Cytostatic compounds in sludge and sediment: extraction and determination by a combination of microwave-assisted extraction and UHPLC-MS/MS.

Cytostatic compounds are an important group of micro-pollutants since they are used to kill cells or stop cell division. For this reason, they are also considered mutagenic. Several cytostatic compounds have been detected in hospital effluents, in the influents and effluents of wastewater treatment plants and even in river water. However, their detection in solid matrices is very scarce. In this work, we have developed a new procedure based on microwave-assisted extraction (MAE) for the extraction of cytostatic compounds from sludge and sediment before determination by ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). To develop this procedure, we have chosen a group of eight widely used cytostatic compounds and carried out a systematic experimental design to optimize the extraction conditions. Under these optimal conditions, the studied cytostatic compounds are extracted with good sensitivity, with recoveries ranging from 65 to 122% in sludge and recoveries varying between 49 and 109% in sediment, with the exception of etoposide, which has a lower recovery from these types of samples. The limits of detection were from 0.42 to 79.8 ng g-1 in sludge and from 0.10 to 87.5 ng g-1 in sediment. Intraday and interday relative standard deviations (RSDs) were below 15% and 18%, respectively, in both matrices at the tested concentrations. The total procedure was applied to samples of sludge taken from the main wastewater treatment plant (WWTP) of the island of Gran Canaria (Spain) and for sediment samples obtained close to the marine outfalls of different wastewater treatment plants for the same island. Graphical abstract.

Occurrence of benzotriazole UV stabilizers in coastal fishes.

Chemicals added in personal care products are of emerging concern because their fate and their effect on the environment is not completely known. Benzotriazole UV stabilizers (BUVSs) are compounds used in different cosmetic products, which may reach the marine environment through marine discharge from treated waters or directly from bathing areas. Once released into the aquatic ecosystem, BUVSs can be bioaccumulated by aquatic organisms. To identify the human exposure risk, it is important to have suitable analytical methods to determine the presence of BUVSs in these organisms. Because of the complexity of such a biological matrix, selective extraction and detection techniques are required to isolate and quantify these kinds of pollutants at trace levels. In the present work, we optimized a method based on microwave-assisted extraction combined with ultra-high performance liquid chromatography and mass spectrometry detection to determine six benzotriazole compounds in fish samples. The absolute extraction yields provided by the proposed method were higher than 40% for most compounds, with intra-day and inter-day relative standard deviations ranging from 0.27 to 6.06 and 1.12-21.3%, respectively. The limits of quantification were in the range of 1.13-9.66 ng g-1 (dry weight). The method was applied to the study of three species of fish (Boops boops, Sphyraena viridensis, Sphoeroides marmoratus) that were collected close to three marine outfalls of treated waters on the Gran Canaria Island (Spain) for two years. Four of the six studied compounds, UV-326, UV-328, UV-329 and UV-360, were found with concentrations ranging from 1.34 ng g-1 to 45.6 ng g-1 (dry weight).

Monitoring and environmental risk assessment of benzotriazole UV stabilizers in the sewage and coastal environment of Gran Canaria (Canary Islands, Spain).

Benzotriazole UV stabilizers (BUVSs) are emerging contaminants that are widely used in personal care products, such as cosmetics and sunscreens, to absorb ultraviolet light. These compounds have been described as bioaccumulative, pseudo-persistent and toxic; therefore, it is of great importance to investigate them and determine their presence and distribution in the environment. In this research, we performed a two-year monitoring study to identify six BUVS compounds (UV-P, UV-326, UV-327, UV-328, UV-329 and UV-360) in different environmental compartments from Gran Canaria (Canary Islands, Spain): influent and effluent from five wastewater treatment plants (WWTPs) and seawater and sediment samples from three marine areas influenced by sewage outfalls discharges from WWTPs. Two methods based on on-line solid-phase extraction and microwave-assisted extraction coupled with ultra-high-performance liquid chromatography with mass spectrometry detection were applied to quantify the analytes in liquid and solid samples, respectively. The target BUVSs were measured in sewage, coastal seawater and sediment samples in concentrations in the ranges of 13.12-1933 ng L-1, 67.01-2419 ng L-1 and 4.42-2162 ng kg-1 dry weight, respectively. The studied compounds exhibited different trends of occurrence in aqueous and solid samples due to their different coefficients of hydrophobicity. The majority of the positive samples belonged to the most touristic sampling location of the island. The estimated hazard quotient, HQ, revealed no risk from the target compounds at the measured concentrations levels.

Developing nurse leaders across the Americas: evaluation of an online nursing leadership course.

