Lithifying and Non-Lithifying Microbial Ecosystems in the Wetlands and Salt Flats of the Central Andes.

The wetlands and salt flats of the Central Andes region are unique extreme environments as they are located in high-altitude saline deserts, largely influenced by volcanic activity. Environmental factors, such as ultraviolet (UV) radiation, arsenic content, high salinity, low dissolved oxygen content, extreme daily temperature fluctuation, and oligotrophic conditions, resemble the early Earth and potentially extraterrestrial conditions. The discovery of modern microbialites and microbial mats in the Central Andes during the past decade has increased the interest in this area as an early Earth analog. In this work, we review the current state of knowledge of Central Andes region environments found within lakes, small ponds or puquios, and salt flats of Argentina, Chile, and Bolivia, many of them harboring a diverse range of microbial communities that we have termed Andean Microbial Ecosystems (AMEs). We have integrated the data recovered from all the known AMEs and compared their biogeochemistry and microbial diversity to achieve a better understanding of them and, consequently, facilitate their protection.

The impact of COVID-19 on supply decision-makers: the case of personal protective equipment in Spanish hospitals.

BACKGROUND: The COVID-19 pandemic has been recognized as a trigger for redefining supply chains at the global level, and has created an intense debate within the academic community and among policy-makers and practitioners. Among other industries, health care has been dramatically hit by the scarcity of "medical products," specifically for personal protective equipment (PPE-like), due to supply chain disruptions coupled with dramatically increased demand. We aimed to analyze how the scarcity of PPE-like during the COVID-19 pandemic has modified the behavior of decision-makers in the PPE-like supply chain at the hospital level, and to explore what changes could be implemented to cope with future PPE-like shortages. METHODS: We used an explorative approach based on semi-structured interviews with key informants in the Spanish health care industry. More specifically, we held interviews to industry experts at three hospitals in three Spanish regions to map the consequences of the COVID-19 pandemic onto the buying decision-making process. RESULTS: Different strategies were developed by decision-makers at hospitals before, during, and after the first wave of the COVID-19 pandemic in Spain. Our paper offers two main findings: a) decision-makers changed their purchasing behavior from a cost main driver to guaranteeing the availability of supplies; b) they supported the idea of giving more "strategic autonomy" to Spain or Europe through back and nearshoring decisions. CONCLUSIONS: This paper could be of interest to health care management at the national, regional, and hospital levels, as well as for policy-makers, since it could help to establish and configure policies to support the sourcing of medical products (specifically PPE-like) to anticipate potential supply disruptions. Our paper contributes to the limited existing literature on how purchasing strategies at the decision-maker level and supply vary in the health care industry when a public health crisis appears, and what potential solutions might be for policy-makers and practitioners involved in the health care industry.

Haloarchaea from the Andean Puna: Biological Role in the Energy Metabolism of Arsenic.

Biofilms, microbial mats, and microbialites dwell under highly limiting conditions (high salinity, extreme aridity, pH, and elevated arsenic concentration) in the Andean Puna. Only recent pioneering studies have described the microbial diversity of different Altiplano lakes and revealed their unexpectedly diverse microbial communities. Arsenic metabolism is proposed to be an ancient mechanism to obtain energy by microorganisms. Members of Bacteria and Archaea are able to exploit arsenic as a bioenergetic substrate in either anaerobic arsenate respiration or chemolithotrophic growth on arsenite. Only six aioAB sequences coding for arsenite oxidase and three arrA sequences coding for arsenate reductase from haloarchaea were previously deposited in the NCBI database. However, no experimental data on their expression and function has been reported. Recently, our working group revealed the prevalence of haloarchaea in a red biofilm from Diamante Lake and microbial mat from Tebenquiche Lake using a metagenomics approach. Also, a surprisingly high abundance of genes used for anaerobic arsenate respiration (arr) and arsenite oxidation (aio) was detected in the Diamante's metagenome. In order to study in depth the role of arsenic in these haloarchaeal communities, in this work, we obtained 18 haloarchaea belonging to the Halorubrum genus, tolerant to arsenic. Furthermore, the identification and expression analysis of genes involved in obtaining energy from arsenic compounds (aio and arr) showed that aio and arr partial genes were detected in 11 isolates, and their expression was verified in two selected strains. Better growth of two isolates was obtained in presence of arsenic compared to control. Moreover, one of the isolates was able to oxidize As[III]. The confirmation of the oxidation of arsenic and the transcriptional expression of these genes by RT-PCR strongly support the hypothesis that the arsenic can be used in bioenergetics processes by the microorganisms flourishing in these environments.

