On a population model with density dependence and Allee effect.

We study the dynamics of a discrete model with two different stages of the population, the pre-adult stage governed by a Beverton-Holt-type map and the adult stage by a [Formula: see text]-Ricker map. The composition of both maps gives the dynamics. The existence of the Allee effect is easily observed. We check that the model can evolve from a sure extinction to complicated dynamics. The presence of an almost sure extinction is proved to exist when the dynamical complexity is the highest possible.

Characteristics of hospitalized patients with hypercalcemia in the province of Malaga: a longitudinal, retrospective, multicenter study.

BACKGROUND AND OBJECTIVE: There are limited studies analyzing hypercalcemia in hospitalized patients. Our objectives were to describe the clinical characteristics of hospitalized patients with hypercalcemia, estimate its prevalence in the hospital setting, analyze the rate of correction of hypercalcemia, and identify prognostic variables. MATERIALS AND METHODS: Observational, longitudinal, retrospective, and bicentric study. Adult patients admitted to two hospitals in Málaga (2014-2018) with a diagnosis of hypercalcemia were included. The minimum follow-up was 2 years or until death. RESULTS: A total of 205 patients with hypercalcemia were included (incidence: 0.13%). The mean age (SD) was 68.2 (13.1) years, with a predominance of males (55.1%). The median (IQR) serum calcium at admission was 13.1 (11.8-14.6) mg/dl. The most common etiologies were neoplasms (75.1%), primary hyperparathyroidism, and medications (both 8.8%). The median (IQR) follow-up period was 5.1 (1.7-60.3) weeks. The most commonly used treatments were fluid therapy (86.8%), loop diuretics (70.9%), bisphosphonates (60.7%), and glucocorticoids (46.2%). The rate of correction of hypercalcemia was 65.2%, with a median (IQR) of 6 (3-10) days. The mortality rate was 81.5%. The median (95% CI) survival was 5.1 (3-7.3) weeks. Factors associated with higher mortality were advanced age, neoplastic etiology, serum calcium at admission, and failure to correct hypercalcemia. CONCLUSIONS: Hypercalcemia in hospitalized patients is mainly due to neoplastic processes and is associated with high mortality. We observed a low rate of adherence to recommendations for the management of hypercalcemia.

A new coding system to test independence of time series.

We introduce a new codification on a time series that combines permutations and another symbol containing quantitative information. With these new codes, we construct a new test to determine whether a time series is independent and identically distributed. We compare our results with those obtained with tests based only on permutations. Our results show that the new test produces better results than those based only on permutations.

Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain.

BACKGROUND: There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. METHODS: We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission factors associated with in-hospital mortality. RESULTS: A total of 1718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n = 819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p < 0.001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p = 0.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p = 0.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p < 0.001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p < 0.001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p < 0.001). CONCLUSIONS: Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.

[Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain]. / Características clínicas y factores de riesgo de mortalidad al ingreso en pacientes con insuficiencia cardíaca hospitalizados por COVID-19 en España.

Background: There are few studies on patients with heart failure (HF) hospitalized for COVID-19. Our aim is to describe the clinical characteristics of patients with HF hospitalized for COVID-19 and identify risk factors for in-hospital mortality upon admission. Methods: We conducted a retrospective, multicenter study in patients with HF hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A multivariate logistic regression analysis was performed to identify admission risk factors associated with in-hospital mortality. Results: A total of 1,718 patients were analyzed (56.5% men; median age 81.4 years). The overall case fatality rate was 47.6% (n=819). The independent risk factors at admission for in-hospital mortality were: age (adjusted odds ratio [AOR]: 1.03; 95% confidence interval [95%CI]: 1.02-1.05; p< .001); severe dependence (AOR: 1.62; 95%CI: 1.19-2.20; p=.002); tachycardia (AOR: 1.01; 95%CI: 1.00-1.01; p=.004); and high C-reactive protein (AOR: 1.004; 95%CI:1.002-1.004; p< .001), LDH (AOR: 1.001; 95%CI: 1.001-1.002; p< .001), and serum creatinine levels (AOR: 1.35; 95%CI: 1.18-1.54; p< .001). Conclusions: Patients with HF hospitalized for COVID-19 have a high in-hospital mortality rate. Some simple clinical and laboratory tests can help to identify patients with a worse prognosis.

