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En la Región Sur del Ecuador se encuentra la zona del bosque seco que abarca desde los 100 metros sobre el nivel del mar (m.s.n.m) hasta los 1200 m.s.n.m, lugar donde se ha adaptado la cabra criolla llamada “Chusca lojana”. El presente trabajo tuvo como objetivo la caracterización fenotípica de este recurso zoogenético, permitiendo disponer de un patrón o estándar racial con fines de identificación, estudio, selección y mejoramiento de esta población. La investigación comprendió una muestra de 163 cabras adultas manejadas en ambiente extensivo, considerando 21 medidas morfométricas y 10 características fanerópticas; para el análisis morfométrico se aplicó una estadística no paramétrica con el Test de Kruskal-Wallis considerando como variables el sexo y los biotipos. Los resultados permitieron identificar 4 biotipos, que de acuerdo a ciertas características peculiares que presentan a nivel de cabeza y orejas se las ha identificado como: Chusca “oreja corta y doblada”, Chusca “oreja de león”, Chusca oreja “torneada” y Chusca “muca”; en el aspecto faneróptico presentan cuernos opistoceros (58%) y ortoceros (37%), siendo un 22% acornes (biotipo Chusca muca), poseen barba y mamelas el 26 y 29%, respectivamente, presentando estas dos características un dimorfismo en favor de los machos; la mayoría de esta población presenta un perfil de rostro recto (67%) y subcóncavo (28%); la forma de la ubre es globosa (64%), el color de pezones (93%) y cascos (87%) es pigmentado; los machos presentan testículos pendulosos (70%) y una característica peculiar es que poseen un escroto dividido en dos sacos (40%). En conclusión, la cabra Chusca es un animal con una tendencia productiva más a leche que a carne, destacando su capacidad torácica que le permite recorrer con facilidad por la topografía irregular de la zona en busca de alimento.

Plastics are widely used for various applications. Once discarded, it is commonly known that they represent a high environmental threat due to their slow degradation; for this reason, there is an imminent need to replace these products with eco-friendlier ones. In the present work, four bacterial polyhydroxybutyrate (PHB) producers, two consortia, and two isolated strains were successfully recovered from the facilities of a paper-manufacturing industry. Spectroscopic studies of the biopolymers obtained from these bacteria corroborated their PHB production capabilities, ranging from 4.04 ± 0.16 to 23.82 ± 3.39 g/L. The characterization of the isolate that presented the highest production yield initially coded as E22 led to the identification of a Klebsiella pneumoniae strain, which, compared with other PHA bacterial producers reported to date, could be considered with high production potential. The strain E22 was grown in 5 different media prepared from fruit peel residues of banana, orange, papaya, watermelon, and melon, to determine its growth and PHA production capabilities in these low-cost media. The results obtained show different bacterial growth yields among the media tested, although PHB production yields and productivities were similar in all these low-cost media. Cellular accumulation of the biopolymer was higher in watermelon peel medium (8.4 × 10−10 g/CFU). These results reveal the potential of K. pneumoniae E22 for PHB production applications and establish encouraging alternatives to be broader explored regarding low-cost media that could enhance the scale-up of bacterial PHA production processes.

The disproportionate representation of Black children in the child welfare system, and its implications for Black female caregivers, must be understood through a critical perspective that considers...

Targeted AAV vectors are needed for safe and efficient delivery to and transduction of specific tissue target(s) in patients. Effective intravitreal delivery for retina gene therapy is not feasible with wildtype AAV. We employed directed evolution in nonhuman primates (NHP) to discover an AAV variant (R100) for intravitreal treatment of multiple target cells in the primate retina. R100 demonstrated superior transduction of human retinal cells compared to wildtype AAV. Furthermore, three R100-based gene therapeutics demonstrated safety, delivery, and durable pan-retinal expression of intracellular or secreted transgenes throughout the NHP retina following intravitreal administration. Finally, efficacy of R100-mediated delivery of therapeutic transgenes was demonstrated in patient-derived retinal cells (monogenic diseases) and in an NHP model of pathogenic retinal angiogenesis.

BACKGROUND Increasing the number of physicians who identify as an underrepresented minority (URM) has been a focus for decades. Despite the US Department of Health and Human Services establishing The Council on Graduate Medical Education focussing on the underrepresentation of minorities in medicine in 1990, US medical students in 1998-1999 were15.2% URM and twenty years later, URM students comprise only 14.6% of matriculants. This reflected our experience at University of Maryland School of Medicine despite our diverse community where over 60% of the population identify as Black or African-American. We share our strategies to mitigate bias in the admissions process and our resulting outcomes. METHODS We implemented multiple interventions including interviewer training, recruitment strategies, holistic screening, changes in the interview process and increased racial, ethnic and gender diversity on our admissions committee. These changes were made over a two-year period initially focussing on the committee, followed by focussed interventions for interviewers. RESULTS With these interventions, we demonstrated an improvement in the number of URM applicants that matriculated. In 2019, we had the first class that was in which no one ethnicity or race comprised the majority of the class, with 54% of matriculants identifying as students of colour. In 2020, in addition to sustaining a majority of the class identifying as students of colour, the proportion of URM students increased from 10%-13% for the preceding 3 years, to 24% of the entering class. CONCLUSION The number of physicians who identify as URM must be increased for the benefit of our patients and health care system. Unconscious bias training for interviewers, focused recruitment strategies, holistic screening deemphasising the MCAT, blinding interviewers to MCAT scores and GPA, and increasing admissions committee diversity are five concrete steps that yielded the desired outcome of increasing URM representation among our medical school matriculants.

