinovarus (+ 10.8%). Improvements in PPV were also observed among MU-JHU clinical team; however, none were significant. Conclusion The diagnostic accuracy of the midwives and clinical team increased, highlighting that BD surveillance, by front-line health care workers (midwives) in LMICs is possible when midwives receive comprehensive training, technical support, funding and continuous professional development.

PurposePrimary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities.MethodsWe analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox’s regression, stratified by city and year of diagnosis.ResultsDuring the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7–11.8), 6.4 (95% CI, 4.2–9.8), 2.8 (95% 2.1–3.8), 2.0 (95% CI, 1.3–2.8) and 2.3 (95% CI, 1.7–3.0), respectively.ConclusionWe found that half of Colombia’s children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.

LHS 1140 b is the second-closest temperate transiting planet to Earth with an equilibrium temperature low enough to support surface liquid water. At 1.730 ± 0.025 R _⊕ , LHS 1140 b falls within the radius valley separating H _2 -rich mini-Neptunes from rocky super-Earths. Recent mass and radius revisions indicate a bulk density significantly lower than expected for an Earth-like rocky interior, suggesting that LHS 1140 b could be either a mini-Neptune with a small envelope of hydrogen (∼0.1% by mass) or a water world (9%–19% water by mass). Atmospheric characterization through transmission spectroscopy can readily discern between these two scenarios. Here we present two JWST/NIRISS transit observations of LHS 1140 b, one of which captures a serendipitous transit of LHS 1140 c. The combined transmission spectrum of LHS 1140 b shows a telltale spectral signature of unocculted faculae (5.8 σ ), covering ∼20% of the visible stellar surface. Besides faculae, our spectral retrieval analysis reveals tentative evidence of residual spectral features, best fit by Rayleigh scattering from a N _2 -dominated atmosphere (2.3 σ ), irrespective of the consideration of atmospheric hazes. We also show through Global Climate Models (GCMs) that H _2 -rich atmospheres of various compositions (100×, 300×, 1000× solar metallicity) are ruled out to >10 σ . The GCM calculations predict that water clouds form below the transit photosphere, limiting their impact on transmission data. Our observations suggest that LHS 1140 b is either airless or, more likely, surrounded by an atmosphere with a high mean molecular weight. Our tentative evidence of a N _2 -rich atmosphere provides strong motivation for future transmission spectroscopy observations of LHS 1140 b.

The study of temperate sub-Neptunes is the new frontier in exoplanetary science. A major development in the past year has been the first detection of carbon-bearing molecules in the atmosphere of a temperate sub-Neptune, K2-18 b, a possible Hycean world, with the James Webb Space Telescope (JWST). The JWST is poised to characterize the atmospheres of several other such planets, with important implications for planetary processes in the temperate regime. Meanwhile, ground-based high-resolution spectroscopy has been highly successful in detecting chemical signatures of giant exoplanets, though low-mass planets have remained elusive. In the present work, we report the atmospheric reconnaissance of a temperate sub-Neptune, TOI-732 c, using ground-based high-resolution transmission spectroscopy. The long orbital period and the low systemic velocity result in a low planetary radial velocity during transit, making this system a valuable test bed for high-resolution spectroscopy of temperate sub-Neptunes. We observe high-resolution time-series spectroscopy in the H and K bands during the planetary transit with the IGRINS instrument ( R ∼ 45,000) on Gemini-South. Using observations from a single transit, we find marginal evidence (2.2 σ ) for the presence of methane (CH _4 ) in the atmosphere and no evidence for ammonia (NH _3 ) despite its strong detectability for a cloud-free H _2 -rich atmosphere. We assess our findings using injection tests with different atmospheric scenarios and find them to be consistent with a high CH _4 /NH _3 ratio and/or the presence of high-altitude clouds. Our results demonstrate the capability of Gemini-S/IGRINS for atmospheric characterization of temperate sub-Neptunes and the complementarity between space- and ground-based facilities in this planetary regime.