Development of leadership capacities in the nursing workforce is essential to achieving universal health in the Region of the Americas. This evaluation considered the effectiveness of an online leadership course offered in English and Spanish to nurses throughout Latin America and the Caribbean. The online course was an asynchronous eight-module leadership nursing course created and offered by the Pan American Health Organization (PAHO) Virtual Campus. A retrospective, descriptive design was used to evaluate learner performance data from the modules. Learner performance on the course was analyzed. Electronic surveys were distributed to individuals who withdrew prior to course completion to obtain information regarding the reason for withdrawal. In all, 289 individuals from 41 countries participated in the online course. Learner performance demonstrated improvement from pre- to post-test. The most frequent reason for not completing the course was being too busy with other obligations. The Spanish-language course version received more enrollment applications than any other course in the virtual campus' 12-year history. The evaluation concluded that continuing education that develops nursing leadership is desired across Latin America and the Caribbean. Online education through the PAHO Virtual Campus may be a low-cost yet powerful means of disseminating knowledge to the nursing workforce throughout the Americas.

El desarrollo de las capacidades de liderazgo en el personal de enfermería es esencial para alcanzar la salud universal en la Región de las Américas. En esta evaluación se analizó la eficacia de un curso de liderazgo en línea en inglés y en español que se ofreció a personal de enfermería en toda América Latina y el Caribe. El curso en línea fue un curso asíncrono de liderazgo en enfermería de ocho módulos, creado y ofrecido por el Campus Virtual de la Organización Panamericana de la Salud (OPS). Se usó un diseño retrospectivo y descriptivo para evaluar los datos de desempeño de los alumnos en los módulos. Se analizó el desempeño de los alumnos en cuanto al aprendizaje el curso. Se enviaron encuestas electrónicas a las personas que abandonaron el curso antes de su finalización para obtener información sobre los motivos de deserción.En total, 289 personas de 41 países participaron en los cursos en línea. Se detectaron mejoras en el desempeño de los alumnos antes y después de la prueba. La razón más frecuente por la que no completaron el curso fue que estaban muy ocupados con otras obligaciones. La versión del curso en español tuvo más inscriptos que cualquier otro curso en los 12 años del Campus Virtual. La conclusión de la evaluación fue que en toda América Latina y el Caribe se desea recibir educación continua que fomente las capacidades de liderazgo en enfermería. La educación en línea por medio del Campus Virtual de la OPS puede ser un medio económico, pero a la vez poderoso, de difundir conocimiento al personal de enfermería en la Región de las Américas.

Desenvolver a capacidade de liderança na equipe de enfermagem é fundamental para alcançar a saúde universal na Região das Américas. Foi realizada uma avaliação da efetividade de um curso online de práticas de liderança em enfermagem ministrado em inglês e em espanhol ao pessoal de enfermagem em toda a América Latina e o Caribe. Tratou-se de um curso online assíncrono com oito módulos sobre práticas de liderança em enfermagem, elaborado e oferecido pelo Campus Virtual da Organização Pan-Americana da Saúde (OPAS). Foi usado um delineamento descritivo retrospectivo para avaliar os dados do desempenho dos alunos nos módulos. Foram enviadas aos participantes que não concluíram o curso uma pesquisa eletrônica para a coleta de dados sobre os motivos do abandono.Ao todo, 289 profissionais de 41 países fizeram o curso online. Houve melhoria no desempenho dos alunos entre o pré-teste e o pós-teste. Estar muito ocupado com outros compromissos foi o motivo mais frequentemente informado para não concluir o curso. O número de inscrições de profissionais no curso na versão em espanhol foi o mais alto dentre os cursos oferecidos nos 12 anos de vida do campus virtual. Esta avaliação demonstrou que existe uma demanda por educação continuada para desenvolver liderança em enfermagem na América Latina e Caribe. A educação online por meio do Campus Virtual da OPAS é um recurso de baixo custo, porém de grande influência, para difundir o conhecimento entre o pessoal de enfermagem nas Américas.

Development and application of a microwave-assisted extraction and LC/MS/MS methodology to the determination of antifouling booster biocides in sea mullets (Mugil cephalus) organisms.

A method is presented for the extraction, preconcentration, and determination of two commonly used booster biocides, Irgarol 1051 and diuron, in samples of muscle and liver tissues from Mugil cephalus by microwave-assisted extraction (MAE) followed by SPE for the preconcentration and cleanup step, coupled with LC/MS/MS. The optimum conditions for MAE were established as power 200 W and irradiation time 4 min. Using these conditions, the LOD was 0.13 ng/g for diuron and 0.10 ng/g for Irgarol 1051. The recoveries calculated at three concentration levels (0.5, 5, and 50 ng/g) were greater than 74%. Repeatability was less than 7.5% and reproducibility less than 12.7%. The optimized method was used to monitor these compounds in M. cephalus from different harbors of Gran Canaria Island. The samples were collected bimonthly and processed following the optimized method. High levels of Irgarol 1051 (6.9 +/- 1.03 ng/g) were found in the liver, while diuron was undetected. However, diuron was found in the muscle (1.41 +/- 0.45 ng/g). The proposed sentinel organism could be used in tropical and subtropical regions to continuously biomonitor for booster biocides over long periods of time. This technique could be a useful tool for improving the management of ocean and coastal waters.