Analyse which factors could influence in earlier hospitalizations for congestive heart failure in geriatric patients with degenerative aortic stenosis. The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38–14.41). The median time to admission for frail patients was 1.08 years (95% CI 0.30–1.86). In our study, there was an increased risk of congestive heart failure admission in frail patients with moderate-severe degenerative aortic stenosis. Degenerative aortic stenosis has become a new valvular epidemic in the last few decades due to its high prevalence in the geriatric population. We sought to analyse factors that could influence earlier hospitalization for congestive heart failure in geriatric patients with moderate–severe degenerative aortic stenosis. This investigation was an ambispective cohort study of 104 patients aged 70 years or older with moderate–severe aortic stenosis. Epidemiological, geriatric, clinical, echocardiographic and electrocardiographic variables were collected. During the follow-up, the number of admissions for congestive heart failure and the time elapsed from diagnosis to first admission were recorded. A total of 45.2% of the patients were admitted for congestive heart failure, with a median time to first admission of 3 years (95% CI 1.88–4.25). For patients aged 85 years or older, this median was 8.07 months (95% CI 0.05–1.99). The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38–14.41), atrial fibrillation (HR 2.19, 95% CI: 1.01–4.73), a high EuroSCORE (HR 1.03, 95% CI: 1.00–1.05), the affected valvular area (HR 0.11, 95% CI: 0.02–0.47), age (HR 1.11, 95% CI: 1.04–1.18) and renal failure (HR 4.13, 95% CI: 1.46–11.63). The median time to admission for frail patients was 1.08 years (95% CI 0.30–1.86). In geriatric patients with moderate–severe degenerative aortic stenosis, frailty is an independent marker of early congestive heart failure admission with a powerful and important association.

BACKGROUND: According to recent estimates, the US transgender population has doubled in the last decade. Incorporating transgender competent care into medical education is a growing need, and a focus of the AAMC. Care of the transgender individual is multifaceted, and medical school curriculae on transgender care are limited and lack standardization. Similarly, strategies for measuring effectiveness and impact of these curriculae remain limited. Methods: Over 3 years, the use of a transgender clinical correlation in the endocrine section of the second-year medical student pre-clerkship curriculum progressed to the use of a triple modality intervention. This included (1) a self-directed written handout with terminology and the basic tenants of medical transition therapy with an optional podcast, (2) a traditional presentation covering social, ethical and multi-disciplinary transgender care, and (3) an interactive session with a transfemale and transmale patient. An anonymous 8 question pre-and post-intervention survey using an electronic clicker system was performed. Questions included interest level, comfort level with various aspects of transgender-competent care and resource awareness. Results: Prior to the intervention, 74% of students were interested in learning more about transgender competent care. After the learning intervention, in all questions focusing on knowledge and skills of transgender care, students reported a significant increase in their comfort level (Figure 1, p Conclusion: Knowledge and skills in the care of transgender individuals is poor in the pre-clerkship medical school years. The interest to learn about transgender care is positive. This multi-modality intervention was successful in increasing medical student comfort and knowledge about comprehensive transgender care, and increased student awareness of available resources. Introduction of transgender care should be implemented early in medical student training. 1. Hembree WC et al. Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. Endocr Pract. 2017 Dec;23(12):1437. 2. Harris M, Johnson C. Only Human. Trans Kids Update: Dating, PMS, And, Yeah, Bathrooms. NYPR WNYC Studios, 2017. Figure 1. Change in student comfort across transgender competent care. * p < 0.05

Crohn's disease and ulcerative colitis affect an increasing number of patients, and utilization of immune suppressant and biologic therapies is also increasing. These agents are linked to adverse events ranging from mild nuisance symptoms to potentially life-threatening complications including infections and malignancies. Areas covered: This review provides an updated discussion on adverse events associated with immunomodulator, anti-TNF-α, anti-integrin, and anti-IL 12/IL-23 antibody therapies. In addition, we review the risk profile of the currently widely available infliximab biosimilar medication. Expert commentary: Providers should engage in risk-benefit discussion with information specific to each medication discussed, and consider individualized risk factors when selecting therapeutic agents. Drug monitoring and shared decision-making results in more personalized medical management of inflammatory bowel disease.

Telemedicine has shown promise in inflammatory bowel disease (IBD). The objective of this study was to compare disease activity and quality of life (QoL) in a 1 year randomized trial of IBD patients receiving telemedicine versus standard care. Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine (monitoring via texts EOW or weekly) or standard care. The primary outcomes were the differences in change in disease activity and QoL between the groups; change in health care utilization among groups was a secondary aim. 348 participants were enrolled (117 control group, 115 TELE-IBD EOW, and 116 TELE-IBD weekly). 259 (74.4%) completed the study. Age was 38.9 ± 12.3 years, 56.6% were women, 91.9% were Caucasian, 67.9% had Crohn’s disease (CD) and 42.5% had active disease at baseline. In CD, all groups experienced a decrease in disease activity (control −5.2 ± 5.0 to 3.7 ± 3.6, TELE-IBD EOW 4.7 ± 4.1 to 4.2 ± 3.9, and TELE-IBD weekly 4.2 ± 4.2 to 3.2 ± 3.4, p