The two-planet transiting system LHS 1140 has been extensively observed since its discovery in 2017, notably with Spitzer, HST, TESS, and ESPRESSO, placing strong constraints on the parameters of the M4.5 host star and its small temperate exoplanets, LHS 1140 b and c. Here, we reanalyze the ESPRESSO observations of LHS 1140 with the novel line-by-line framework designed to fully exploit the radial velocity content of a stellar spectrum while being resilient to outlier measurements. The improved radial velocities, combined with updated stellar parameters, consolidate our knowledge of the mass of LHS 1140 b (5.60 ± 0.19 M _⊕ ) and LHS 1140 c (1.91 ± 0.06 M _⊕ ) with an unprecedented precision of 3%. Transits from Spitzer, HST, and TESS are jointly analyzed for the first time, allowing us to refine the planetary radii of b (1.730 ± 0.025 R _⊕ ) and c (1.272 ± 0.026 R _⊕ ). Stellar abundance measurements of refractory elements (Fe, Mg, and Si) obtained with NIRPS are used to constrain the internal structure of LHS 1140 b. This planet is unlikely to be a rocky super-Earth, as previously reported, but rather a mini-Neptune with a ∼0.1% H/He envelope by mass or a water world with a water-mass fraction between 9% and 19%, depending on the atmospheric composition and relative abundance of Fe and Mg. While the mini-Neptune case would not be habitable, a water-abundant LHS 1140 b potentially has habitable surface conditions according to 3D global climate models, suggesting liquid water at the substellar point for atmospheres with relatively low CO _2 concentration, from Earth-like to a few bars.

The recent advancements in exoplanet observations enable the potential detection of exo-Venuses, rocky planets with carbon-rich atmospheres. How extended these atmospheres can be, given high carbon abundances, has not been studied. To answer this, we present a model for a theoretical class of exoplanets—puffy Venuses—characterized by thick, carbon-dominated atmospheres in equilibrium with global magma oceans (MOs). Our model accounts for carbon and hydrogen partition between the atmosphere and the MO, as well as the C–H–O equilibrium chemistry throughout a semi-gray, radiative-convective atmosphere. We find that radius inflation by puffy Venus atmospheres is significant on small and irradiated planets: carbon content of 1200 ppm (or that of ordinary chondrites) can generate an atmosphere of ∼0.16–0.3 R _⊕ for an Earth-mass planet with equilibrium temperatures of 1500–2000 K. We identify TOI-561 b as an especially promising puffy Venus candidate, whose underdensity could be attributed to a thick C-rich atmosphere. We also advocate for a puffy Venus interpretation of 55 Cancri e, where a recent JWST observation indicates the presence of a CO/CO _2 atmosphere. Puffy Venuses may thus constitute a testable alternative interpretation for the interior structure of underdense low-mass exoplanets.

Planets and the stars they orbit are born from the same cloud of gas and dust, and the primordial compositions of rocky exoplanets have been assumed to have iron and refractory abundance ratios consistent with their host star. To test this assumption, we modeled the interior iron-to-rock ratio of 20 super-Earth-sized (1–1.8 R _⊕ ) exoplanets around stars with homogeneously measured stellar parameters. We computed the core mass fraction (CMF) for each planet and an equivalent “core mass fraction” for each host star based on its Fe and Mg abundances. We then fit a linear correlation using two methods (ordinary least squares and orthogonal distance regression) between planetary and stellar CMF, obtaining substantially different slopes between these two methods ( m = 1.3 ± 1.0 and m = 5.6 ± 1.6, respectively). Additionally, we find that 75% of planets have a CMF consistent with their host star to within 1 σ , and do not identify a distinct population of high-density super-Mercuries. Overall, we conclude that current uncertainties in observational data and differences in modeling methods prevent definitive conclusions about the relationship between planet and host-star chemical compositions.