A proteoliposome formulation derived from Bordetella pertussis induces protection in two murine challenge models.

Whooping cough remains a health problem despite high vaccination coverage. It has been recommended that development of new strategies provide long-lasting immunity. The aim of this work was to evaluate the potential of proteoliposomes (PL) extracted from Bordetella pertussis as a vaccine candidate against whooping cough. The size of the B. pertussis PL was estimated to be 96.7 ± 50.9 nm by Scanning Correlation Spectroscopy and the polydispersity index was 0.268. Western blots using monoclonal antibodies revealed the presence of pertussis toxin, pertactin, and fimbriae 3. The Limulus Amebocyte Lisate (LAL) assay showed endotoxin levels lower than those reported for whole cell pertussis licensed vaccines, while the Pyrogen Test indicated 75 ng/mL/Kg. The PL showed high protection capacity in mouse challenge models. There was 89.7% survival in the intracerebral challenge and total reduction of the number of CFU in the intranasal challenge. No significant differences (p > 0.05) were observed between mice immunized with B. pertussis PL and the Cuban DTwP vaccine, whichever challenge model used. These results encouraged us to continue the development of the B. pertussis PL as a component of a new combined vaccine formulated with tetanus and diphtheria toxoids or as a booster dose for adolescents and adults.

KLRF1, a novel marker of CD56bright NK cells, predicts improved survival for patients with locally advanced bladder cancer.

BACKGROUND: Bladder tumor-infiltrating CD56bright NK cells are more tumor cytotoxic than their CD56dim counterparts. Identification of NK cell subsets is labor-intensive and has limited utility in the clinical setting. Here, we sought to identify a surrogate marker of bladder CD56bright NK cells and to test its prognostic significance. METHODS: CD56bright and CD56dim NK cells were characterized with the multiparametric flow (n = 20) and mass cytometry (n = 21) in human bladder tumors. Transcriptome data from bladder tumors (n = 351) profiled by The Cancer Genome Atlas (TCGA) were analyzed. The expression levels of individual markers in intratumoral CD56bright and CD56dim NK cells were visualized in tSNE plots. Expressions of activation markers were also compared between Killer Cell Lectin-Like Receptor Subfamily F Member 1 (KLRF1)+ and KLRF1- NK cells. RESULTS: Intratumoral CD56bright NK cells displayed a more activated phenotype compared to the CD56dim subset. Multiple intratumoral cell types expressed CD56, including bladder tumor cells and nonspecific intratumoral CD56 expression was associated with worse patient survival. Thus, an alternative to CD56 as a marker of CD56bright NK cells was sought. The activation receptor KLRF1 was significantly increased on CD56bright but not on CD56dim NK cells. Intratumoral KLRF1+ NK cells were more activated and expressed higher levels of activation molecules compared with KLRF1- NK cells, analogous to the distinct effector function of NK cells across CD56 expression. High intratumoral KLRF1 was associated with improved recurrence-free survival (hazard ratio [HR] 0.53, p = 0.01), cancer-specific survival (HR 0.47, p = 0.02), and overall survival (HR 0.54, p = 0.02) on multivariable analyses that adjusted for clinical and pathologic variables. CONCLUSIONS: KLRF1 is a promising prognostic marker in bladder cancer and may guide treatment decisions upon validation.

Fate and distribution of benzotriazole UV filters and stabilizers in environmental compartments from Gran Canaria Island (Spain): A comparison study.

Tourism is an economic sector of great importance worldwide. In coastal areas, this activity is associated with the use of personal care products, such as ultraviolet (UV) filters and stabilizers. Therefore, assessing their presence and the exposure of living organisms to the impact of this kind of pollutant in such areas could be especially important. The Canary Islands (Spain) are considered an outermost region, and their main economic activity is based on tourism, both national and international. Thus, this area could be remarkably vulnerable to this kind of pollution, and its characterization could be useful to infer conclusions for other similar regions. With this aim, the occurrence of organic UV filters and stabilizers in different environmental matrices in Gran Canaria Island is presented in this work. Six benzotriazole compounds, UV-P, UV-326, UV-327, UV-328, UV-329 and UV-360, were found in wastewater, seawater, sludge, sediment, seaweed and fish samples. The numerous studies devoted to establishing the distribution of these target compounds in many different matrices on a touristic and particularly overcrowded island such as Gran Canaria can be used to understand the pollution situation in similar locations. The works in which determination procedures using different extraction techniques were optimized and validated for the analysis of liquid and solid samples are summarized. They are critically discussed regarding their characteristics and analytical parameters. This research is of interest to environmental managers specializing in the conservation of coastal areas where tourism is an important industry since the active components of UV filters and stabilizers can bioaccumulate and biomagnify in the trophic chain.