Background Depression is common in patients with inflammatory bowel disease (IBD) and is known to be associated with poor adherence in the usual care setting. In the last decade, there has been an increase in the use of information technology (IT) for the delivery of IBD care, but the association between depressive symptoms (DS) and adherence to self-testing in this context is not known. We aimed to investigate this association among IBD patients managed via a text messaging-based telemedicine system. Methods This was a prospective study of participants in the 2 intervention arms of the Telemedicine for Patients with IBD (TELE-IBD) trial. Depressive symptoms were measured at baseline, and then participants received periodic text messages to initiate IBD-specific self-testing. Treatment plans were similarly conveyed, and adherence to self-testing was evaluated at the end of 1 year. Regression analyses were performed, and age-stratified models were constructed to evaluate for effect modification. Results Of the 193 study participants, 48% had DS at baseline. Overall, there was no significant association between DS and adherence to self-testing. However, upon stratification by age, adherence increased with depressive symptoms in those that were 40 years and younger (P = 0.02), but there was no association between depressive symptoms and adherence in the older group (P = 0.53). Conclusions Younger IBD patients with DS have high adherence when managed in a text messaging-based telemedicine program. Telemedicine interventions have the potential to improve health outcomes in this demographic-a group that is often thought to be difficult to manage due to nonadherence.

Background Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients’ limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge. Methods TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn’s and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups. Results This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms. Conclusions Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.

Background: Functional traits related to water transport in plants, their variations and correlations can be related to the latitudinal range limits of tree species.Aims: We evaluated whether the variation and covariation of traits related to safety and efficiency in water transport in Nothofagus dombeyi could help to explain its climatic and geographic limits along the Chilean Andes.Methods: We quantified and correlated the intraspecific variations of leaf mass per area, wood density (WD) and leaf and xylem hydraulic conductivities in three populations of N. dombeyi near its northern and southern range limits and in its mid-latitudinal distribution.Results: N. dombeyi showed a considerable intraspecific variation in traits related to safety and efficiency of water transport. These traits showed functional restrictions both in the northern and southern distribution limits, where climatic conditions could be considered stressful. We found a negative covariation between safety and efficiency traits ...

Black women’s college experiences are often compounded with psychological stressors such as race- and gender-related oppression, which may influence psychosocial adjustment. Generally, coll...

The goal of this work was the modification of silicone rubber (SR) by radiation grafting of glycerol methacrylate (GlyMA) which was limited just on the surface, allowing the control of hydrophilicity and swelling properties. The grafted SRs were activated by derivatization of GlyMA to 2-oxoethyl methacrylate using sodium periodate, enabling the chemical immobilization of lysozyme by covalent bonds. The presence of lysozyme was confirmed by non-specific assay and by the enzymatic activity at 30 °C with Micrococcus lysodeikticus (coccus, Gram-positive). The materials were characterized by Fourier transform infrared spectroscopy-attenuated total reflectance, thermogravimetric analysis, water contact angle, and by mechanical properties as well as scanning electron microscope.

Premise of research. Crassulacean acid metabolism (CAM), a photosynthetic pathway that evolved in response to aridity, is beneficial for plant species in arid and semiarid environments, with positive effects on plant fitness. However, since it implies a higher metabolic cost compared with that for C3 plants, its expression under moist conditions, where it might be less necessary, could have fewer positive or even negative effects on plant fitness. Variations of the effects of CAM expression under different moisture regimes have never been addressed. Our objectives were to determine whether there are such variations and, if so, their possible ecological and evolutionary implications.Methodology. We measured CAM expression (as nocturnal acidification, ∆H+) and moisture-related morphological leaf traits, estimating their impact on reproductive effort in two populations of Puya chilensis living under contrasting moisture regimes in a natural climatic gradient in central Chile. To evaluate the effects of the m...

In this work we present a FCT- like Maximum-Principle Preserving (MPP) method to solve the transport equation. We use high-order polynomial spaces; in particular, we consider up to 5th order spaces in two and three dimensions and 23rd order spaces in one dimension. The method combines the concepts of positive basis functions for discontinuous Galerkin finite element spatial discretization, locally defined solution bounds, element-based flux correction, and non-linear local mass redistribution. We consider a simple 1D problem with non-smooth initial data to explain and understand the behavior of different parts of the method. Convergence tests in space indicate that high-order accuracy is achieved. Numerical results from several benchmarks in two and three dimensions are also reported.

This article describes the development and implementation of a pilot program to prepare teachers seeking New York state certification as school district administrators, by assigning them as administrative interns to a school district. The superintendent of a large urban school district and the director of a college program to prepare school district administrators partnered to design a pilot experiential course in which candidates for a master’s degree and state certificate would have an opportunity to develop skills and learn by experiencing situations that support new learning (Kolb, 1984), to take the place of an existing internship course for eight candidates. The dual purpose was to provide an authentic learning experience for the candidates and to provide actionable information for the superintendent for improvement of the district instructional program. To identify areas of academic concern, the candidates reviewed the New York State District Report Card1, conducted research, and interviewed district personnel in order to be able tomake actionable suggestions and recommendations to the superintendent that might result in academic improvement. Findings and recommendations to inform district improvement efforts and for improvement of the existing course were presented to the superintendent and his administrative staff. Recommendations are included.