TOI-6255 b (GJ 4256) is an Earth-sized planet (1.079 ± 0.065 R _⊕ ) with an orbital period of only 5.7 hr. With the newly commissioned Keck Planet Finder and CARMENES spectrographs, we determine the planet’s mass to be 1.44 ± 0.14 M _⊕ . The planet is just outside the Roche limit, with P _orb / P _Roche = 1.13 ± 0.10. The strong tidal force likely deforms the planet into a triaxial ellipsoid with a long axis that is ∼10% longer than the short axis. Assuming a reduced stellar tidal quality factor ${Q}_{\star }^{{\prime} }\approx {10}^{7}$ , we predict that tidal orbital decay will cause TOI-6255 to reach the Roche limit in roughly 400 Myr. Such tidal disruptions may produce the possible signatures of planet engulfment that have been seen on stars with anomalously high refractory elemental abundances compared to their conatal binary companions. TOI-6255 b is also a favorable target for searching for star–planet magnetic interactions, which might cause interior melting and hasten orbital decay. TOI-6255 b is a top target (with an Emission Spectroscopy Metric of about 24) for phase-curve observations with the James Webb Space Telescope.

Mercury is notoriously difficult to form in Solar System simulations, due to its small mass and iron-rich composition. Smooth particle hydrodynamics simulations of collisions have found that a Mercury-like body could be formed by one or multiple giant impacts, but due to the chaotic nature of collisions, it is difficult to create a scenario where such impacts will take place. Recent work has found more success forming Mercury analogues by adding additional embryos near Mercury’s orbit. In this work, we aim to form Mercury by simulating the formation of the Solar System in the presence of the giant planets Jupiter and Saturn. We test out the effect of an inner disk of embryos added on to the commonly used narrow annulus of initial material. We form Mercury analogues with core-mass fractions (CMFs) > 0.4 in ∼10% of our simulations, and twice that number of Mercury analogues form during the formation process but are unstable and do not last to the end of the simulations. Mercury analogues form at similar rates for both disks with and without an inner component, and most of our Mercury analogues have lower CMFs than that of Mercury, ∼0.7, due to significant accretion of debris material. We suggest that a more in-depth understanding of the fraction of debris mass that is lost to collisional grinding is necessary to understand Mercury’s formation, or some additional mechanism is required to stop this debris from accreting.

This paper employs the concepts of sustainability and habitability to define and measure ecological urbanism in informal settlements founded by people who have been forcibly displaced by violence. The objective is to identify the obstacles in meeting the tenets of ecological urbanism in informal settlements. We offer primary research from La Primavera, an informal settlement founded by internally displaced people in the late 1970s, located in the corregimiento El Hatillo of Barbosa, Antioquia in northwestern Colombia. Primary research includes qualitative and quantitative data gathered through 72 surveys and 45 technical assessments of properties and houses in the settlement. Situated between the Aburrá River and the northbound highway, above a gas pipeline and under an electricity pylon, La Primavera exists in a state of extreme risk, exacerbated by increasing migration which threatens to exceed the carrying capacity of the territory. Moreover, in Article 35 of Law 388 of 1997, the territory was declared a protected or restricted area and earmarked for the development of the regional commuter train, called the Tren de Cercanías, in 2017. The case study highlights the contradictions in the development agenda in Colombia by showing how development projects designed for the economic betterment and environmental conservation of the region negatively impact the quality of life for the most vulnerable inhabitants and expose them to greater environmental, economic, and social risk.

Plain English Summary Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income countries with Uganda having one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes, including major external birth defects, between adolescents, (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals. All informative births, including live births, stillbirths, and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2018 were examined. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes. Of the 100,189 births, 11.0% were among adolescent mothers and 89.0% among mothers (20–34 years). Adolescent mothers were more likely than mothers (20–34 years) to have an infant with preterm delivery, low birth weight, early neonatal death, and major external birth defects. Adolescent pregnancies were also associated with an increased risk of gastroschisis when compared to mothers (20–34 years). In conclusion, this study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years. Research on the potential underlying causes or mechanisms for these adverse outcomes among adolescent births is necessary to identify possible interventions.