Assessing the Crop-Water Status in Almond (Prunus dulcis Mill.) Trees via Thermal Imaging Camera Connected to Smartphone.

Different tools are being implemented in order to improve the water management in agricultural irrigated areas of semiarid environments. Thermography has been progressively introduced as a promising technique for irrigation scheduling and the assessing of crop-water status, especially when deficit irrigation is being implemented. However, an important limitation is related to the cost of the actual cameras, this being a severe limitation to its practical usage by farmers and technicians. This work evaluates the potential and the robustness of a thermal imaging camera that is connected to smartphone (Flir One) recently developed by Flir Systems Inc. as a first step to assess the crop water status. The trial was developed in mature almond (Prunus dulcis Mill.) trees that are subjected to different irrigation treatments. Thermal information obtained by the Flir One camera was deal with the thermal information obtained with a conventional Thermal Camera (Flir SC660) with a high resolution, and subsequently, confronted with other related plant physiological parameters (leaf water potential, Ψleaf, and stomatal conductance, gs). Thermal imaging camera connected to smartphone provided useful information in estimating the crop-water status in almond trees, being a potential promising tool to accelerate the monitoring process and thereby enhance water-stress management of almond orchards.

Cephalometric landmark identification consistency between undergraduate dental students and orthodontic residents in 3-dimensional rendered cone-beam computed tomography images: A preliminary study.

INTRODUCTION: The aim of this study was to compare 3-dimensional landmark consistency and precision in skeletal structures in groups with different levels of experience with 2-dimensional cephalometrics. METHODS: Sixteen observers, all undergraduate or graduate students, were divided into 4 groups with different levels of experience in 2-dimensional landmarking and no previous experience in 3 dimensions. Group 1 consisted of 4 third-year dental students with no experience in cephalometric landmarking. Groups 2, 3, and 4 consisted of first-, second-, and third-year graduate students, with increasing levels of experience. The participants located 18 landmarks in 12 surface models of cone-beam computed tomography scans of patients on 3 separate occasions. The average of all examiners locating each landmark was defined as the centroid. The mean of the distances of each located point to the centroid of that landmark was used as the mean consistency (MC), and the standard deviation (SD) was used as the precision. Analysis of variance and post hoc Tukey comparisons between groups were done. RESULTS: The MC and SD values across landmarks, patients, and examiners were 1.03 ± 1.14 mm. The MC and SD were 0.89 ± 0.83 mm for group 1 with no experience, 1.02 ± 0.95 mm for group 2, 1.17 ± 1.60 mm for group 3, and 1.05 ± 1.00 mm for group 4. Significant differences were found among the groups. CONCLUSIONS: Comparing the observer groups studied, the undergraduate dental school students without previous experience in bidimensional cephalometrics obtained the best values in volumetric landmark location. Graduate students with increasing amounts of experience did not perform as well. These results and conclusions should be interpreted with caution because the number of subjects in each group was small.

Prevention of violence against women and girls: what does the evidence say?

In this Series paper, we review evidence for interventions to reduce the prevalence and incidence of violence against women and girls. Our reviewed studies cover a broad range of intervention models, and many forms of violence--ie, intimate partner violence, non-partner sexual assault, female genital mutilation, and child marriage. Evidence is highly skewed towards that from studies from high-income countries, with these evaluations mainly focusing on responses to violence. This evidence suggests that women-centred, advocacy, and home-visitation programmes can reduce a woman's risk of further victimisation, with less conclusive evidence for the preventive effect of programmes for perpetrators. In low-income and middle-income countries, there is a greater research focus on violence prevention, with promising evidence on the effect of group training for women and men, community mobilisation interventions, and combined livelihood and training interventions for women. Despite shortcomings in the evidence base, several studies show large effects in programmatic timeframes. Across different forms of violence, effective programmes are commonly participatory, engage multiple stakeholders, support critical discussion about gender relationships and the acceptability of violence, and support greater communication and shared decision making among family members, as well as non-violent behaviour. Further investment in intervention design and assessment is needed to address evidence gaps.