Background The carcinoid syndrome is characterized by extensive and several clinical manifestations. The diarrhea, the cutaneous flushing are the most frequents symptoms while cardiac manifestations (carcinoid heart disease) (CHD) occurs in a mean of 40%. Nowadays, the number of cases of CHD is lower than 20%, as a consequence of the widespread use of somatostatin analogues. At present, there is a mean delay in diagnosis of CHD of 1.5 years from the time of carcinoid syndrome detection. Hence, CHD is associated with a poor prognosis for clinical management. Case report We present a case of 45-years-old active woman, with Thrombocytopenia absent radius (TAR). This is characterized by a bilateral absence of the radio with the presence of both thumbs and thrombocytopenia. Our patient was attended for dyspnea of medium efforts, history of diarrhea, cutaneous flushing with tachycardia and elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) (89,6 mg/24 (2,0-9,0)). The Transthoracic echocardiography showed morphologic changes that affected the tricuspid valve: diminished curvature of the leaflets, altered dynamic motion of the leaflets during diastole, fused and shortened chordae retraction and reduced excursion of the valve. A moderate to severe tricuspid regurgitation and tricuspid stenosis with gradient media de 5 mmHg was observed. In addition, the right ventricle was dilated, a severe pulmonary hypertension, a right pleural effusion and a minor pericardial effusion circumference were detected. All these findings were consistent with CHD. Conclusions This report describes an unusual case of CHD in TAR patient. In fact, the interest of this case is the role played by the echocardiogram in the differential diagnosis for tricuspid valve diseases. Tricuspid stenosis is an infrequent condition and it is usually related with rheumatic disease associated with mitral valve disease. Although the carcinoid syndrome is infrequent, any changes in the anatomical structure of the tricuspid valve (thickening, fibrosis and rigidity associated with stenosis and tricuspid regurgitation) should alert us to the suspicion of CHD Abstract P225 Figure.

Funding Acknowledgements VII Convocatoria del Banco de Santander and Alfonso X el Sabio University. Background Detection of symptoms in geriatric population with aortic stenosis (AS) is challenging, especially when they associate other comorbidities or frailty. Left ventricular global longitudinal strain (GLS) occurs before left ventricular ejection fraction impairment and could be useful for risk stratification and management of these patients. Purpose We sought to analyze the usefulness of GLS for predicting major cardiovascular adverse events (MACEs) in geriatric patients with asymptomatic severe AS. Material and Methods: Prospective study on 54 patients older than 70 years old with severe asymptomatic AS. Patient evaluation included biochemistry tests, electrocardiogram and echocardiography. We use a GLS cut-off point of 18% to dichotomize patients. Outcomes were defined as the composite of MACEs – occurrence of death from any cause, hospitalization for heart failure, appearance of symptoms or change in treatment. Results The mean age was 83.2 ± 7.1, with 60.4% of women. 24.5% showed atrial fibrillation. At 6 months of follow-up, 33% of patients reached the endpoint: 5.6% CHF, 11.1% death, 3.7% symptoms without changes in management and 13% were referred to an invasive treatment. The event-free survival rate at 6 months for the global population was 83%. 41.5 % of the subjects had GLS < 18%. Kaplan Meier analysis showed that the probability of freedom from MACEs was not significant in patients with lower GLS (Log Rank p = 0.39). In the multivariate analysis only AVA was an inverse predictor of events (AVA) HR 0.05 (95% CI 0.007- 0.471, p < 0.05). Conclusions The value of GLS was not a predictor of short term events in geriatric patients. Only assessment of AVA was an independent marker of MACES and in this kind of subjects. Charasteristics of the global population Global N = 53 (%) GLS ≥ 18 N = 31 (58.5%) GLS 50% 48 (92) 31 (100) 17 (77.2) 0.05 Peak velocity 3.72 ± 0.72 3.81 ± 0.71 3.60 ± 0.74 0.315 Mean gradient 34.01 ± 14.06 35.61 ± 13.54 32.09 ± 15.07 0.29 Integral ratio 0.25 ± 0.08 0.26 ± 0.09 0.25 ± 0.08 0.83 AVA 0.8 ± 0.26 0.78 ± 0.27 0.83 ± 0.26 0.651 Indexed AVA 0.48 ± 0.16 0.48 ± 0.17 0.48 ± 0.16 0.9 AVA Aortic valve area; CVD: cerebro vascular disease; HBP: High blood presure; LVEF: left ventricule ejection fraction. Abstract P905 Figure. Kapplan-Meier event-free survival curves

Background Depression is common in patients with inflammatory bowel disease (IBD) and contributes to poor quality of life (QoL). The use of information technology for the remote management of patients with IBD is growing, but little is known about its impact on depressive symptoms (DS) and QoL. We aimed to evaluate the impact of telemedicine on DS and generic QoL in IBD patients. Methods We analyzed data from the Telemedicine for Patients with IBD (TELE-IBD) study. During this 12-month clinical trial, patients were randomized to receive text message-based telemedicine weekly (TELE-IBD W), every other week (TELE-IBD EOW), or to standard care. Depressive symptoms and QoL were assessed over time with the Mental Health Inventory 5 (MHI-5) and the Short Form 12 (SF-12), respectively. We compared the change in MHI-5 and SF-12 (with separate physical (PCS) and mental component summary (MCS) scores) between the study arms. Results A total of 217 participants were included in this analysis. After 1 year, there was no significant difference in the change in MHI-5 (TELE-IBD W +3.0 vs TELE-IBD EOW +0.7 vs standard care +3.4; P = 0.70), MCS (TELE-IBD W +1.4 vs TELE-IBD EOW +1.0 vs standard care +2.5; P = 0.89), and PCS scores (TELE-IBD W +0.4 vs TELE-IBD EOW +0.6 vs standard care +3.7; P = 0.06) between the groups. Conclusions Text message-based telemedicine does not improve DS or QoL when compared with standard care in IBD patients treated at tertiary referral centers. Further studies are needed to determine whether telemedicine improves DS or QoL in settings with few resources., Lay Summary This study showed that, in patients with inflammatory bowel disease, the use of information technology to deliver care via text messaging did not improve depressive symptoms or quality of life when compared with usual healthcare.