After Zika virus (ZIKV) infection in Costa Rica was confirmed in January 2016, the national surveillance system was enhanced to monitor associated birth defects. To characterize the ZIKV outbreak among live-born infants during March 2016–March 2018, we conducted a descriptive analysis. Prevalence of ZIKV-associated birth defects was 15.3 cases/100,000 live births. Among 22 infants with ZIKV-associated birth defects, 11 were designated as confirmed (positive for ZIKV) and 11 were designated as probable cases (negative for ZIKV or not tested, but mother was expsed to ZIKV during pregnancy). A total of 91% had microcephaly (head circumference >2 SDs below mean for age and sex), 64% severe microcephaly (head circumference >3 SDs below mean for age and sex), 95% neurodevelopmental abnormalities, 82% brain anomalies, 41% eye abnormalities, and 9% hearing loss. Monitoring children for >1 year can increase identification of ZIKV-associated abnormalities in addition to microcephaly.

Sustainable birth defects surveillance systems provide countries with estimates of the prevalence of birth defects to guide prevention, care activities, and evaluate interventions. We used free and open-source software (Open Data Kit) to implement an electronic system to collect data for a hospital-based birth defects surveillance system at four major hospitals in Kampala, Uganda. We describe the establishment, successes, challenges, and lessons learned from using mobile tablets to capture data and photographs. After intensive training, surveillance midwives collected data using Android tablets with inbuilt logic checks; another surveillance midwife checked the quality of the data in real-time before data were securely uploaded onto a local server. Paper forms were used when needed as a backup for the electronic system. We experienced several challenges implementing the surveillance system, including forgotten passwords, unstable network, reduced tablet speed and freezing, loss of touch-screen sensitivity, decreased battery strength, and repetitive extensive retraining. We addressed these challenges by backing up and removing all photos from the tablet, uninstalling irrelevant applications to the study to increase storage space and speed, and monitoring and updating the system based mainly on feedback from the midwives. From August 2015 to December 2018, surveillance midwives documented information on 110,752 births at the participating hospitals. Of these, 110,573 (99.8%) were directly entered into the electronic data system and 179 (0.2%) were captured on paper forms. The use of mobile tablets for real-time data collection was successful in a hospital-based birth defects surveillance system in a resource-limited setting. Extensive training and follow-up can overcome challenges and are key to preparing staff for a successful data collection system.

TOI-561 is a galactic thick-disk star hosting an ultra-short-period (0.45-day-orbit) planet with a radius of 1.37 R _⊕ , making it one of the most metal-poor ([Fe/H] = −0.41) and oldest (≈10 Gyr) sites where an Earth-sized planet has been found. We present new simultaneous radial velocity (RV) measurements from Gemini-N/MAROON-X and Keck/HIRES, which we combined with literature RVs to derive a mass of M _b = 2.24 ± 0.20 M _⊕ . We also used two new sectors of TESS photometry to improve the radius determination, finding R _b = 1.37 ± 0.04 R _⊕ and confirming that TOI-561 b is one of the lowest-density super-Earths measured to date ( ρ _b = 4.8 ± 0.5 g cm ^−3 ). This density is consistent with an iron-poor rocky composition reflective of the host star’s iron and rock-building element abundances; however, it is also consistent with a low-density planet with a volatile envelope. The equilibrium temperature of the planet (∼2300 K) suggests that this envelope would likely be composed of high mean molecular weight species, such as water vapor, carbon dioxide, or silicate vapor, and is likely not primordial. We also demonstrate that the composition determination is sensitive to the choice of stellar parameters and that further measurements are needed to determine whether TOI-561 b is a bare rocky planet, a rocky planet with an optically thin atmosphere, or a rare example of a nonprimordial envelope on a planet with a radius smaller than 1.5 R _⊕ .