Bacterial Diversity in Microbial Mats and Sediments from the Atacama Desert.

The Atacama Desert has extreme environmental conditions that allow the development of unique microbial communities. The present paper reports the bacterial diversity of microbial mats and sediments and its mineralogical components. Some physicochemical conditions of the water surrounding these ecosystems have also been studied trying to determine their influence on the diversity of these communities. In that way, mats and sediments distributed among different hypersaline lakes located in salt flats of the Atacama Desert were subjected to massive parallel sequencing of the V4 region of the 16S rRNA genes of Bacteria. A higher diversity in sediment than in mat samples have been found. Lakes that harbor microbial mats have higher salinity than lakes where mats are absent. Proteobacteria and/or Bacteroidetes are the major phyla represented in all samples. An interesting item is the finding of a low proportion or absence of Cyanobacteria sequences in the ecosystems studied, suggesting the possibility that other groups may be playing an essential role as primary producers in these extreme environments. Additionally, the large proportion of 16S rRNA gene sequences that could not be classified at the level of phylum indicates potential new phyla present in these ecosystems.

Microbial characterization of microbial ecosystems associated to evaporites domes of gypsum in Salar de Llamara in Atacama desert.

The Central Andes in northern Chile contains a large number of closed basins whose central depression is occupied by saline lakes and salt crusts (salars). One of these basins is Salar de Llamara (850 m a.s.l.), where large domed structures of seemingly evaporitic origin forming domes can be found. In this work, we performed a detailed microbial characterization of these domes. Mineralogical studies revealed gypsum (CaSO(4)) as a major component. Microbial communities associated to these structures were analysed by 454 16S rDNA amplicon sequencing and compared between winter and summer seasons. Bacteroidetes Proteobacteria and Planctomycetes remained as the main phylogenetic groups, an increased diversity was found in winter. Comparison of the upper air-exposed part and the lower water-submerged part of the domes in both seasons showed little variation in the upper zone, showing a predominance of Chromatiales (Gammaproteobacteria), Rhodospirillales (Alphaproteobacteria), and Sphingobacteriales (Bacteroidetes). However, the submerged part showed marked differences between seasons, being dominated by Proteobacteria (Alpha and Gamma) and Verrucomicrobia in summer, but with more diverse phyla found in winter. Even though not abundant by sequence, Cyanobacteria were visually identified by scanning electron microscopy (SEM), which also revealed the presence of diatoms. Photosynthetic pigments were detected by high-performance liquid chromatography, being more diverse on the upper photosynthetic layer. Finally, the system was compared with other endoevaporite, mats microbialite and Stromatolites microbial ecosystems, showing higher similitude with evaporitic ecosystems from Atacama and Guerrero Negro. This environment is of special interest for extremophile studies because microbial life develops associated to minerals in the driest desert all over the world. Nevertheless, it is endangered by mining activity associated to copper and lithium extraction; thus, its environmental protection preservation is strongly encouraged.

Prophylactic maintenance with venetoclax/azacitidine after reduced-intensity conditioning allogeneic transplant for high-risk MDS and AML.

ABSTRACT: We conducted a phase 1 trial assessing safety and efficacy of prophylactic maintenance therapy with venetoclax and azacitidine (Ven/Aza) for patients with high-risk myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML) undergoing reduced intensity allogeneic stem cell transplantation (allo-SCT) after Ven and fludarabine/busulfan conditioning (Ven/FluBu2 allo-SCT) with tacrolimus and methotrexate as graft-versus-host disease (GVHD) prophylaxis. Among 27 patients who underwent Ven/FluBu2 allo-SCT (55.6% with prior Ven exposure, and 96% with positive molecular measurable residual disease), 22 received maintenance therapy with Aza 36 mg/m2 intravenously on days 1 to 5, and Ven 400 mg by mouth on days 1 to 14 per assigned dose schedule/level (42-day cycles × 8, or 28-day cycles × 12). During maintenance, the most common grade 3-4 adverse events were leukopenia, neutropenia, and thrombocytopenia, which were transient and manageable. Infections were uncommon (n = 4, all grade 1-2). The 1-year and 2-year moderate/severe chronic GVHD rates were 4% (95% confidence interval [CI], 0.3%-18%) and 22% (95% CI, 9%-40%), respectively. After a median follow-up of 25 months among survivors, the median overall survival (OS) was not reached. Among the 22 patients who received Ven/Aza maintenance, the 2-year OS, progression-free survival, nonrelapse mortality, and cumulative incidence of relapse rates were 67% (95% CI, 43%-83%), 59% (95% CI, 36%-76%), 0%, and 41% (95% CI, 20%-61%), respectively. Immune monitoring demonstrated no significant impact on T-cell expansion but identified reduced B-cell expansion compared with controls. This study demonstrates prophylactic Ven/Aza maintenance can be safely administered for patients with high-risk MDS/AML, but a randomized study is required to properly assess any potential benefit. This trial was registered at www.clinicaltrials.gov as #NCT03613532.

Valorisation of waste ilmenite mud in the manufacture of sulphur polymer cement.

This paper reports the preparation of sulphur polymer cements (SPCs) incorporating waste ilmenite mud for use in concrete construction works. The ilmenite mud raw material and the mud-containing SPCs (IMC-SPCs) were characterised physico-chemically and radiologically. The optimal IMC-SPC mixture had a sulphur/mud ratio (w/w) of 1.05 (mud dose 20 wt%); this cement showed the greatest compressive strength (64 MPa) and the lowest water absorption coefficient (0.4 g cm(-2) at 28 days). Since ilmenite mud is enriched in natural radionuclides, such as radium isotopes (2.0·10(3) Bq kg(-1)(228)Ra and 5.0·10(2) Bq kg(-1)(226)Ra), the IMC-SPCs were subjected to leaching experiments, which showed their environmental impact to be negligible. The activity concentration indices for the different radionuclides in the IMC-SPCs containing 10% and 20% ilmenite mud met the demands of international standards for materials used in the construction of non-residential buildings.

Cellular immune response after vaccination with Salmonella Gallinarum 9R in laying hens and addition of aflatoxin and absorbent in the feed.

Salmonella Gallinarum greatly impacts commercial flocks and vaccination with S. Gallinarum 9R (SG9R) is one of the most effective control strategies in some countries. However, mycotoxins can affect immunization success. Herein, we measured the cellular immune response in SG9R-vaccinated hens, quantified the impact of aflatoxins on the immune response, and determined whether the anti-mycotoxin additive (adsorbent) influences immunity after vaccination. One-day-old chicks of commercial laying hens were raised until 49 days of age and were assigned to six groups. T1 (control group): control diet (no detectable concentration of aflatoxin), no vaccine or adsorbent. T2: vaccine SG-9R at day 28, aflatoxins 2.5 ppm from day 1 to day 49, and adsorbent 2.5 Kg/ton. T3: control diet and vaccine. T4: aflatoxins and vaccine. T5: control diet and aflatoxins. T6: aflatoxins and adsorbent. Body weights were evaluated on days 1, 31, and 41. Cellular immune response was evaluated by flow cytometry at 31, 41, and 49 days of age. T lymphocytes, B lymphocytes, monocytes, phagocytic monocytes and heterophils were evaluated. Aflatoxins suppressed peripheral and mucosal helper T lymphocytes, and mucosal cytotoxic T lymphocytes in vaccinated birds (T2 and T4). However, inclusion of the adsorbent in the feed of vaccinated birds neutralized the effects of aflatoxin (T6). The concentration of immune cells may show differences after SG9R vaccination, particularly an increase in the monocyte concentration. The SG9R vaccine reduced the concentration of activated cytotoxic T lymphocytes, making this marker a good parameter to analyze before and three weeks after immunization.

Visual perception of skeletal class and biotype in Spain.