The general development assessment test (EVADE) for children and adolescents aged 6-14 years is the only national screening tool for development assessment of school-age children and adolescents. This article presents the results obtained after applying the face validity process to the test, the handbook, and the standardized materials.An exploratory, descriptive study was conducted with a quantitative-qualitative methodology. The EVADE test was applied to a sample of 730 children and adolescents between 6 and 14 years of age, for which the expert judgment technique was used. Data analysis was carried out through a psychometric analysis of the items and by the triangulation method.From the 730 participants included, 44.5% were from rural areas (n = 325) and 55.4% from urban areas (n = 405), of which 51.7% (n = 378) of females and 48.2% (n = 352) of males were assessed by the test. The difficulty level and discriminative effectiveness quotient of the items were calculated, which, together with the experts' findings, resulted in 22-item modifications and the creation of four new items in the cognitive and language areas. The qualification by areas also changed, improving the handbook and creating new materials.This research provides a validated screening test for the child and adolescent population, which was included in the Costa Rican comprehensive childcare public policy. However, subsequent validation processes are recommended to improve specific areas, such as motor skills and social-affective development.La prueba general para la evaluación del desarrollo (EVADE) para niñas, niños y adolescentes entre 6 y 14 años es la única prueba a nivel nacional que valora el desarrollo en población escolar y adolescente. Este artículo presenta los resultados tras someter la prueba, el instructivo y los materiales estandarizados al proceso de validación de apariencia.Se llevó a cabo un estudio descriptivo exploratorio, con metodología cuantitativa-cualitativa. La prueba EVADE se aplicó a una muestra de 730 niñas, niños y adolescentes entre 6 y 14 años; asimismo, se utilizó la técnica de juicio de expertos. El análisis de los datos se efectuó a través de un análisis psicométrico de los enunciados y triangulación.De los 730 participantes, el 44.5% correspondió a zonas rurales (n = 325) y el 55.4% a zonas urbanas (n = 405). El 51.7% de ellos eran de sexo femenino (n = 378) y el 48.2%, de sexo masculino (n = 352). Se calculó el nivel de dificultad y el coeficiente de efectividad discriminativa para los enunciados. A la par de los hallazgos referidos por los expertos, resultó en la modificación de 22 enunciados, la creación de cuatro nuevos artículos en las áreas cognitiva y de lenguaje. También se cambió la calificación por áreas, se mejoró el instructivo y se crearon nuevos materiales.La presente investigación aporta una prueba validada para la población infantil escolar y adolescente, que fue incluida en la política pública de atención integral de la población infantil costarricense. Se recomiendan procesos de validación subsecuentes con el fin de mejorar áreas específicas, como motricidad y socioafectiva.

Background Cardiac-targeted gene therapy vectors are needed. Fabry disease is a rare, X-linked disorder caused by mutations in the GLA gene, which encodes α-galactosidase A (GLA). Storage and accumulation of glycolipid substrates of GLA leads to organ damage. Cardiovascular disease is the most common cause of mortality in Fabry disease (75% of deaths). Enzyme replacement therapy (ERT; first line treatment for most patients) demonstrates clearance of Gb3 from capillary endothelial cells. However, Gb3 accumulation in podocytes, cardiomyocytes, and vascular smooth muscle cells persists. Gene replacement strategies leveraging adeno-associated virus (AAV) vectors with high tropism for affected organs (namely the heart) may directly address the underlying pathophysiology of Fabry disease. Purpose To unlock the full potential of cardiac gene therapy, novel targeted vectors are needed with enhanced tropism for specific target tissues when delivered in vivo. Methods An industrialized “directed evolution” approach (Therapeutic Vector Evolution) was applied in the most relevant animal species (non-human primate; NHP) which led to the discovery of C102, a novel AAV variant capable of efficient gene delivery throughout the primate heart following a single intravenous (IV) administration. C102 biodistribution using a ubiquitous promoter was evaluated in mice and NHP at doses at least 10-fold lower than current AAV-based clinical trials for neuromuscular gene therapy. Animal studies conformed to the NIH Principles of Laboratory Animal Care. To evaluate the ability of the C102 capsid to transduce human target cells relevant to Fabry disease, human pluripotent stem cell-derived cardiomyocytes were transduced. To evaluate the ability of C102 to correct Fabry disease, cultured patient fibroblasts were transduced with the C102.GLA product. Results Following a single IV administration in mice, the onset of C102.luciferase expression was rapid (14 days) and durable. Dose-dependent luciferase activity was observed in Fabry disease target tissues, including heart and liver. Following a single IV administration in NHP, superior delivery to heart was demonstrated and immunogenicity was markedly reduced compared to first generation wild-type vectors (AAV8,9), and genomes were present throughout the heart and skeletal muscle groups. In human cardiomyocytes in vitro, C102.EGFP demonstrated significantly higher transduction compared to wild-type AAV1 and 9 vectors (immunofluorescence imaging and quantification by flow cytometry) at all doses. Following transduction with increasing doses of the C102.GLA product in Fabry patient fibroblasts, dose-dependent GLA expression and function was observed. C102 Genome Delivery in NHP Conclusion The data generated using the novel C102 capsid and the C102.GLA Fabry product validate the Therapeutic Vector Evolution approach for cardiac tissue targeting in vivo and provide a strong preclinical data package to enable clinical translation.