Abstract Background In 2010, the World Health Assembly passed a resolution calling upon countries to prevent birth defects where possible. Though birth defects surveillance programs are an important source of information to guide implementation and evaluation of preventive interventions, many countries that shoulder the largest burden of birth defects do not have surveillance programs. This paper shares the results of a hospital-based birth defects surveillance program in Uganda which, can be adopted by similar resource-limited countries. Methods All informative births, including live births, stillbirths and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2017 were examined for birth defects. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes and entered in an electronic data collection tool. Identified birth defects were confirmed through bedside examination by a physician and review of photographs and a narrative description by a birth defects expert. Informative births (live, still and spontaneous abortions) with a confirmed birth defect were included in the numerator, while the total informative births (live, still and spontaneous abortions) were included in the denominator to estimate the prevalence of birth defects per 10,000 births. Results The overall prevalence of birth defects was 66.2/10,000 births (95% CI 60.5–72.5). The most prevalent birth defects (per 10,000 births) were: Hypospadias, 23.4/10,000 (95% CI 18.9–28.9); Talipes equinovarus, 14.0/10,000 (95% CI 11.5–17.1) and Neural tube defects, 10.3/10,000 (95% CI 8.2–13.0). The least prevalent were: Microcephaly, 1.6/10,000 (95% CI 0.9–2.8); Microtia and Anotia, 1.6/10,000 (95% CI 0.9–2.8) and Imperforate anus, 2.0/10,000 (95% CI 1.2–3.4). Conclusion A hospital-based surveillance project with active case ascertainment can generate reliable epidemiologic data about birth defects prevalence and can inform prevention policies and service provision needs in low and middle-income countries.

Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May–November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia’s existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).

The marked increase in infants born with microcephaly in Brazil after a 2015 outbreak of Zika virus (Zika virus) disease suggests an association between maternal Zika virus infection and congenital microcephaly. To project the timing of delivery of infants born to mothers infected during early pregnancy in 1 city in Bahia State, Brazil, we incorporated data on reported Zika virus disease cases and microcephaly cases into a graphical schematic of weekly birth cohorts. We projected that these births would occur through February 2016. Applying similar projections to a hypothetical location at which Zika virus transmission started in November, we projected that full-term infants at risk for Zika virus infection would be born during April–September 2016. We also developed a modifiable spreadsheet tool that public health officials and researchers can use for their countries to plan for deliveries of infants to women who were infected with Zika virus during different pregnancy trimesters.

We report the results of pathologic examinations of 2 fetuses from women in Colombia with Zika virus infection during pregnancy that revealed severe central nervous system defects and potential associated abnormalities of the eye, spleen, and placenta. Amniotic fluid and tissues from multiple fetal organs tested positive for Zika virus.

Prenatal exposure to Zika virus (ZIKV) is associated with congenital anomalies of the brain and the eye and neurodevelopmental sequelae. The spectrum of disease outcomes may relate to timing of infection as well as genetic and environmental factors. Congenital infections occurring in twin pregnancies can inform the clinical spectrum of these conditions and provide unique information regarding timing of infection and in utero environment with disease pathophysiology. Herein, we report a monozygotic dichorionic-diamniotic twin pregnancy with probable prenatal ZIKV exposure identified through the Colombian ZIKV disease surveillance system. Multidisciplinary clinical evaluations were provided to the twins during their first three years of life through a national program for children with in utero ZIKV exposure. Laboratory evidence of congenital infection as well as microcephaly, brain, eye, and neurodevelopmental compromise related to prenatal ZIKV infection were identified in only one infant of the twin pregnancy. This is the first report of monozygotic twins discordant for Zika-associated birth defects. The evaluation of the pathophysiology of discordance in disease outcome for congenital infections in twin pregnancies may lead to a better understanding of potential complex environmental and genetic interactions between the mother, her offspring, and an infectious exposure.

El derecho fundamental a la buena Administración pública, desde su inserción en la Carta de Derechos Fundamentales de la Unión Europea, pasó a ser incorporado en distintos ordenamientos jurídicos. Este trabajo tiene como objetivo explicar sus orígenes, contenido jurídico y contribuciones para el derecho administrativo, y su recepción por el derecho brasilero. La investigación encuentra que, pese a que el artículo 41 de la Carta de Niza no contiene un desarrollo novedoso sino una consolidación de derechos ya reconocidos doctrinaria y jurisprudencialmente, el reconocimiento de ese derecho tiene un valor simbólico importante para el derecho administrativo, por colocar en el centro de esta disciplina jurídica el ser humano y la protección de su dignidad.