The aim of this study was to determine and compare the visual accuracy of students and experienced orthodontists in distinguishing the different skeletal classes and facial biotypes using only lateral photographs. A group of 19 orthodontic students (4 males and 15 females, aged between 23 and 30 years) and 9 experienced orthodontists (three males and six females, aged between 30 and 56 years) were shown a slide presentation of 100 (50 males and 50 females) patients aged between 8 and 42 years and were asked to indicate the skeletal class and the facial biotype of each subject. Data were analysed using a one-way repeated measures analysis of variance, with Bonferroni post hoc adjustment for multiple testing. P-values less than 0.05 were considered statistically significant. Only 32.75 per cent of the participants identified the facial biotype of the patients with respect to Rickett's vertical (Vert) pattern and 47.96 per cent the skeletal class. The students performed better than the experienced orthodontists (P < 0.05) but only for skeletal class. The results indicate that lateral photographs are not sufficient for determining the skeletal class or facial biotype of patients.

Reproductive aspects of the poorly known and critically endangered freshwater snail Heleobia atacamensis (Gastropoda: Truncatelloidea).

Knowing the reproductive biology of threatened species is essential for conservation and to establish proper management plans. Heleobia atacamensis, a freshwater snail only known from two locations in the Atacama Saltpan, northern Chile, is currently classified as Data Deficient on the IUCN Red List and Critically Endangered by the Ministerio del Medio Ambiente of Chile. Based on size-frequency distribution, multivariate analysis of shell measurements, and microdissections, we studied the reproductive strategy, recruitment period, sex ratio and sexual dimorphism in this species. Heleobia atacamensis is an oviparous species, with direct development (non-planktotrophic). Females lay capsules of a single egg from which a juvenile resembling a miniature adult hatches after intracapsular metamorphosis is completed. The development type was confirmed by the observation of a paucispiral protoconch (= protoconch I) using scanning electron microscopy. Recruitment was observed across the four seasons of the year, with an increment at the end of austral summer. Results also showed that sex ratio was 1:1, whereas sexual dimorphism was not detected using univariate and multivariate analysis of the shell. The reproductive data provided in this study are a starting point for future management plans.

Carbon fixation and rhodopsin systems in microbial mats from hypersaline lakes Brava and Tebenquiche, Salar de Atacama, Chile.

In this work, molecular diversity of two hypersaline microbial mats was compared by Whole Genome Shotgun (WGS) sequencing of environmental DNA from the mats. Brava and Tebenquiche are lakes in the Salar de Atacama, Chile, where microbial communities are growing in extreme conditions, including high salinity, high solar irradiance, and high levels of toxic metals and metaloids. Evaporation creates hypersaline conditions in these lakes and mineral precipitation is a characteristic geomicrobiological feature of these benthic ecosystems. The mat from Brava was more rich and diverse, with a higher number of different taxa and with species more evenly distributed. At the phylum level, Proteobacteria, Cyanobacteria, Chloroflexi, Bacteroidetes and Firmicutes were the most abundant, including ~75% of total sequences. At the genus level, the most abundant sequences were affilitated to anoxygenic phototropic and cyanobacterial genera. In Tebenquiche mats, Proteobacteria and Bacteroidetes covered ~70% of the sequences, and 13% of the sequences were affiliated to Salinibacter genus, thus addressing the lower diversity. Regardless of the differences at the taxonomic level, functionally the two mats were similar. Thus, similar roles could be fulfilled by different organisms. Carbon fixation through the Wood-Ljungdahl pathway was well represented in these datasets, and also in other mats from Andean lakes. In spite of presenting less taxonomic diversity, Tebenquiche mats showed increased abundance and variety of rhodopsin genes. Comparison with other metagenomes allowed identifying xantorhodopsins as hallmark genes not only from Brava and Tebenquiche mats, but also for other mats developing at high altitudes in similar environmental conditions.

Geobiology of Andean Microbial Ecosystems Discovered in Salar de Atacama, Chile.

The Salar de Atacama in the Chilean Central Andes harbors unique microbial ecosystems due to extreme environmental conditions, such as high altitude, low oxygen pressure, high solar radiation, and high salinity. Combining X-ray diffraction analyses, scanning electron microscopy and molecular diversity studies, we have characterized twenty previously unexplored Andean microbial ecosystems in eight different lakes and wetlands from the middle-east and south-east regions of this salt flat. The mats and microbialites studied are mainly formed by calcium carbonate (aragonite and calcite) and halite, whereas the endoevaporites are composed predominantly of gypsum and halite. The carbonate-rich mats and microbialites are dominated by Bacteroidetes and Proteobacteria phyla. Within the phylum Proteobacteria, the most abundant classes are Alphaproteobacteria, Gammaproteobacteria and Deltaproteobacteria. While in the phylum Bacteroidetes, the most abundant classes are Bacteroidia and Rhodothermia. Cyanobacteria, Chloroflexi, Planctomycetes, and Verrucomicrobia phyla are also well-represented in the majority of these systems. Gypsum endoevaporites, on the contrary, are dominated by Proteobacteria, Bacteroidetes, and Euryarchaeota phyla. The Cyanobacteria phylum is also abundant in these systems, but it is less represented in comparison to mats and microbialites. Regarding the eukaryotic taxa, diatoms are key structural components in most of the microbial ecosystems studied. The genera of diatoms identified were Achnanthes, Fallacia, Halamphora, Mastogloia, Navicula, Nitzschia, and Surirella. Normally, in the mats and microbialites, diatoms form nano-globular carbonate aggregates with filamentous cyanobacteria and other prokaryotic cells, suggesting their participation in the mineral precipitation process. This work expands our knowledge of the microbial ecosystems inhabiting the extreme environments from the Central Andes region, which is important to ensure their protection and conservation.

Flexibility and Bed Margins of the Community of Madrid's Hospitals during the First Wave of the SARS-CoV-2 Pandemic.

Background: The COVID-19 pandemic has had global effects; cases have been counted in the tens of millions, and there have been over two million deaths throughout the world. Health systems have been stressed in trying to provide a response to the increasing demand for hospital beds during the different waves. This paper analyzes the dynamic response of the hospitals of the Community of Madrid (CoM) during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the period between 18 March and 31 May 2020. The aim was to model the response of the CoM's health system in terms of the number of available beds. Methods: A research design based on a case study of the CoM was developed. To model this response, we use two concepts: "bed margin" (available beds minus occupied beds, expressed as a percentage) and "flexibility" (which describes the ability to adapt to the growing demand for beds). The Linear Hinges Model allowed a robust estimation of the key performance indicators for capturing the flexibility of the available beds in hospitals. Three new flexibility indicators were defined: the Average Ramp Rate Until the Peak (ARRUP), the Ramp Duration Until the Peak (RDUP), and the Ramp Growth Until the Peak (RGUP). Results: The public and private hospitals of the CoM were able to increase the number of available beds from 18,692 on 18 March 2020 to 23,623 on 2 April 2020. At the peak of the wave, the number of available beds increased by 160 in 48 h, with an occupancy of 90.3%. Within that fifteen-day period, the number of COVID-19 inpatients increased by 200% in non-intensive care unit (non-ICU) wards and by 155% in intensive care unit (ICU) wards. The estimated ARRUP for non-ICU beds in the CoM hospital network during the first pandemic wave was 305.56 beds/day, the RDUP was 15 days, and the RGUP was 4598 beds. For the ICU beds, the ARRUP was 36.73 beds/day, the RDUP was 20 days, and the RGUP was 735 beds. This paper includes a further analysis of the response estimated for each hospital. Conclusions: This research provides insights not only for academia, but also for hospital management and practitioners. The results show that not all of the hospitals dealt with the sudden increase in bed demand in the same way, nor did they provide the same flexibility in order to increase their bed capabilities. The bed margin and the proposed indicators of flexibility summarize the dynamic response and can be included as part of a hospital's management dashboard for monitoring its behavior during pandemic waves or other health crises as a complement to other, more steady-state indicators.

No safe place: Prevalence and correlates of violence against conflict-affected women and girls in South Sudan.