Introduction The classification of lymphomas by the World Health Organization (WHO) and its updates is widely known and adopted by hematopathologists. However, its application in clinical practice is poorly understood. Objective Analyze and compare an initial evaluation by a general pathologist in relation to an evaluation by a hematopathologist. Material and methods Retrospective case series, which included patients with the novo lymphoma diagnosis, relapse and resistance/failure of treatment. An initial evaluation was issued by a general pathologist, which was then sent to a hematopathologist for a revision. Discrepancies were sorted by: “Major”, where the therapeutic approach was modified, “Minor”, where the diagnosis changed, but therapeutic approach remain the same, and “In Accordance”, meaning full concordance between initial evaluation and revision. Results Fourteen cases were analyzed (5 females and 9 males). Mean age was 44 years. In Accordance were found in 2 cases (14%), Major discrepancies were found in 11 (79%) and Minor Discrepancies were found in 1 (7%). Immunohistochemical studies were performed, presenting a variance between initial evaluation and revision of 5 (0–8) and 9.5 (6–18), respectively. Conclusion There is a great need to generate pathologists with the necessary training and experience to perform the diagnostics attached to the current WHO classification.

La variabilidad en atributos anatómicos de las plantas podría estar relacionada con las condiciones del medio donde ellas se desarrollan (bajas temperaturas, estrés hídrico, corta estación de crecimiento), y esta variabilidad reflejaría la capacidad de una especie de establecerse en hábitats que difieren en la disponibilidad de estas condiciones. Maihuenia poeppigii (Otto ex Pfeiff.) K. Schum. no sólo es una de las especies de la familia Cactaceae con distribución más austral de América, sino que además presenta poblaciones creciendo en un amplio rango altitudinal (aprox. desde 15 hasta 2.600 m s.n.m.), en donde el clima varía notablemente. Este estudio evalúa la variabilidad en atributos anatómicos del tallo, relacionados con la conducción del xilema (densidad, diámetro y conductividad hidráulica relativa de los vasos) y almacenamiento de agua (grado de suculencia del tallo y hojas), de tres poblaciones de M. poeppigii que se encuentran establecidas en un gradiente de altitud en la zona centro sur de Chile. Adicionalmente, se determinó la altura máxima de los cojines de forma de estimar el grado de exposición de estos al ambiente, considerando la variación en la altura de las plantas a mayores altitudes. El promedio de la densidad, diámetro y conductividad hidráulica relativa de los vasos varió significativamente entre las poblaciones de distinta altitud. Con el incremento en la altitud aumentó la densidad de vasos y disminuyó el diámetro y el aporte relativo de los mismos a la conductividad hidráulica. Asimismo, con el aumento en la altitud disminuyó la altura de los cojines y aumentó la suculencia de los tallos. La suculencia de las hojas no difirió entre las tres poblaciones. La variación encontrada en dichos atributos anatómicos refleja una estrategia diferencial en la utilización y almacenamiento del agua entre las poblaciones establecidas en el gradiente de altitud. Este patrón de respuestas funcionales puede explicar la capacidad de esta especie de cactácea de ocupar sitios inhóspitos que difieren en altitud.

INTRODUCTION: Limitations in inflammatory bowel disease (IBD) care necessitate greater patient activation and self-efficacy, measures associated with positive health outcomes. METHODS: We assessed change in patient activation and general self-efficacy from baseline to 12 months through our TELEmedicine for IBD trial, a multicenter, randomized controlled trial consisting of a web-based monitoring system that interacts with participants via text messaging. A total of 222 adults with IBD who had experienced an IBD flare within 2 years prior to the trial were randomized into either a control arm that received standard care (SC) or an intervention arm that completed self-testing through the TELE-IBD system every other week (EOW) or weekly (W). RESULTS: Changes in self-efficacy scores were not significantly different between control and experimental groups. Patient activation scores were significantly different between standard care and the TELE-IBD EOW group only (p = 0.03). CONCLUSIONS: Use of remote monitoring did not improve self-efficacy or patient activation compared to routine care.

The patient presenting with chronic abdominal pain presents difficulties in both diagnosis and management. The incidence of serious missed diagnoses increases with age. Referral to a gastroenterologist for follow-up within approximately 2 weeks is recommended for patients with chronic abdominal pain after evaluation in an acute care setting has ruled out urgent etiologies. Colitis, malignancy, functional abdominal pain syndromes/irritable bowel syndromes, and adhesions from prior surgical procedures are commonly established diagnoses with specific therapeutic options. Magnetic resonance imaging (MRI) is a valuable option in patients who may have already accumulated a high burden of radiation exposure due to multiple prior CT scans. Analgesia for chronic abdominal pain can be a challenge but is best guided by understanding the underlying cause.