Resumen: El propósito de la presente investigación fue identificar factores causales de la explotación sexual comercial en la infancia y la adolescencia en Colombia. Para ello se analizaron tres casos de estudio: Medellín, Sincelejo y Magangué. Se realizaron talleres y se aplicaron encuestas en cada una de las ciudades en Instituciones gubernamentales encargadas de intervenir el fenómeno y en algunas instituciones educativas, con la participación de funcionarios, profesionales, docentes, directivos y estudiantes. Para el análisis de datos se realizó una matriz explicativa con la participación de 4 jurados. Las categorías de análisis fueron factores medioambientales, familiares e individuales. Abstract: The purpose of this piece of research aimed to identify causal factors of trade sexual exploitation on children and adolescents in Colombia. For this purpose, three case studies were analyzed: Medellín, Sincelejo, and Magangué. Workshops were conducted and surveys were implemented in each of the cities in both governmental institutions, in charge of intervening the phenomenon and in some educational institutions, with the participation of officials, professionals, teachers, directors, and students. As for the data analysis, an explanatory matrix was carried out, with the participation of 4 judges. The categories of analysis were those related to the environment, the family, and the individual.

RESUMEN: The suburban areas represent a category of use and appropriation of the soil that is particularly problematic in the Latin American context. The conflicts that tend to occur in this type of areas are given by the uncontrolled expansion of cities in a competition with the rural areas which deprives these from various environmental conditions and positive housing conditions. This article is the product of the research project “Methodology for the Intervention of Suburban Soils, Northern Aburra: A Case Study” in Medellin, Colombia, in order to disseminate core concepts that guide the study and generate academic exchange in this regard. Resumen: Las zonas suburbanas representan una categoría de uso y apropiación del suelo que es particularmente problemática en el contexto latinoamericano. Los conflictos que suelen verificarse en este tipo de zonas se dan por la expansión incontrolada de las ciudades en una competencia con las áreas rurales que priva a éstas de varias de sus condiciones ambientales y de habitabilidad positivas. El artículo es producto del proyecto de investigación “Metodología para la intervención de suelos suburbanos, caso de estudio Aburrá Norte” en Medellín, Colombia, con el fin de divulgar los conceptos de base que orientan el estudio y generar intercambio académico al respecto.

Dysphagia is a frequently pathological condition in pa­tients with stroke and carries a substantial risk of dehy­dration, malnutrition and aspiration pneumonia. So far there are two methods for diagnosis; Videofluoroscopy (VFC) and Fiberoptic Endoscopic Evaluation of Swa­llowing (FEES). The first is considered the gold standard method, with a high cost, radiation exposure that requires the transfer of the patient to radiology, the patient’s abili­ty to follow simple commands and time required to com­plete. VFC does not replicate physiological conditions in which the patient is routinely, so it is considered that its representation is limited, the second test is an alternative procedure to be more economical, safe, well tolerated, wi­dely available, lasting approximately 20 minutes and with the possibility of doing it in the patient’s bed. Unlike FVC, to evaluate the presence of pharyngeal, this correlates with the risk of aspiration. Clinical report: The objective of this report is to present a male patient, 33 years old, who admitted to a health institution because it presents a clini­ cal picture compatible with stroke, as findings found right hemiplegia and swallowing disorder, as required gastros­tomy tubes. We performed Fiberoptic Endoscopic Evalua­tion of Swallowing (FEES) as a diagnostic method, which allowed visualization of the anatomic and functional en­vironment, the type of food consistency could be secure in their feeding process, thus avoiding silent aspirations and insights that could lead an aspiration pneumonia. It also allowed the group to make recommendations for nutritio­nal support, physiotherapy and speech therapy for ambu­latory management of the patient.

