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This study reports on a set of experiments designed to clarify the impact of the rotational transform on confinement quality at the TJ-II stellarator. For this purpose, the net plasma current is controlled using external coils, resulting in the modification of the rotational transform profile. Significant and systematic variations of the edge electron density gradients (up to $50\,\%{-}60\,\%$) and the plasma energy content ($20\,\%{-}30\,\%$) are achieved. The explanation of this behaviour relies on the placement of low-order rational surfaces in relation to the edge gradient region, which affect local turbulence fluctuation levels, facilitating the formation of zonal flows and concomitant transport barriers. This hypothesis is confirmed experimentally on the basis of a broad array of diagnostic measurements. Calculations based on a resistive magnetohydrodynamic turbulence model provide qualitative support for this hypothesis, clarifying the impact on confinement of specific rational surfaces and highlighting the complex nature of magnetically confined fusion plasmas.
We provide a fine classification of bisimilarities between states of possibly different labelled Markov processes (LMP). We show that a bisimilarity relation proposed by Panangaden that uses direct sums coincides with “event bisimilarity” from his joint work with Danos, Desharnais, and Laviolette. We also extend Giorgio Bacci’s notions of bisimilarity between two different processes to the case of nondeterministic LMP and generalize the game characterization of state bisimilarity by Clerc et al. for the latter.
We describe a 12-year-old boy with agenesis of the intrahepatic segment of the inferior vena cava (a rare congenital anomaly) in whom an electrified coronary guidewire with electrocautery was used percutaneously to perforate and open the atretic segment, followed by stent implantation. This technique may be a safe and feasible option for paediatric patients, offering a therapeutic alternative for complex cardiac anatomies.
In 1962, Spain implemented significant banking law changes to boost competition. This study investigates their impact on provincial banking concentration from 1964 to 1975, utilising novel provincial-level private bank balance sheet data and including savings banks. Results show a substantial decline in concentration across most provinces. Panel data models identify the determinants of banking concentration: larger populations and higher gross domestic product per capita correlate with lower concentration, while agrarian-focused provinces exhibit higher concentration. The provincial financial sector’s structure also matters, with a higher number of branches and headquarters per capita associated with reduced banking concentration. These findings refine existing literature and provide new insights into the intricate relationship between banking concentration and regional economies in Spain.
OBJECTIVES/GOALS: We will describe the community-driven development and impact of the new Community Research Capacity-Building grants from the Alliance for Research in Chicagoland Communities, Northwestern University. Communities expressed that to enter equitably into partnerships with academics they need support to build their own community research capacity. METHODS/STUDY POPULATION: ARCC Seed Grants, since 2008, included Partnership Development and Research Pilots, which are both jointly submitted by a community-academic partnership. The new Community Grants are submitted only by community partners and don’t require an academic partner. These grants, $3,000 over 6 months, support the development or strengthening of organizational or community-level research capacity. This may include assessing community capacity to lead and/or collaborate on research; building research capacity of community organizations (staff, leadership, residents), developing community infrastructure (e.g. research principles; staff research responsibilities; process for assessing/ tracking researcher inquiries; template memorandum of understanding) or community research priorities, etc. RESULTS/ANTICIPATED RESULTS: Eight ARCC Community Research Capacity-Building Seed Grants have been awarded so far as a part of three cycles of applications over 2022-23 (2 in 2022, 6 in 2023). During this time period, data has been collected during the application process, in final reports, and in informal group and individual discussions. Information about the profile of grantees (community representation, health focus, etc.), the initial impact of grants, and feedback from grantees about the positive and challenging aspects of the grants will be shared. Grantees have informally shared that the awards have helped to address concerns that many low-income communities of color have their voices are not adequately included in research and other decision-making. The poster will be co-presented by a community grant recipient. DISCUSSION/SIGNIFICANCE: To ensure that research partnerships are community-driven & equitable, it is necessary to invest in community research capacity-building. More evaluation is needed to understand the grants impact, as well as other approaches to community research capacity and leadership development. Poster will be co-presented by a community grant recipient.
The Mg-vermiculite from Santa Olalla has been treated with aliphatic amides—formamide (FM), acetamide (AM) and propionamide (PM)—in aqueous solution. These treatments produce the transformation towards NH4-vermiculite and interstratified NH4-vermiculite-Mg-vermiculite phases. The NH4-vermiculite, Mg-vermiculite and interstratified (mixed-layer) phases have been identified from basal X-ray diffraction (XRD) interval peaks between 10.3 Å and 14.4 Å, and confirmed by direct Fourier transform method, as well as by atomic absorption spectrometry (AAS), infrared (IR) spectroscopy and thermal analysis.
According to their NH4-vermiculite/Mg-vermiculite probability coefficients ratio (PA/PB), and PAA, these interstratified phases can be divided into 3 categories: 1) If the PA/PB ratio is ≥ 7/3 and PAA ≥ 0.7, there are interstratified phases with a strong tendency toward segregation (case of FM, AM and PM). 2) If the PA/PB ratio is between 5/5 and 6/4, with PAA in the range 0.45–0.6, there are nearly regular alternating and random interstratified phases (case of AM and PM). 3) If the PA/PB ratio is ≤ 5/5 and PAA ≤ 0.45, there are interstratified phases with a strong tendency toward alternation (case of PM).
Experimental evidence reported in the present work indicates that the mechanism of interaction of Mg-vermiculite with FM, AM and PM in an aqueous medium takes place by ion exchange of NH4 between the layers. The hydrolysis of these aliphatic amides leads to the liberation of NH4+ into the medium. It has been found that the NH4+ sorption depends on the physico-chemical characteristics of the particular aliphatic amide, and the transformation of Mg-vermiculite to interstratified and/or NH4-vermiculite phases depends on the amide concentration. These treatments allow one to control the formation of interstratified and NH4-vermiculite phases.
The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
Methods
The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
Results
About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
Conclusions
The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.
Aims
This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).
Method
A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.
Results
The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.
Conclusions
The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
Ancho (width) chile peppers have economic, social, culinary and cultural importance in Mexico and worldwide. This chile type considers divergent subtypes that altogether have not been analysed and therefore their morphological diversity has not been systematically described. The objectives were to describe the morphological diversity of ancho pepper landraces from Mexico, to identify groups of similarity and to define the traits with the higher contribution to the total variation. Eighty-six landraces of ancho chile peppers (red, ‘mulatos’, ‘miahuatecos’, ‘cristalinos’ and ‘huacle’), collected in six states of Mexico, and two commercial controls were evaluated in two localities, in a simple randomized complete block experimental design. We recorded 76 morphological traits. Statistical analysis included a combined ANOVA, Pearson's correlation coefficient, discriminant analysis, principal components and clusters. The morphological diversity in ancho chile peppers was mainly made up of fruit width, fruit wall thickness, stem diameter, corolla length, seed weight per fruit, plant height, stem length and pubescence. We defined four groups, which made it possible to differentiate ancho chile peppers of Puebla and the huacle chile pepper of Oaxaca from populations collected in the north and ‘Bajío’ (midland) parts of Mexico. Ancho chile peppers of Mexico showed wide morphological differences according to the type of chile pepper and seed collection regions. The traits that contributed the greatest morphological diversity were fruit width, fruit wall thickness, stem diameter, corolla length, seed weight per fruit, plant height, stem length and pubescence.
Peru’s health infrastructures, particularly hospitals, are exposed to disaster threats of different natures. Traditionally, earthquakes have been the main disaster in terms of physical and structural vulnerability, but the coronavirus disease 2019 (COVID-19) pandemic has also shown their functional vulnerability. Public hospitals in Lima are very different in terms of year constructed, type of construction, and number of floors, making them highly vulnerable to earthquakes. In addition, they are subject to a high demand for care daily. Therefore, if a major earthquake were to occur in Lima, the hospitals would not have the capacity to respond to the high demand.
Objective:
The aim of this study was to analyze the Hospital Safety Index (HSI) in hospitals in Lima (Peru).
Materials and Methods:
This was a cross-sectional observational study of 18 state-run hospitals that met the inclusion criteria; open access data were collected for the indicators proposed by the Pan American Health Organization (PAHO) Version 1. Associations between variables were calculated using the chi-square test, considering a confidence level of 95%. A P value less than .05 was considered to determine statistical significance.
Results:
The average bed occupancy rate was 90%, the average age was 70 years, on average had one bed per 25,126 inhabitants, and HSI average score was 0.36 with a vulnerability of 0.63. No association was found between HSI and hospital characteristics.
Conclusion:
Most of the hospitals were considered Category C in earthquake and disaster safety, and only one hospital was Category A. The hospital situation needs to be clarified, and the specific deficiencies of each institution need to be identified and addressed according to their own characteristics and context.
Image-processing pipelines require the design of complex workflows combining many different steps that bring the raw acquired data to a final result with biological meaning. In the image-processing domain of cryo-electron microscopy single-particle analysis (cryo-EM SPA), hundreds of steps must be performed to obtain the three-dimensional structure of a biological macromolecule by integrating data spread over thousands of micrographs containing millions of copies of allegedly the same macromolecule. The execution of such complicated workflows demands a specific tool to keep track of all these steps performed. Additionally, due to the extremely low signal-to-noise ratio (SNR), the estimation of any image parameter is heavily affected by noise resulting in a significant fraction of incorrect estimates. Although low SNR and processing millions of images by hundreds of sequential steps requiring substantial computational resources are specific to cryo-EM, these characteristics may be shared by other biological imaging domains. Here, we present Scipion, a Python generic open-source workflow engine specifically adapted for image processing. Its main characteristics are: (a) interoperability, (b) smart object model, (c) gluing operations, (d) comparison operations, (e) wide set of domain-specific operations, (f) execution in streaming, (g) smooth integration in high-performance computing environments, (h) execution with and without graphical capabilities, (i) flexible visualization, (j) user authentication and private access to private data, (k) scripting capabilities, (l) high performance, (m) traceability, (n) reproducibility, (o) self-reporting, (p) reusability, (q) extensibility, (r) software updates, and (s) non-restrictive software licensing.
To describe the epidemiological profile of multiple casualty incidents (MCI) and contribute to the better understanding of their impacts in Northern Spain.
Method:
Retrospective, population-based observational study of MCI between 2014 and 2020 in 5 autonomous communities (Aragón, Castilla y León, Galicia, the Basque Country and Principado de Asturias) that participated in the MCI Database of Northern Spain. Inclusion criteria was any incident with 4 or more patients needing ambulance mobilization. A total of 54 variables were collected. This study presents the most relevant results.
Results:
There were 253 MCI. Of these, 79.8% were road traffic accidents, 12.3% fires or explosions, 2.0% poisonings and 5.9% defined as others. Monthly average was 2.9 (SD = 0.35; EEM = 15.90), average of victims by MCI was 6.8 (CI95% 6.16 - 7.60). There were significantly (P < 0.05) more victims in 3 types of MCI (fires, poisonings, and others). We saw 37.7% of MCI involved 4 victims, 18.8% 5 victims, and 37.9% more than 5. Mean response time was 30.8 minutes (95% CI 28.6 - 33.1), longer in maritime incidents. A total of 67% (95% CI 64.5 - 69.5) of victims were mild.
Conclusions:
Road traffic accidents are the most frequent MCI and minor injuries predominate. More than 50% of the MCI have 5 or fewer patients. Fires had significantly more mild patients and significantly more resources deployed. Maritime incidents had a significantly longer response time.
There exist two notions of equivalence of behavior between states of a Labelled Markov Process (LMP): state bisimilarity and event bisimilarity. The first one can be considered as an appropriate generalization to continuous spaces of Larsen and Skou’s probabilistic bisimilarity, whereas the second one is characterized by a natural logic. C. Zhou expressed state bisimilarity as the greatest fixed point of an operator $\mathcal {O}$, and thus introduced an ordinal measure of the discrepancy between it and event bisimilarity. We call this ordinal the Zhou ordinal of $\mathbb {S}$, $\mathfrak {Z}(\mathbb {S})$. When $\mathfrak {Z}(\mathbb {S})=0$, $\mathbb {S}$ satisfies the Hennessy–Milner property. The second author proved the existence of an LMP $\mathbb {S}$ with $\mathfrak {Z}(\mathbb {S}) \geq 1$ and Zhou showed that there are LMPs having an infinite Zhou ordinal. In this paper we show that there are LMPs $\mathbb {S}$ over separable metrizable spaces having arbitrary large countable $\mathfrak {Z}(\mathbb {S})$ and that it is consistent with the axioms of $\mathit {ZFC}$ that there is such a process with an uncountable Zhou ordinal.
Este artículo explora las manifestaciones arqueológicas del poder y de la diferenciación social en las sociedades muiscas que habitaron el norte del Altiplano Cundiboyacense, centro de Colombia, y que fueron descritas por los españoles del siglo dieciséis como grupos profundamente jerárquicos e inequitativos. Se analiza aquí la relación entre la diferenciación social y las condiciones de vida de las personas sepultadas en el Cercado Grande de los Santuarios, un importante centro político y ritual prehispánico, y se aborda a través de indicadores de diferenciación social. Estos últimos se expresan en el ajuar (presencia o ausencia de vasijas, composición), en la modificación craneal artificial, y mediante indicadores óseos y dentales de estrés fisiológico (hiperostosis porótica, cribra orbitalia, hipoplasia del esmalte dental, reacción perióstica) y de actividad física (cambios entesiales y enfermedad articular degenerativa). Los resultados permiten sugerir que la población no exhibía diferencias importantes en sus condiciones de vida. De acuerdo con los indicadores analizados, si existió diferenciación social, esta no estuvo acompañada de una distinción en las tareas propias de la vida cotidiana que conllevara una separación del grupo dominante.
Hepatitis A (HA) is a liver disease with a low mortality rate, but it can cause debilitating symptoms and fulminant hepatitis in some cases. Its incidence is greater in geographical areas with poor sanitation and hygiene. Spain is considered a low-endemicity country, so universal childhood immunization against HA is currently not financed by the National Health System. The aim of this study was to synthesize the scientific evidence on the cost effectiveness of universal childhood vaccination against HA.
Methods
Full economic evaluations, published in the English or Spanish languages, were included if they reported outcome measures related to the prevention of HA, adverse effects, or incremental cost-effectiveness ratios (ICERs). The Medline, Embase and Cochrane Library databases were searched for articles published from the beginning of the databases to April 2018.
Results
A total of 23 economic evaluations were included: one in a country of high endemicity, nine in countries of intermediate endemicity, and 13 in countries with low endemicity. Only one Spanish study, published in 1997, was found. Studies conducted in high- and intermediate- endemicity countries concluded that a universal childhood vaccination program against HA was a cost-effective option. However, in the case of countries with low endemicity the results were heterogeneous, although most agreed that a systematic vaccination strategy would not be a cost-effective option and that the adoption of such a strategy would not be justified given the limited benefits it would offer. The results of the economic evaluations depended on parameters such as the price and duration of the vaccine effect and the program coverage.
Conclusions
In countries with low endemicity the results were heterogeneous, although most studies concluded that the implementation of a universal vaccination strategy is not justified from the point of view of cost effectiveness.
Assertion checking is an invaluable programmer’s tool for finding many classes of errors or verifying their absence in dynamic languages such as Prolog. For Prolog programmers, this means being able to have relevant properties, such as modes, types, determinacy, nonfailure, sharing, constraints, and cost, checked and errors flagged without having to actually run the program. Such global static analysis tools are arguably most useful the earlier they are used in the software development cycle, and fast response times are essential for interactive use. Triggering a full and precise semantic analysis of a software project every time a change is made can be prohibitively expensive. This is specially the case when complex properties need to be inferred for large, realistic code bases. In our static analysis and verification framework, this challenge is addressed through a combination of modular and incremental (context- and path-sensitive) analysis that is responsive to program edits, at different levels of granularity. In this tool paper, we present how the combination of this framework within an integrated development environment (IDE) takes advantage of such incrementality to achieve a high level of reactivity when reflecting analysis and verification results back as colorings and tooltips directly on the program text – the tool’s VeriFly mode. The concrete implementation that we describe is Emacs-based and reuses in part off-the-shelf “on-the-fly” syntax checking facilities (flycheck). We believe that similar extensions are also reproducible with low effort in other mature development environments. Our initial experience with the tool shows quite promising results, with low latency times that provide early, continuous, and precise assertion checking and other semantic feedback to programmers during the development process. The tool supports Prolog natively, as well as other languages by semantic transformation into Horn clauses.
The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
To investigate if depression risk modifies the association between frailty and mortality in older adults.
Design:
Ongoing cohort study.
Setting:
Albacete city, Spain
Participants:
Eight hundred subjects, 58.8% women, over 70 years of age from the Frailty and Dependence in Albacete (FRADEA) study.
Measurements:
Frailty phenotype, Geriatric Depression Scale (GDS), comorbidity, disability, and drug use were collected at baseline. Six groups were categorized: (G1: non-frail/no depression risk; G2: non-frail/depression risk; G3: prefrail/no depression risk; G4: prefrail/depression risk; G5: frail/no depression risk; and G6: frail/depression risk). Mean follow-up was 2542 days (SD 1006). GDS was also analyzed as a continuous variable. The association between frailty and depression risk with 10-year mortality was analyzed.
Results:
Mean age was 78.5 years. Non-frail was 24.5%, prefrail 56.3%, frail 19.3%, and 33.5% at depression risk. Mean GDS score was 3.7 (SD 3.2), increasing with the number of frailty criteria (p < 0.001). Ten-year mortality rate was 44.9%. Mortality was 21.4% for the non-frail, 45.6% for the prefrail, and 72.7% for the frail participants, 56% for those with depression risk, and 39.3% for those without depression risk. Mean survival times for groups G1 to G6 were, respectively, 3390, 3437, 2897, 2554, 1887, and 1931 days. Adjusted mortality risk was higher for groups G3 (HR 2.1; 95% confidence interval (CI) 1.4–3.1), G4 (HR 2.5; 95% CI 1.7–3.8), G5 (HR 3.8; 95% CI 2.4–6.1), and G6 (HR 4.0; 95% CI 2.6–6.2), compared with G1 (p < 0.001). Interaction was found between frailty and depression risk, although they were independently associated with mortality.
Conclusions:
Depression risk increases mortality risk in prefrail older adults but not in non-frail and frail ones. Depression should be monitored in these older adults to optimize health outcomes. Factors modulating the relationship between frailty and depression should be explored in future studies.
Background: Estimating the burden of intestinal colonization with antibiotic-resistant gram-negative bacteria (AR-GNB) is critical to understanding their global epidemiology and spread. We aimed to determine the prevalence of, and risk factors for, intestinal colonization due to AR-GNB in population-based hospital and community settings in Chile. Methods: Between December 2018 and May 2019, we enrolled randomly selected hospitalized adults in 4 tertiary-care public hospitals (Antofagasta, Santiago, Curico and Puerto Montt), and adults residing in a community-based cohort in the rural town of Molina. Following informed consent, we collected rectal swabs and epidemiological information through a standardized questionnaire. Swabs were plated onto MacConkey agar with 2 µg/mL ciprofloxacin or ceftazidime. All recovered morphotypes were identified, and antibiotic susceptibility testing was performed via disk diffusion. The primary outcome was the prevalence of colonization with fluoroquinolone (FQ)- or third-generation cephalosporin (3GC)–resistant GNB. The secondary outcome was the prevalence of colonization with multidrug-resistant (MDR) GNB, defined as GNB resistant to ≥3 antibiotic classes. Categories were not mutually exclusive. Bivariate and multivariate analyses were performed to describe risk factors for colonization with these categories. Results: In total, 775 hospitalized adults and 357 community participants were enrolled, with a median age of 60 years (IQR, 42–72) and 55 years (IQR, 48–62) years, respectively. Among hospitalized participants, the prevalence of colonization with FQ- or 3GC-resistant GNB was 47% (95% CI, 43%–50%) and 41% (95% CI, 38%–45%), respectively, whereas the prevalence of MDR-GNB colonization was 27% (95% CI, 24%–31%). In the community setting, the prevalence of colonization with either FQ-, 3GC-resistant GNB, or MDR-GNB was 40% (95% CI, 34%–45%), 29% (95% CI, 24%– 34%), and 5% (95% CI, 3%–8%), respectively. Independent risk factors for hospital MDR-GNB colonization included the hospital of admission, unit of hospitalization (intensive care units carried the highest risk), in-hospital antimicrobial exposure, comorbidities (Charlson index), and length of stay. In the community setting, recent antibiotic exposure (<3 months) predicted colonization with either FQ- or 3GC-resistant GNB, and alcohol consumption was inversely associated with MDR GNB colonization. Conclusions: A high burden of colonization with AR-GNB was observed in this sample of hospitalized and community-dwelling adults in Chile. The high burden of colonization with GNB resistant to commonly used antibiotics such as FQ and 3GC found in community dwellers, suggests that the community may be a relevant source of antibiotic resistance. Efforts to understand relatedness between resistant strains circulating in the community and the hospital are needed.