Immunocompromised patients often lack the classic clinical abdominal pain presentations, making the etiology difficult to ascertain. Knowledge of the patient’s immunocompromised status, whether it is due to chemotherapy, transplantation, HIV, or autoimmune disease, will help clinicians assess the unique complications that arise in each of these patient populations. In patients with an immunocompromised status, localized infections can quickly become systemic, and timing of antibiotic administration is crucial. In addition, toxicity to medications such as chemotherapeutics, steroids, antiretroviral, and immunosuppressive agents can cause numerous gastrointestinal abnormalities. Imaging should be considered when there is a concern for an infectious complication such as abscess or a possible surgical issue such as perforation, small bowel obstruction, or large bowel obstruction. If the CT is negative, a gastroenterology consult may be needed to continue the workup. Whether that workup should be conducted on an inpatient versus outpatient basis depends upon the need for IV pain control, PO tolerance (oral intake), or presence of concerning signs/symptoms such as fever, leukocytosis, or GI bleeding.

Complementary therapies for inflammatory bowel disease (IBD) have earned growing interest from patients and investigators alike, with a dynamic landscape of research in this area. In this article, we review results of the most recent studies evaluating the role of cannabis and turmeric for the treatment of IBD and other intestinal illnesses. Cannabinoids are well-established modulators of gut motility and visceral pain and have demonstrated anti-inflammatory properties. Clinical trials suggest that there may be a therapeutic role for cannabinoid therapy in the treatment of IBD, irritable bowel syndrome (IBS), nausea and vomiting, and GI motility disorders. Recent reports of serious adverse effects from synthetic cannabinoids highlight the need for additional investigation of cannabinoids to establish their efficacy and safety. Turmeric trials have demonstrated some promise as adjuvant treatment for IBD, though not in other GI disease processes. Evidence suggests that the use of cannabis and turmeric is potentially beneficial in IBD and IBS; however, neither has been compared to standard therapy in IBD, and thus should not be recommended as alternative treatment for IBD. For cannabis in particular, additional investigation regarding appropriate dosing and timing, given known adverse effects of its chronic use, and careful monitoring of potential bleeding complications with synthetic cannabinoids are imperative.

Degenerative aortic stenosis has become a new valvular epidemic in the last few decades due to its high prevalence in the geriatric population. We sought to analyse factors that could influence earlier hospitalization for congestive heart failure in geriatric patients with moderate-severe degenerative aortic stenosis.This investigation was an ambispective cohort study of 104 patients aged 70 years or older with moderate-severe aortic stenosis. Epidemiological, geriatric, clinical, echocardiographic and electrocardiographic variables were collected. During the follow-up, the number of admissions for congestive heart failure and the time elapsed from diagnosis to first admission were recorded.A total of 45.2% of the patients were admitted for congestive heart failure, with a median time to first admission of 3 years (95% CI 1.88-4.25). For patients aged 85 years or older, this median was 8.07 months (95% CI 0.05-1.99). The first admission for congestive heart failure was independently related to frailty (HR 4.46, 95% CI: 1.38-14.41), atrial fibrillation (HR 2.19, 95% CI: 1.01-4.73), a high EuroSCORE (HR 1.03, 95% CI: 1.00-1.05), the affected valvular area (HR 0.11, 95% CI: 0.02-0.47), age (HR 1.11, 95% CI: 1.04-1.18) and renal failure (HR 4.13, 95% CI: 1.46-11.63). The median time to admission for frail patients was 1.08 years (95% CI 0.30-1.86).In geriatric patients with moderate-severe degenerative aortic stenosis, frailty is an independent marker of early congestive heart failure admission with a powerful and important association.

This research presents the design and implementation of a precision agriculture system using sensor networks as the basis in precision agriculture for farmers tomatoes (Solanum lycopersicum) in Colombia with the aim of transferring knowledge and mitigating the effects of the soil and climate change on of tomato crops. Finally we found the optimal ranges to improve productivity and avoid losses due to uncontrolled agroclimatic variables such as relative temperature, soil temperature, relative humidity, soil moisture and luminosity. Also, this paper aim a IoT architecture for the respective storage and traceability of tomato crops in the cloud.