Con el fin de evaluar el efecto de niveles crecientes de proteína degradable en rumen (PDR) sobre las concentraciones de amonio y piruvato en hígado, se utilizaron 15 vacas Holstein que cursaban los primeros cien días posparto. Estas se asignaron aleatoriamente a tres tratamientos experimentales que consistieron en el suministro de un suplemento alimenticio comercial al que se le adicionó urea de tal manera que se incrementará el consumo de PDR en aproximadamente 0 (T0), 10 (T1) y 15% (T2) respecto a los requerimientos. A estas vacas se les determinaron las concentraciones hepáticas de amonio (Ahep) y piruvato (Pihep). Se realizó un balance nutricional de energía neta de lactancia (ENL), proteína metabolizable (PM), PDR y proteína no degradable en rumen (PNDR) donde se encontraron diferencias significativas entre los tratamientos (PIn order to test the effect of growing levels of diet rumen degradable protein on hepatic concentrations of ammonia and piruvate, fifteen cows Holstein in their first one hundred post calving days were used. They were assigned at random to three different experimental treatments, which consisted on the supply of a commercial feeding supplement without any addition of urea as a source of NNP (T0); the second treatment (T1) consisted on the supply of the same supplement with an addition of urea, so that the supply of PDR was increased 10% approximately to the requirements;finally, in the third treatment, (T2) the cows were given the same supplement which was added with enough urea so that the supply of PDR was increased 15% approximately to the requirements. In these cows were determined hepatic concentrations of ammonia (Ahep) and pyruvate (Pyhep). The concentrations of Ahep were different among treatments, whereas the concentrations of Pihep were similar. Negative relations between Ahep and ENL, Ahep and PNDR, Ahep, and PM, were found it; while Pihep was positively related with Ahep. These results suggest the metabolizable protein use as energy source, increasing nitrogen excess and probably rest amino acids for biosynthetic process.

94% of all birth defects (BD) and 95% of deaths due to the BD occur in low and middle income countries, many of which are preventable. In Tanzania, there is currently a paucity of BD data necessary to develop data informed prevention activities. Methods A cross-sectional analysis was conducted of deliveries identified with BD in the labor ward registers at four Dar es Salaam hospitals between October, 2011 and February, 2012. The birth prevalence of structural BD, case fatality proportion, and the distribution of structural defects associated deaths within total deaths were calculated. A total of 28 217 resident births were encountered during the study period. Overall birth prevalence of selected defects was 28.3/10 000 live births. Neural tube defects and indeterminate sex were the most and least common defects at birth (9.9 and 1.1/10 000 live births respectively). Among stillbirths (66.7%) and deaths that occurred within less than 5 days of an affected live birth (18.5%), neural tube defects were the most frequently associated structural defect. Structural BD is common and contributes to perinatal mortality in Dar es Salaam. More than half of perinatal deaths encountered among the studied selected external structural BD are associated with neural tube defects, a birth defect with well–established evidence based prevention interventions. By establishing a population–based BD surveillance program, Tanzania would have the information about neural tube defects and other major structural BD needed to develop and monitor prevention activities.

INTRODUCTION: Neural tube defects such as anencephaly, spina bifida, and encephalocele are congenital anomalies of the central nervous system. Data on the prevalence of neural tube defects in Kenya are limited. This study characterizes and estimates the prevalence of spina bifida and encephalocele reported in a referral hospital in Kenya from 2005-2010. METHODS: Cases were defined as a diagnosis of spina bifida or encephalocele. Prevalence was calculated as the number of cases by year and province of residence divided by the total number of live-births per province. RESULTS: From a total of 6,041 surgical records; 1,184 (93%) had reported diagnosis of spina bifida and 88 (7%) of encephalocele. Estimated prevalence of spina bifida and encephalocele from 2005-2010 was 3.3 [95% Confidence Interval (CI): 3.1-3.5] cases per 10,000 live-births. The highest prevalence of cases were reported in 2007 with 4.4 (95% CI: 3.9-5.0) cases per 10,000 live-births. Rift Valley province had the highest prevalence of spina bifida and encephalocele at 6.9 (95% CI: 6.3-7.5) cases per 10,000 live-births from 2005-2010. CONCLUSION: Prevalence of spina bifida and encephalocele is likely underestimated, as only patients seeking care at the hospital were included. Variations in regional prevalence could be due to referral patterns and healthcare access. Implementation of a neural tube defects surveillance system would provide a more thorough assessment of the burden of neural tube defects in Kenya.