Expression of CTX-M-15 limits the efficacy of ceftolozane/tazobactam against Escherichia coli in a high-inoculum murine peritonitis model.

OBJECTIVES: Among carbapenem-sparing therapies, ceftolozane/tazobactam has been proposed for the treatment of infections due to CTX-M-15-producing Escherichia coli. However, few data exist on its in vivo activity in infections associated with a high bacterial inoculum. METHODS: We analysed ceftolozane/tazobactam activity against susceptible E. coli CFT073-RR and its CTX-M-15-producing transconjugant E. coli CFT073-RR Tc blaCTX-M-15, in vitro at low and high inocula, and in a high-inoculum murine model of peritonitis. RESULTS: Against E. coli CFT073-RR Tc blaCTX-M-15, ceftolozane/tazobactam bactericidal effect was impaired in vitro with only a minor inoculum effect; this translated into reduced activity compared with imipenem in the mouse peritonitis model. CONCLUSIONS: Combination of extended spectrum ß-lactamase expression and high inoculum size may be a clinical situation at risk of reduced bactericidal activity of ceftolozane/tazobactam.

Antimicrobial activity of Citrus spp. and Anethum graveolens components against Candida metapsilosis in ranch sauce.

In this paper, a study was carried out to test the inhibitory effect of a natural food compound (NFC), based on flavonoids (naringenin, hesperetin, tangeritin, luteolin, apigenin and kaempferol) from citrus and dill, in ranch sauce. A strain of C. metapsilosis, isolated from a spoiled sample of ranch sauce, was used as target pathogen microorganism. The inhibitory effect of NFC was compared with a common mixture of chemical preservatives used in this type of sauces: potassium sorbate and sodium benzoate (S/B). An in vitro test was performed by the microtiter plate assay at 10, 25 and 37 °C for 24 h in modified Tryptic Soy Broth. An additive antimicrobial effect had been observed in the combination of acetic acid and NFC. The results of the microtiter assay were validated in a challenge test in ranch sauce at 5, 25 and 37 °C for 10 weeks. NFC showed partial fungicidal effect against C. metapsilosis, reducing two logarithmic units at 5 °C for 10 weeks. At 5 °C, the traditional doses of S/B used in ranch sauce decreased viable cells to non-detectable counts from the second week of the experiment. At 25 and 37 °C, the use of S/B mixture or the use of NFC showed the same fungicidal effect. The incorporation of NFC, alone or in combination with acetic acid, opens the possibility of formulating clean label sauces with good protection against the development of the acid resistant yeast C. metapsilosis.

[Diagnostic accuracy of blood pressure determination in clinics in control of hypertension: Proposal of new cut-off values]. / Precisión diagnóstica de la determinación de la presión arterial en consulta en el control del hipertenso: Propuesta de nuevos valores de corte.

AIM: This study seeks to determine the optimal cut-off values for the determination of the blood pressure in the clinic as a follow-up test in Primary Care practice. DESIGN: A total of 153 hypertensive patients under 80years of age who met inclusion and exclusion criteria for the study, were subjected to ambulatory monitoring of their blood pressure for 24hours (ABPM). After which two clinic-based measurements were obtained. With the results obtained from the clinic, and taking the ABMP as a reference, the ROC curve was calculated choose the optimal cut-off point. The agreement between both measurements was determined by the intraclass correlation coefficient and the Bland-Altman equation. A validation study was then carried out with the objective of diagnosing whether or not the hypertensive patient was in control. RESULTS: The optimal cut-off values were 137mmHg for systolic BP (sensitivity: 89.3%; specificity: 72.2%) and 84mmHg for diastolic blood pressure (sensitivity: 79.4%; specificity: 72.3%). The agreement in the diagnosis of control between clinic-based measurement and ABPM was 58.9% (Kappa: 0.418). CONCLUSION: The optimal cut-off value of the diastolic BP for follow-up is lower than the values currently established.

Tree-ring correlations suggest links between moderate earthquakes and distant rockfalls in the Patagonian Cordillera.