Los hongos del género Marasmius Fr. son importantes degradadores de hojarasca y se reportan como los más abundantes en los trópicos. La Ecorregión Lachuá es uno de los remanentes más importantes de selvas tropicales en Guatemala, y de los más amenazados por la pérdida de hábitat debido al avance de la frontera agrícola. Se ha determinado que durante los últimos 5 años se ha perdido el 75% de cobertura original fuera de las áreas protegidas de la ecorregión, debido principalmente al aumento de la agricultura. Estos cambios ocasionados por la pérdida de cobertura vegetal influyen en las condiciones microclimáticas de las cuales los hongos dependen para poder reproducirse. Este estudio constituye el primer acercamiento para comprender como responde este grupo de hongos a las fluctuaciones causadas por el cambio en condiciones climáticas y su vulnerabilidad a la pérdida de hábitat. Se evaluó la producción de cuerpos fructíferos del género Marasmius en respuesta a los factores climáticos temperatura, humedad relativa, precipitación, temporalidad y tamaño de remanente en la en época de lluvias durante 2010 y 2011 en ocho remanentes boscosos en la Ecorregión Lachuá. Se recolectaron 98 ejemplares pertenecientes a 56 morfoespecies y 2 especies. Las mayores riquezas (r) y frecuencias acumuladas (a) de cuerpos fructíferos se presentaron en junio (r=16, a=21) y en la localidad de Santa Lucía Lachuá (r =15, a=16). Los rangos de las variables climáticas donde se presentó mayor frecuencia acumulada fue T°= 26°C–27°C; Precipitación= 8–12 mm y 40mm y H%= 88–90%. La composición de Marasmius está influenciada por la temporalidad que de junio a agosto presenta mayor número de especies compartidas, disminuyéndose considerablemente en octubre y noviembre. No se observó un cambio en la composición de Marasmius en relación al tamaño de remanente, sin embargo espacialmente es posible diferenciar entre remanentes rodeados por áreas con cobertura y remanentes rodeados por áreas abiertas, determinando que este género responde a los cambios de hábitat. Estos cambios en riqueza y abundancia acumulada de hongos en el tiempo y el espacio, pueden ser utilizados como indicadores de estas perturbaciones. La información generada permite proponer el monitoreo de este género a través del tiempo para generar planes de manejo adecuados para el área.

This document details of the conventional electric method for measuring partial discharges (DP) based on the norm IEC 60156, various test were performed on dielectric oils which had different qualities, the test results were processed through MATLAB's signal processing filters in conjunction with fast fourier transform (FFT) in order to determine the type of partial discharge based on the quality of the dielectric oil and it's contamination level.

The Southern Annular Mode (SAM) is the main driver of climatevariability at mid to high latitudes in the Southern Hemisphere,affecting wildfire activity, which in turn pollutes the air and contributesto human health problems and mortality, and potentiallyprovides strong feedback to the climate system through emissionsand land cover changes. Here we report the largest Southern Hemispherenetwork of annually resolved tree ring fire histories, consistingof 1,767 fire-scarred trees from 97 sites (from 22 °S to 54 °S) in southernSouth America (SAS), to quantify the coupling of SAM and regionalwildfire variability using recently created multicentury proxyindices of SAM for the years 1531?2010 AD. We show that at interannualtime scales, as well as at multidecadal time scales across 37?54 °S,latitudinal gradient elevated wildfire activity is synchronous with positivephases of the SAM over the years 1665?1995. Positive phases ofthe SAM are associated primarily with warm conditions in thesebiomass-rich forests, in which widespread fire activity depends on fueldesiccation. Climate modeling studies indicate that greenhouse gaseswill force SAM into its positive phase even if stratospheric ozonereturns to normal levels, so that climate conditions conducive to widespreadfire activity in SAS will continue throughout the 21st century. Fil: Holz, Andrés. Portland State University; Fil: Paritsis, Juan. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche. Laboratorio de Ecotono; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Mundo, Ignacio Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Veblen, Thomas. State University of Colorado Boulder; Estados Unidos Fil: Kitzberger, Thomas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche. Laboratorio de Ecotono; Argentina Fil: Williamson, Grant J.. University of Tasmania; Australia Fil: Aráoz, Ezequiel. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional.; Argentina Fil: Bustos Schindler, Carlos. Universidad Austral de Chile; Chile Fil: González, Mauro E.. Universidad Austral de Chile; Chile Fil: Grau, Hector Ricardo. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo; Argentina. Universidad Nacional de Tucumán. Instituto de Ecología Regional. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Ecología Regional.; Argentina Fil: Quezada Álvarez, Juan Mauricio. Universidad Nacional de Misiones. Facultad de Ciencias Forestales; Argentina

Crassulacean acid metabolism (CAM) is a photosynthetic pathway found in many plant species from arid and semiarid environments. Few studies aiming to characterise plant species as CAM or C3 account for inter-population differences in photosynthetic pathway, often relying on samples taken from herbarium material and/or a single plant or population. This may be especially problematic for species growing under contrasting climate conditions, as is the case for species with a wide geographic range. We used Puya chilensis, a species previously reported as CAM and C3, to study among-population variation in expression of the CAM pathway within its distribution range, which spans a significant climate gradient. We carried out a wide sampling scheme, including five populations and a combination of analytical methods (quantification of nocturnal acidification and stable isotope measurements). The study populations of P. chilensis encompass the entire latitudinal distribution range, from semi-arid to temperate oceanic climates. Our results indicate that CAM decreased with latitude. However, even in the southern (wetter) populations, where d 13 C values were indicative of C3 metabolism, we found some nocturnal acidification. We stress the value of using two methods along with the use of samples from different populations, as this allows more reliable conclusions on the photosynthetic pathway for ‘probable’ CAM species that face varying climate conditions within their distribution ranges.

This manuscript is a secondary analysis of a large multicenter randomized controlled trial. The primary study is Cross RK et al., A Randomized Controlled Trial of TELEmedicine for patients with Inflammatory Bowel Disease (TELE-IBD). Am J Gastroenterol, 2019 Mar.

Many patients with inflammatory bowel disease (IBD) are vitamin D deficient. The purpose of our study was to identify risk factors for vitamin D deficiency in IBD and to assess the impact of vitamin D repletion on disease activity and quality of life (QOL). Patients with at least one 25-OH vitamin D level measured between 2004 and 2011 were included. Patients with a level