Randomized clinical trial of the effect of the onset time of skin-to-skin contact at birth, immediate compared to early, on the duration of breastfeeding in full term newborns.

BACKGROUND: Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding. METHODS: A randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate's breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration. RESULTS: A total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28). CONCLUSIONS: The percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators. TRIAL REGISTRATION: ClinicalTrials.gov NCT02687685 .

An assessment of the concentration of pharmaceuticals adsorbed on microplastics.

In the last decade, microplastics (MPs) have become an increasing cause for concerning. These particles are scattered throughout seas and oceans and have the capability of transporting adsorbed pollutants as pharmaceutical compounds, which can cause toxic effects and be transferred along the food chain. The development, optimization and validation of a sensitive and reliable analytical procedure for the extraction and determination of ten common pharmaceuticals adsorbed on MPs is reported in this study. This method involves ultrasound-assisted extraction coupled with ultra-high-performance liquid chromatography and tandem mass spectrometry. All of the variables included in the extraction process, such as the extraction time and type and solvent volume, were studied and optimised. Under optimal conditions, good reproducibility and repeatability, with relative standard deviations lower than 15% in most cases, were obtained while limits of detection between 0.25 and 15.8 ng g-1 were achieved. Last, the method was applied to the analysis of samples collected from beaches in the Canary Islands (Spain). The results indicated the presence of several analytes adsorbed on MPs in concentrations ranging from 34.0 to 111 ng g-1.

Efficacy and Safety of Infliximab in HLA-B27-associated Ocular Inflammation Refractory or Intolerant to Conventional Immunomodulatory Therapy.

PURPOSE: To determine the efficacy and safety of infliximab therapy in patients with HLA B-27-associated ocular inflammation resistant or intolerant to conventional immunomodulatory therapy. METHODS: This was a retrospective observational case series. All cases were uveitic patients with positive HLA-B27, confirmed through HLA testing, resistant or intolerant to conventional immunomodulatory therapy. The primary outcome of the study was to identify the efficacy of infliximab determined by the control of inflammation, duration of remission, and the ability to reduce conventional immunomodulatory therapy. The secondary outcome was an improvement of two or more lines of best-corrected visual acuity (BCVA) on the Snellen visual acuity chart. RESULTS: Twenty-four patients (38 eyes) were included in the study. All patients were followed for 24 months. Twenty-one (87.5%) patients completed 24 months of follow-up. Sixteen (66.7%) patients had active uveitis at the beginning of therapy. One patient out of these active patients had active inflammation at the end of follow-up period. Thirteen (87.5%) out of sixteen active patients were in steroid-free remission. The mean duration of treatment to induce remission was 16.5 months (range 6-24 months). Corticosteroid was stopped in 19 (90.5%) patients by the end of the study. At the end of the study, in patients who achieved remission, 14 (58.3%) patients were in remission on infliximab therapy and 6 (25%) patients were in remission off infliximab therapy. Of the 38 eyes, 8 (21.05%) showed improvement in BCVA (three eyes had successful cataract extraction with intraocular lens implantation during infliximab therapy with no subsequent inflammation), while 26 eyes (68.4%) had stable BCVA over the 24-month study period. The side effects included allergic reaction, fatigue, cellulitis, headache, restlessness, elevation of liver enzymes, and anemia. Two patients (n = 24, 8.3%) experienced severe adverse effects and the treatment was stopped prematurely in these two patients. CONCLUSION: Infliximab might induce and maintain the steroid-free remission in HLA-B27-associated ocular inflammation in patients resistant or intolerant to conventional immunomodulatory therapy.

Rapid development and use of patient-specific ctDNA biomarkers to avoid a "rash decision" in an ovarian cancer patient.

Epithelial ovarian cancer (OvCa) is the most lethal female reproductive tract malignancy. A major clinical hurdle in patient management and treatment is that when using current surveillance technologies 80% of patients will be clinically diagnosed as having had a complete clinical response to primary therapy. In fact, the majority of women nonetheless develop disease recurrence within 18 mo. Thus, without more accurate surveillance protocols, the diagnostic question regarding OvCa recurrence remains framed as "when" rather than "if." With this background, we describe the case of a 61-yr-old female who presented with a 3-mo history of unexplained whole-body rash, which unexpectedly led to a diagnosis of and her treatment for OvCa. The rash resolved immediately following debulking surgery. Nearly 1 yr later, however, the rash reappeared, prompting the prospect of tumor recurrence and requirement for additional chemotherapy. To investigate this possibility, we undertook a genomics-based tumor surveillance approach using a targeted 56-gene NGS panel and biobanked tumor samples to develop personalized ctDNA biomarkers. Although tumor-specific TP53 and PTEN mutations were detectable in all originally collected tumor samples, pelvic washes, and blood samples, they were not detectable in any biosample collected beyond the first month of treatment. No additional chemotherapy was given. The rash spontaneously resolved. Now, 2 yr beyond the patient's original surgery, and in the face of continued negative ctDNA findings, the patient remains with no evidence of disease. As this single case report suggests, we believe for the first time that ctDNA can provide an additional layer of information to avoid overtreatment.

Analysis and occurrence of benzotriazole ultraviolet stabilisers in different species of seaweed.

Benzotriazole ultraviolet stabilisers (BUVSs) are emerging compounds used in personal care products and in other products, such as plastics, to absorb UV light. BUVSs have been described as bioaccumulative, persistent and toxic, so it is of great interest to understand their presence in the environment. Some marine organisms, such as seaweeds, have been used as bioindicators of contamination in the environment because they are able to accumulate metals and organic compounds. We have selected seaweeds to develop a novel method to extract, identify and determine six BUVSs (UV P, UV 326, UV 327, UV 328, UV 329, UV 360) based on microwave assisted extraction (MAE) and ultra-high-performance liquid chromatography with diode array (UHPLC-DAD) and mass spectrometry confirmation (UHPLC-MS/MS). Under optimum conditions, recoveries ranging from 49.8 to 92.3% were obtained, while intra-day and inter-day precision values were lower than 10% for most of the compounds. Limits of detection in the ranges 1.79-4.58 and 0.89-1.76 ng g-1 dry weight (dw) were obtained for UHPLC-DAD and UHPLC-MS/MS, respectively. The optimised method was applied for the analysis of twelve species of seaweed sampled during four months in 2018 from Las Canteras beach (Gran Canaria, Spain), with the results confirmed by UHPLC-MS/MS. UV 360 was found in concentrations between 42.5 and 115 ng g-1 (dw) in five of the twelve species. Although the highest concentrations were found in Asparagopsis taxiformis, the presence of UV 360 in other species could suggest that seaweeds can act as potential bioindicators of the occurrence of these compounds in the coastal environment.

Two-Dimensional Zymography of Proteases from Steatotic Duck Liver.

Protease activity present in liver cells with steatosis can be electrophoretically characterized. Zymographic techniques allow semi-quantitative results, successfully detecting cathepsin and metalloprotease activity using polyacrylamide gels copolymerized with gelatin and quantified by densitometry. By using specific inhibitors, the identity of the proteases can be confirmed. 2D zymography allows the determination of both M r. and pI of the metalloprotease and cathepsin activity present in the homogenates. The analysis of liver proteases activities in force fed ducks may elucidate the mechanisms behind steatosis development.

The effect of skin-to-skin contact at birth, early versus immediate, on the duration of exclusive human lactancy in full-term newborns treated at the Clínica Universidad de La Sabana: study protocol for a randomized clinical trial.

BACKGROUND: Human lactancy is a simple and cost-effective strategy that influences infant and maternal mortality rates. Skin-to-skin contact (SSC) is an immediate postpartum period strategy that has proven to benefit the initiation and continuation of human lactation and to decrease hospitalization during the first week of life. This study aims to determine the effect of SSC initiation at birth (immediate versus early) in healthy, full-term newborns treated at the Universidad de La Sabana Clinic on the duration of exclusive human lactation. METHODS/DESIGN: A randomized, blind clinical trial will be performed with full-term healthy newborns born at the Universidad de La Sabana Clinic. The blind trial participants will be those persons measuring the results and analyzing the data. The sample size will be calculated for a type I error of 5 %, a two-tailed type II error of 20 %, and an estimated percentage loss of 30 %; 150 infants will be included in each group. Randomization will be performed using permuted, size-6 blocks. Descriptive analysis will be conducted using central tendency and dispersion measurements. A bivariate analysis will be performed to determine which variables are associated with exclusive lactancy at 6 months. For continuous variables, Student's t test will be used for independent samples, and the Wilcoxon rank sum test will be used if the assumptions of normality for the t tests are not fulfilled. The assumption of normality will be evaluated using the Shapiro-Wilk and Kolmogorov-Smirnov tests. Categorical variables in contingency tables will be constructed to assess the independence between variables using the chi-square test, or Fisher's exact test when the assumption of the number of cases is not met by the values in the contingency tables multiplied by two. This will be calculated as a measurement of the effect of relative risk (RR) with confidence intervals; the adjusted measurements will be calculated using a multivariate regression Poisson model. Variables with significant results will be used in the bivariate analysis, and those with biological plausibility will be used for the adjustment. The analysis will be carried out for a two-tailed type I error level of 5 %. The Stata 11 program will be used for data analysis. An interim analysis will be performed upon the submission of half the expected events (106), setting limits for the early termination of the trial according to the method proposed by Pampallona and Tsiatis (1994). INTERVENTION: There will be two SSC randomization groups: early versus immediate. After completing the neonatal adaptation process and based on the group assignment, the mother will be left with her newborn child in hospital accommodation. Prior to discharge, the Infant Breast-Feeding Assessment Tool (IBFAT) will be applied. Monitoring will initially be performed with a face-to-face assessment between 3 and 10 days of life, followed by monthly telephone calls for 6 months to verify lactation status. DISCUSSION: SSC at birth has shown benefits in the short and long term for both the mother and the full-term newborn. Although the meta-analysis that have been done have shown the benefits of this technique, multiple differences in the SSC interventions have been identified because criteria such as the initiation or duration of SSC (dose) have not been unified. Colombia has a malnutrition risk of 11,4 % in the total population for the period 2012-2014, so it is necessary to promote strategies that generate a positive impact on the duration of human lactation, providing support from the clinical setting of humanized delivery which is included in the IAMI strategy (Instituciones Amigas de la Mujer y la Infancia - Friends of Women and Children Institution). Therefore, we propose that the initiation time of SSC in full-term new-borns is related to the duration of exclusive human lactation. TRIAL REGISTRATION: Registered ClinicalTrials.gov Identifier: NCT 02687685 . Registered on 2 February 2016. This study is not yet open for participant recruitment.

A sentence sliding window approach to extract protein annotations from biomedical articles.

BACKGROUND: Within the emerging field of text mining and statistical natural language processing (NLP) applied to biomedical articles, a broad variety of techniques have been developed during the past years. Nevertheless, there is still a great ned of comparative assessment of the performance of the proposed methods and the development of common evaluation criteria. This issue was addressed by the Critical Assessment of Text Mining Methods in Molecular Biology (BioCreative) contest. The aim of this contest was to assess the performance of text mining systems applied to biomedical texts including tools which recognize named entities such as genes and proteins, and tools which automatically extract protein annotations. RESULTS: The "sentence sliding window" approach proposed here was found to efficiently extract text fragments from full text articles containing annotations on proteins, providing the highest number of correctly predicted annotations. Moreover, the number of correct extractions of individual entities (i.e. proteins and GO terms) involved in the relationships used for the annotations was significantly higher than the correct extractions of the complete annotations (protein-function relations). CONCLUSION: We explored the use of averaging sentence sliding windows for information extraction, especially in a context where conventional training data is unavailable. The combination of our approach with more refined statistical estimators and machine learning techniques might be a way to improve annotation extraction for future biomedical text mining applications.

Development of an anticoagulation stewardship program at a large tertiary care academic institution.

Pharmacist-directed anticoagulation management services (AMSs) have been shown to significantly lower anticoagulation-related mortality, length of hospital stay, bleeding complications, blood transfusion requirements, and cost of therapy. AMSs are only 1 component of an anticoagulation stewardship program. Frequently, stewardship programs are limited to inpatient populations. Incorporating components that facilitate transition to outpatient status will ideally encompass complete care. The purpose of this program was to expand anticoagulation services and standardize care by implementing a full-service stewardship program including a transition of care service. The first component of the study involved medication surveillance for inpatients on anticoagulation therapy. The second component involved transitioning patients on anticoagulation, primarily with venous thromboembolism (VTE) to outpatient management. Finally, the pharmacist identified areas for optimization. Optimization involved developing or updating protocols to reflect updates in the literature as well as updating institution-specific information resources. Interventions made through medication surveillance and utilization of the VTE transition of care services translated into a total cost savings of approximately US$270 320. A postgraduate, first-year pharmacy resident contributed to improving patient outcomes while reducing utilization of hospital services and obtaining substantial cost savings through participation in anticoagulation stewardship services.

Developing nurse leaders across the Americas: evaluation of an online nursing leadership course

[ABSTRACT]. Development of leadership capacities in the nursing workforce is essential to achieving universal health in the Region of the Americas. This evaluation considered the effectiveness of an online leadership course offered in English and Spanish to nurses throughout Latin America and the Caribbean. The online course was an asynchronous eight-module leadership nursing course created and offered by the Pan American Health Organization (PAHO) Virtual Campus. A retrospective, descriptive design was used to evaluate learner performance data from the modules. Learner performance on the course was analyzed. Electronic surveys were distributed to individuals who withdrew prior to course completion to obtain information regarding the reason for withdrawal. In all, 289 individuals from 41 countries participated in the online course. Learner performance demonstrated improvement from pre- to post-test. The most frequent reason for not completing the course was being too busy with other obligations. The Spanish-language course version received more enrollment applications than any other course in the virtual campus’ 12-year history. The evaluation concluded that continuing education that develops nursing leadership is desired across Latin America and the Caribbean. Online education through the PAHO Virtual Campus may be a low-cost yet powerful means of disseminating knowledge to the nursing workforce throughout the Americas.