Earthquakes with magnitudes M > 7 can trigger large landslides and rockfalls at epicenter distances of up to 400 km, whereas moderate shaking (M = 5-7) is generally thought to result in abundant co-seismic mass movements in the vicinity of the epicenter. Although one might anticipate that large magnitude earthquakes off the Chilean coast would result in abundant rockfall in the Patagonian Cordillera, only limited research has explored this hypothesis. Here, we use tree-ring records from 63 cross-sections of century-old (103.9 ± 40.1 yr) Nothofagus pumilio trees to develop a calendar-dated record of small rockfall events (101-102 m3) on a talus slope located next to Monte Fitz Roy (El Chaltén, Argentina; 49°4'S, 72°57'W). The resulting rockfall record is used to infer that subduction zone seismicity at the Triple Junction and intraplate shaking around Lago Argentino almost systematically caused rockfall activity at this site, even if seismicity occurred at large distances (up to 300 km away) and with moderate intensity (M = 5-7). About one third of the rockfalls are triggered by factors other than earthquakes, predominantly in spring when freeze-thaw cycles occur frequently at the site. Despite the fact that seismicity is not the only trigger of rockfall activity at Cerro Crestón, at the foot of Monte Vespignani, we conclude that, in regions where topographic amplification plays a role, small rockfalls can be triggered by earthquakes of moderate intensity at large distances from the epicenter.

[Prophylactic antibiotherapy in hip arthroplasty. Cohort study]. / Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohortes.

OBJECTIVE: The surgical site infection is the main cause of nosocomial infection in surgical patients, being antibiotic prophylaxis one of the most important factors for preventing it. This study evaluates adequacy of antibiotic prophylaxis in hip arthroplasty surgery as well as its effect on preventing surgical site infection. METHODS: A prospective cohort study was carried out from January 2011 to December 2016. We assessed the degree of adequacy of antibiotic prophylaxis in hip arthroplasty. Incidence of surgical site infection was studied after a maximum incubation period of 90 days. In order to assess the effect of inadequate prophylaxis on surgical site infection we used the relative risk adjusted with a logistic regression model. RESULTS: We studied 681 patients. Incidence of surgical site infection was 4% (95% CI 2.5-5.5). Antibiotic prophylaxis was administered in 99% of cases, with an overall protocol adequacy of 74%. The main cause of non-compliance was the length of prescription (22.2%; 149 patients). The effect of inadequate prophylaxis on surgical site infection was RRadjusted=0.47; 95%CI 0.19-1.17, (p>0.05). CONCLUSIONS: Adequacy of antibiotic prophylaxis was high. No relationship between prophylaxis adequacy and incidence of surgical site infection was founded. Surveillance allows us to assess surgical site infection and risk factors.

Climate warming enhances snow avalanche risk in the Western Himalayas.

Ongoing climate warming has been demonstrated to impact the cryosphere in the Indian Himalayas, with substantial consequences for the risk of disasters, human well-being, and terrestrial ecosystems. Here, we present evidence that the warming observed in recent decades has been accompanied by increased snow avalanche frequency in the Western Indian Himalayas. Using dendrogeomorphic techniques, we reconstruct the longest time series (150 y) of the occurrence and runout distances of snow avalanches that is currently available for the Himalayas. We apply a generalized linear autoregressive moving average model to demonstrate linkages between climate warming and the observed increase in the incidence of snow avalanches. Warming air temperatures in winter and early spring have indeed favored the wetting of snow and the formation of wet snow avalanches, which are now able to reach down to subalpine slopes, where they have high potential to cause damage. These findings contradict the intuitive notion that warming results in less snow, and thus lower avalanche activity, and have major implications for the Western Himalayan region, an area where human pressure is constantly increasing. Specifically, increasing traffic on a steadily expanding road network is calling for an immediate design of risk mitigation strategies and disaster risk policies to enhance climate change adaption in the wider study region.

[Analysis of the quality of life in patients affected by scoliosis]. / Análisis de la calidad de vida en los pacientes afectos de escoliosis vertebral.