BACKGROUND: Conflict and humanitarian crises increase the risk of both intimate partner violence and non-partner sexual violence against women and girls. We measured the prevalence and risk factors of different forms of violence against women and girls in South Sudan, which has suffered decades of conflict, most recently in 2013. METHODS: A population-based survey was conducted among women aged 15-64 in three conflict-affected sites in South Sudan: Juba, Rumbek, and the Protection of Civilian Sites (PoCs) in Juba between 2015 and 2016. FINDINGS: A total of 2,244 women between the ages of 15-64 were interviewed. Fifty percent (in the Juba PoCs) to 65% (in Juba and Rumbek) of all female respondents experienced either physical or sexual violence from a partner or non-partner in the course of their lifetimes. Approximately 35% of respondents have experienced rape, attempted rape or other forms of sexual violence by a non-partner during their lifetime. For ever-partnered women, lifetime prevalence of physical and/or sexual partner violence ranged between 54% in the Juba PoCs and 73% in Rumbek. Restrictive marital practices and gender norms, and experiences of conflict were major drivers of both partner and non-partner violence. CONCLUSION: Women and girls in South Sudan suffer among the highest levels of physical and sexual violence in the world. Although the prevalence of sexual assault by non-partners is four times the global average, women are still at greatest risk of physical and sexual assault from intimate partners. Conflict-related and intimate partner violence reinforce each other and are upheld by restrictive gender norms and marital practices. Expansion of comprehensive services, including health and psycho-social support for survivors is urgently needed. Moreover, policies and laws to prevent violence against women and provide survivors with access to justice should be given high priority within the ongoing peacebuilding process in South Sudan.

Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture.

Academic literature and practitioners acknowledge that there is a need to improve efficiency and service quality in the healthcare industry. In Spain, osteoporotic fractures represent a great cost in socio-economic and morbi-mortality terms, hip fracture being the surgical pathology with the second highest consumption of resources. The research questions that govern this study concern the use of Lean principles to identify waste, and an evaluation of the application of an innovative approach in the hip fracture surgery process. A research design based on a case study and action research was developed. Findings relate to (i) the identification of the main types of waste or muda (being the most frequent delay, transportation, over-processing and defects); (ii) the analysis of existing processes based on a Lean approach (identifying opportunities for improvement as a reduction of the number of steps and participants, improving communication, automation, standardization, etc.); and (iii) the application of an innovative process based on the Lean approach and action research in the healthcare industry. This research provides insights for academia, practitioners, management, and society: waste identification and process redesign helps to continue the improvement of operations, increase efficiency, reduce costs, and enhance services, providing benefits to patients, families, hospital employees, and the healthcare system.

Shear bond strength of a flash-free orthodontic adhesive system after thermal aging procedure.

In this article by Carlos and colleagues (J Clin Exp Dent. 2019 Feb 1;11(2):e154-61), there is an error in the Material and Methods of the abstract. The correct Material and Methods of the abstract is: Material and Methods: A total of 120 human premolars were randomly divided into two groups (n=60) according to the orthodontic adhesive used: APC Flash-Free Adhesive Coated Appliance System (APC FF) or Transbond PLUS Color Change Adhesive (TP), as control. A SBS test was performed and ARI value for each specimen was also assessed. Results were analyzed by two-way ANOVA and Tukey's Chi-square test (p<0.05).

Shear bond strength of a flash-free orthodontic adhesive system after thermal aging procedure.

BACKGROUND: The aim of this study was to compare the shear bond strength (SBS) of a flash-free and precoated orthodontic adhesive with a compomer orthodontic adhesive before and after thermocycling. The adhesive remnant index (ARI) was also determined for both adhesives. MATERIAL AND METHODS: The adhesive remnant index (ARI) was also determined for both adhesives. Material and Methods: A total of 120 human premolars were randomly divided into two groups (n=60) according to the orthodontic adhesive used: APC Flash-Free Adhesive Coated Appliance System (APC FF) or Transbond PLUS Color Change Adhesive (TP), as control. A SBS test was performed and ARI value for each specimen was also assessed. Results were analyzed by two-way ANOVA and Tukey's Chi-square test (p<0.05). RESULTS: SBS values were significantly influenced by thermocycling (p<0.01). Neither the orthodontic adhesive nor the interaction between adhesive and thermocycling statistically affected SBS results (p>0.05). CONCLUSIONS: APC FF and TP showed similar bond strength results. Thermocycling induced a significant decrease in SBS values for the two adhesives tested, without differences between 10,000 and 20,000 thermal cycles. Moreover, APC FF left less adhesive remnants on the enamel compared to TP. Key words:APC Flash-Free, APC cement, aging, orthodontics, resin cements.