[RESUMEN]. El desarrollo de las capacidades de liderazgo en el personal de enfermería es esencial para alcanzar la salud universal en la Región de las Américas. En esta evaluación se analizó la eficacia de un curso de liderazgo en línea en inglés y en español que se ofreció a personal de enfermería en toda América Latina y el Caribe. El curso en línea fue un curso asíncrono de liderazgo en enfermería de ocho módulos, creado y ofrecido por el Campus Virtual de la Organización Panamericana de la Salud (OPS). Se usó un diseño retrospectivo y descriptivo para evaluar los datos de desempeño de los alumnos en los módulos. Se analizó el desempeño de los alumnos en cuanto al aprendizaje el curso. Se enviaron encuestas electrónicas a las personas que abandonaron el curso antes de su finalización para obtener información sobre los motivos de deserción. En total, 289 personas de 41 países participaron en los cursos en línea. Se detectaron mejoras en el desempeño de los alumnos antes y después de la prueba. La razón más frecuente por la que no completaron el curso fue que estaban muy ocupados con otras obligaciones. La versión del curso en español tuvo más inscriptos que cualquier otro curso en los 12 años del Campus Virtual. La conclusión de la evaluación fue que en toda América Latina y el Caribe se desea recibir educación continua que fomente las capacidades de liderazgo en enfermería. La educación en línea por medio del Campus Virtual de la OPS puede ser un medio económico, pero a la vez poderoso, de difundir conocimiento al personal de enfermería en la Región de las Américas.

[RESUMO]. Desenvolver a capacidade de liderança na equipe de enfermagem é fundamental para alcançar a saúde universal na Região das Américas. Foi realizada uma avaliação da efetividade de um curso online de práticas de liderança em enfermagem ministrado em inglês e em espanhol ao pessoal de enfermagem em toda a América Latina e o Caribe. Tratou-se de um curso online assíncrono com oito módulos sobre práticas de liderança em enfermagem, elaborado e oferecido pelo Campus Virtual da Organização Pan-Americana da Saúde (OPAS). Foi usado um delineamento descritivo retrospectivo para avaliar os dados do desempenho dos alunos nos módulos. Foram enviadas aos participantes que não concluíram o curso uma pesquisa eletrônica para a coleta de dados sobre os motivos do abandono. Ao todo, 289 profissionais de 41 países fizeram o curso online. Houve melhoria no desempenho dos alunos entre o pré-teste e o pós-teste. Estar muito ocupado com outros compromissos foi o motivo mais frequentemente informado para não concluir o curso. O número de inscrições de profissionais no curso na versão em espanhol foi o mais alto dentre os cursos oferecidos nos 12 anos de vida do campus virtual. Esta avaliação demonstrou que existe uma demanda por educação continuada para desenvolver liderança em enfermagem na América Latina e Caribe. A educação online por meio do Campus Virtual da OPAS é um recurso de baixo custo, porém de grande influência, para difundir o conhecimento entre o pessoal de enfermagem nas Américas.

Developing nurse leaders across the Americas: evaluation of an online nursing leadership course / Capacitación de líderes en enfermería en toda la Región de las Américas: evaluación de un curso en línea de liderazgo en enfermería / Desenvolver a liderança em enfermagem nas Américas: avaliação de um curso online de práticas de liderança em enfermagem

ABSTRACT Development of leadership capacities in the nursing workforce is essential to achieving universal health in the Region of the Americas. This evaluation considered the effectiveness of an online leadership course offered in English and Spanish to nurses throughout Latin America and the Caribbean. The online course was an asynchronous eight-module leadership nursing course created and offered by the Pan American Health Organization (PAHO) Virtual Campus. A retrospective, descriptive design was used to evaluate learner performance data from the modules. Learner performance on the course was analyzed. Electronic surveys were distributed to individuals who withdrew prior to course completion to obtain information regarding the reason for withdrawal. In all, 289 individuals from 41 countries participated in the online course. Learner performance demonstrated improvement from pre- to post-test. The most frequent reason for not completing the course was being too busy with other obligations. The Spanish-language course version received more enrollment applications than any other course in the virtual campus' 12-year history. The evaluation concluded that continuing education that develops nursing leadership is desired across Latin America and the Caribbean. Online education through the PAHO Virtual Campus may be a low-cost yet powerful means of disseminating knowledge to the nursing workforce throughout the Americas.

RESUMEN El desarrollo de las capacidades de liderazgo en el personal de enfermería es esencial para alcanzar la salud universal en la Región de las Américas. En esta evaluación se analizó la eficacia de un curso de liderazgo en línea en inglés y en español que se ofreció a personal de enfermería en toda América Latina y el Caribe. El curso en línea fue un curso asíncrono de liderazgo en enfermería de ocho módulos, creado y ofrecido por el Campus Virtual de la Organización Panamericana de la Salud (OPS). Se usó un diseño retrospectivo y descriptivo para evaluar los datos de desempeño de los alumnos en los módulos. Se analizó el desempeño de los alumnos en cuanto al aprendizaje el curso. Se enviaron encuestas electrónicas a las personas que abandonaron el curso antes de su finalización para obtener información sobre los motivos de deserción. En total, 289 personas de 41 países participaron en los cursos en línea. Se detectaron mejoras en el desempeño de los alumnos antes y después de la prueba. La razón más frecuente por la que no completaron el curso fue que estaban muy ocupados con otras obligaciones. La versión del curso en español tuvo más inscriptos que cualquier otro curso en los 12 años del Campus Virtual. La conclusión de la evaluación fue que en toda América Latina y el Caribe se desea recibir educación continua que fomente las capacidades de liderazgo en enfermería. La educación en línea por medio del Campus Virtual de la OPS puede ser un medio económico, pero a la vez poderoso, de difundir conocimiento al personal de enfermería en la Región de las Américas.

RESUMO Desenvolver a capacidade de liderança na equipe de enfermagem é fundamental para alcançar a saúde universal na Região das Américas. Foi realizada uma avaliação da efetividade de um curso online de práticas de liderança em enfermagem ministrado em inglês e em espanhol ao pessoal de enfermagem em toda a América Latina e o Caribe. Tratou-se de um curso online assíncrono com oito módulos sobre práticas de liderança em enfermagem, elaborado e oferecido pelo Campus Virtual da Organização Pan-Americana da Saúde (OPAS). Foi usado um delineamento descritivo retrospectivo para avaliar os dados do desempenho dos alunos nos módulos. Foram enviadas aos participantes que não concluíram o curso uma pesquisa eletrônica para a coleta de dados sobre os motivos do abandono. Ao todo, 289 profissionais de 41 países fizeram o curso online. Houve melhoria no desempenho dos alunos entre o pré-teste e o pós-teste. Estar muito ocupado com outros compromissos foi o motivo mais frequentemente informado para não concluir o curso. O número de inscrições de profissionais no curso na versão em espanhol foi o mais alto dentre os cursos oferecidos nos 12 anos de vida do campus virtual. Esta avaliação demonstrou que existe uma demanda por educação continuada para desenvolver liderança em enfermagem na América Latina e Caribe. A educação online por meio do Campus Virtual da OPAS é um recurso de baixo custo, porém de grande influência, para difundir o conhecimento entre o pessoal de enfermagem nas Américas.

Producción científica de autores de la provincia Ciego de Ávila en la revista MediCiego desde 1995 hasta 2009 / Authors scientific production of Ciego de Avila province in MediCiego Journal from 1995 to 2009

Se realizó un estudio métrico para lo cual se revisaron todos los números de la revista desde 1995 hasta 2009, que se encuentran incluidos en el mapa del conocimiento del portal GesCon del Centro Provincial de Información de Ciencias Médicas de Ciego de Ávila. Durante el periodo se publicaron 859 artículos que presentaron una distribución similar en los seis primeros años, con un aumento importante a partir del año 2001. La producción científica de los profesionales de la salud fue aproximadamente 20 artículos por cada 100 profesionales. El promedio autor/artículo fue de 3,57 y la razón hombre: mujer, de forma global fue 0.97:1. El tipo de investigación más frecuente en los artículos fue la clínica, seguida por los artículos de Salud Pública. La mayoría de los artículos fueron originales, seguidos por los de revisión. La distribución de las categorías docentes y científicas se corresponde con la pirámide de estas categorías en la provincia. Los médicos fueron los profesionales que más publicaron en este período, seguidos de los profesionales no propios del sector. La mayoría de los autores proceden de los hospitales provinciales de Ciego de Ávila y Morón, seguidos por la Facultad de Ciencias Médicas de Ciego de Ávila.

A metric study was carried out in which all journal numbers were reviewed from 1995 to 2009,these are included in GesCon knowledment porch´s map of CPICM, Ciego de Avila city. 859 artículos were publiched during the period mention before, these articles presented a similar distribution in the fist six years, with an important increase from 2001 on.The Scientific production of healthcare professionals was aproximately 20 articles by each an every 100 profetionals.Theaverage article/author was 3,57 and the man reazon: woman, 0.97:1 global way. The most frequent invetigation in articles was clinic followed by public health articles.The majority of articles were original,followed by the revision.The distribution of the teaching and scientific categories corresponds with the pyramid of these categories in the province. Doctors were the profecionals to publicated most in this period, followed by other professionals.The majority of authors come from Ciego de Avila and Moron hospital followed by the Medical Sciences School of Ciego de Avila.