OBJECTIVES: To assess the quality of life using the SRS 22 test in patients with scoliosis of 20 or more degrees Cobb. MATERIAL AND METHODS: A prospective descriptive study was conducted between April and May 2016 on patients with scoliosis of at least 20 degrees Cobb and aged between 10 and 20 years. A record was made of weight, height, body mass index, and the SR 22 specific quality of life questionnaire for patients with scoliosis was completed. Patients were divided into two groups for analysis: a) scoliosis between 20 and 29 degrees Cobb (n=44); and b) scoliosis with a Cobb of 30 degrees or greater (n=32). RESULTS: There were significant differences in the dimensions that assess pain, image self-perception, and satisfaction with treatment, being valued worse when the degree of scoliosis Cobb is 30 degrees or higher. There were no significant differences in function/activity or mental health. The overall score of the questionnaire was also worse in the group with the highest degree of scoliosis. The weight, height, and BMI showed no significant differences due to the varying degrees of scoliosis. CONCLUSIONS: Scoliosis significantly affects the quality of life of people who suffer it, and there is a negative correlation between the severity of scoliosis measured by degrees Cobb and quality of life.

Gully evolution and geomorphic adjustments of badlands to reforestation.

Badlands and gullied areas are among those geomorphic environments with the highest erosion rates worldwide. Nevertheless, records of their evolution and their relations with anthropogenic land transformation are scarcer. Here we combine historical data with aerial photographs and tree-ring records to reconstruct the evolution of a badland in a Mediterranean environment of Central Spain. Historical sources suggest an anthropogenic origin of this badland landscape, caused by intense quarrying activities during the 18th century. Aerial photographs allowed detection of dramatic geomorphic changes and the evolution of an emerging vegetation cover since the 1960s, due to widespread reforestation. Finally, tree-ring analyses of exposed roots allowed quantification of recent channel incision of the main gully, and sheet erosion processes. Our results suggest that reforestation practices have influenced the initiation of an episode of incision in the main channel in the 1980s, through the hypothesized creation of disequilibrium in water-sediment balance following decoupling of hillslopes from channel processes. These findings imply an asymmetry in the geomorphic response of badlands to erosion such that in the early evolution stages, vegetation removal results in gullying, but that reforestation alone does not necessarily stabilize the landforms and may even promote renewed incision.

SFPQ associates to LSD1 and regulates the migration of newborn pyramidal neurons in the developing cerebral cortex.

The development of the cerebral cortex requires the coordination of multiple processes ranging from the proliferation of progenitors to the migration and establishment of connectivity of the newborn neurons. Epigenetic regulation carried out by the COREST/LSD1 complex has been identified as a mechanism that regulates the development of pyramidal neurons of the cerebral cortex. We now identify the association of the multifunctional RNA-binding protein SFPQ to LSD1 during the development of the cerebral cortex. In vivo reduction of SFPQ dosage by in utero electroporation of a shRNA results in impaired radial migration of newborn pyramidal neurons, in a similar way to that observed when COREST or LSD1 expressions are decreased. Diminished SFPQ expression also associates to decreased proliferation of progenitor cells, while it does not affect the acquisition of neuronal fate. These results are compatible with the idea that SFPQ, plays an important role regulating proliferation and migration during the development of the cerebral cortex.

[Assessment of antibiotic prophylaxis adequacy in rectal surgery]. / Evaluación de la adecuación de la profilaxis antibiótica en la cirugía de recto.

OBJECTIVE: Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection (SSI), so the development of guidelines and assessment of its monitoring is essential. In this study protocol compliance of antibiotic prophylaxis in rectal surgery and the effect of its adequacy in terms of pre-ention of SSI was assessed. METHODS: Prospective cohort study was conducted from 1 January 2009 to 30 December 2015. The degree of compliance with antibiotic prophylaxis and causes of non-compliance in rectal surgery was evaluated. The incidence of SSI was studied after a maximum period of 30 days of incubation. To assess the effect of prophylaxis non-compliance on SSI the relative risk (RR) adjusted with the aid of a logistic regression model was used. RESULTS: The study covered a total of 244 patients. The patients infected reached 20 cases with a SSI cumulative incidence of 8.2% (CI95%: 4.8-11.6). Antibiotic prophylaxis was indicated in all patients and was administered in 98% of cases, with an overall protocol compliance 92.5%. The principal cause of non-compliance was the choice of antibiotic 55.6% (n=10). The effect of inadequacy of antibiotic prophylaxis on surgical infection was RR=0.58, CI95%: 0.10-4.10 (P>0.05). CONCLUSIONS: Compliance with antibiotic prophylaxis was high. No relationship between the adequacy of prophylaxis and incidence of surgical site infection in rectal surgery was found.

[Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care]. / Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria.

BACKGROUND: Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. MATERIAL AND METHODS: The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. RESULTS: About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. CONCLUSIONS: Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.

Debris-flow risk analysis in a managed torrent based on a stochastic life-cycle performance.

Two key factors can affect the functional ability of protection structures in mountains torrents, namely (i) infrastructure maintenance of existing infrastructures (as a majority of existing works is in the second half of their life cycle), and (ii) changes in debris-flow activity as a result of ongoing and expected future climatic changes. Here, we explore the applicability of a stochastic life-cycle performance to assess debris-flow risk in the heavily managed Wartschenbach torrent (Lienz region, Austria) and to quantify associated, expected economic losses. We do so by considering maintenance costs to restore infrastructure in the aftermath of debris-flow events as well as by assessing the probability of check dam failure (e.g., as a result of overload). Our analysis comprises two different management strategies as well as three scenarios defining future changes in debris-flow activity resulting from climatic changes. At the study site, an average debris-flow frequency of 21 events per decade was observed for the period 1950-2000; activity at the site is projected to change by +38% to -33%, according to the climate scenario used. Comparison of the different management alternatives suggests that the current mitigation strategy will allow to reduce expected damage to infrastructure and population almost fully (89%). However, to guarantee a comparable level of safety, maintenance costs is expected to increase by 57-63%, with an increase of maintenance costs by ca. 50% for each intervention. Our analysis therefore also highlights the importance of taking maintenance costs into account for risk assessments realized in managed torrent systems, as they result both from progressive and event-related deteriorations. We conclude that the stochastic life-cycle performance adopted in this study represents indeed an integrated approach to assess the long-term effects and costs of prevention structures in managed torrents.

Regional reconstruction of flash flood history in the Guadarrama range (Central System, Spain).

Flash floods are a common natural hazard in Mediterranean mountain environments and responsible for serious economic and human disasters. The study of flash flood dynamics and their triggers is a key issue; however, the retrieval of historical data is often limited in mountain regions as a result of short time series and the systematic lack of historical data. In this study, we attempt to overcome data deficiency by supplementing existing records with dendrogeomorphic techniques which were employed in seven mountain streams along the northern slopes of the Guadarrama Mountain range. Here we present results derived from the tree-ring analysis of 117 samples from 63 Pinus sylvestris L. trees injured by flash floods, to complement existing flash flood records covering the last ~200years and comment on their hydro-meteorological triggers. To understand the varying number of reconstructed flash flood events in each of the catchments, we also performed a comparative analysis of geomorphic catchment characteristics, land use evolution and forest management. Furthermore, we discuss the limitations of dendrogeomorphic techniques applied in managed forests.

Flash floods in the Tatra Mountain streams: frequency and triggers.

Flash floods represent a frequently recurring natural phenomenon in the Tatra Mountains. On the northern slopes of the mountain chain, located in Poland, ongoing and expected future changes in climate are thought to further increase the adverse impacts of flash floods. Despite the repeat occurrence of major floods in the densely populated foothills of the Polish Tatras, the headwaters have been characterized by a surprising lack of data, such that any analysis of process variability or hydrometeorological triggers has been largely hampered so far. In this study, dendrogeomorphic techniques have been employed in four poorly-gauged torrential streams of the northern slope of the Tatra Mountains to reconstruct temporal and spatial patterns of past events. Using more than 1100 increment cores of trees injured by past flash floods, we reconstruct 47 events covering the last 148 years and discuss synoptic situations leading to the triggering of flash floods with the existing meteorological and flow gauge data. Tree-ring analyses have allowed highlighting the seasonality of events, providing new insights about potential hydrometeorological triggers as well as a differentiating flash flood activity between catchments. Results of this study could be useful to design future strategies to deal with flash flood risks at the foothills of the Polish Tatras and in the Vistula River catchment.

[Spanish adaptation of Beers criteria]. / Adaptación española de los criterios Beers.

BACKGROUND: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. PATIENTS AND METHODS: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. RESULTS: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. CONCLUSIONS: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario.