Ad libitum caffeine consumption, cognitive performance, and sleep in special forces soldiers during a 96-h combat exercise.

Introduction: This observational study investigated the effects of sleep deprivation and ad libitum caffeine consumption on cognitive performance, risk behavior, and mood among 28 Israeli Special Forces (SF) soldiers (mean age: 20.57 ± 0.92 years) during a 96-hour combat exercise. Methods: Actigraphy was used to monitor sleep and activity; cognitive function, risk-taking propensity, mood states, and self-reported sleepiness were assessed using the Psychomotor Vigilance Task (PVT), Evaluation of Risks Scale (EVAR), Profile of Mood States (POMS), Karolinska Sleepiness Scale (KSS); and caffeine consumption by questionnaire at 0, 50, and 96 hours. For analyses, participants were divided into Low (<400 mg) and High (≥400 mg) caffeine consumption groups. Results: The soldiers hiked 108.5 ± 0.52 km and slept for 12.7 ± 0.5 h, with a notable transition from multiple short sleep epochs in the initial 50 hours to a consolidated 5-hour sleep period subsequently. In the High caffeine group, PVT reaction time was faster (p = 0.024) compared to the Low caffeine group, with fewer premature response errors (p = 0.026). However, this group showed increased risk-taking (p = 0.037), particularly reduced Self-Control (p = 0.010). No significant impact of ad libitum caffeine intake on mood was observed. However, degradation over the course of the exercise in both groups in mood states, including anger, fatigue, tension, and vigor, was noted (p < 0.05). KSS scores increased significantly at 50 and 96 h (p < 0.001). Discussion: These results suggest that while caffeine enhances cognitive function, its ad libitum consumption did not consistently improve these measures in this cohort of SF soldiers. The study highlights the complex relationship between sleep deprivation and caffeine intake and their combined effects on soldiers' cognitive and behavioral functions, indicating a need for evidence-based caffeine use guidelines for using caffeine in military settings.

Association of COVID-19-Related Restrictions With Changes in Functional Skills of Adults With Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization.

Intellectual disability (ID) is assumed to be a dynamic phenomenon influenced by personal and environmental factors. During the 18 months of the coronavirus disease (COVID-19) pandemic, most day centers remained open for adults with ID who lived with their families (most of them with severe/profound [S/P] ID) but were closed to those who lived in group homes (with moderate and mild ID). Owing to the fewer participants in day centers, adults with S/P ID received more hours of therapy than before the pandemic. Using a functional screening tool, functional and environmental changes were mapped and discussed in team meetings. As expected, the pandemic caused environmental and personnel changes that affected all groups. The moderate (n = 29) and mild (n = 31) groups deteriorated over the 18 months of the study, especially the senior ones. However, the functional state of the S/P group (n = 16) improved. These results support the understanding that ID is truly dynamic throughout the lifespan. Functional improvements for S/P ID can occur during adulthood with intense and individually adapted interventions.

Data resource profile: COVid VAXines effects on the aged (COVVAXAGE).

Background: To improve the assessment of COVID-19 vaccine use, safety, and effectiveness in older adults and persons with complex multimorbidity, the COVid VAXines Effects on the Aged (COVVAXAGE) database was established by linking CVS Health and Walgreens pharmacy customers to Medicare claims. Methods: We deterministically linked CVS Health and Walgreens customers who had a pharmacy dispensation/encounter paid for by Medicare to Medicare enrollment and claims records. Linked data include U.S. Medicare claims, Medicare enrollment files, and community pharmacy records. The data currently span 01/01/2016 to 08/31/2022. "Research-ready" files were created, with weekly indicators for vaccinations, censoring, death, enrollment, demographics, and comorbidities. Data are updated quarterly. Results: As of November 2022, records for 27,086,723 CVS Health and 23,510,025 Walgreens unique customer IDs were identified for potential linkage. Approximately 91% of customers were matched to a Medicare beneficiary ID (95% for those aged 65 years or older). In the final linked cohort, there were 38,250,873 unique beneficiaries representing ~60% of the Medicare population. Among those alive and enrolled in Medicare as of January 1, 2020 (n = 33,721,568; average age = 73 years, 74% White, 51% Medicare Fee-for-Service, and 11% dual-eligible for Medicaid), the average follow-up time was 130 weeks. The cohort contains 16,021,055 beneficiaries with evidence a first COVID-19 vaccine dose. Data are stored on the secure Medicare & Medicaid Resource Information Center Health & Aging Data Enclave. Data access: Investigators with funded or in-progress funding applications to the National Institute on Aging who are interested in learning more about the database should contact Dr Vincent Mor [Vincent_mor@brown.edu] and Dr Kaleen Hayes [kaley_hayes@brown.edu]. A data dictionary can be provided under reasonable request. Conclusions: The COVVAXAGE cohort is a large and diverse cohort that can be used for the ongoing evaluation of COVID-19 vaccine use and other research questions relevant to the Medicare population.

El terremoto de 1746 y su impacto en la salud en la ciudad de Lima / The earthquake of 1746 and its impact on health in the city of Lima

RESUMEN Durante el siglo XVIII la ciudad de Lima fue afectada por una serie de desastres de origen natural y de epidemias que mermaron tanto la población como la producción agrícola. A continuación, analizaremos el caso del terremoto producido en Lima el 28 de octubre de 1746 y su impacto en el sistema de salud de la ciudad. Dada la magnitud de su destrucción en la infraestructura y el alto número de muertes, marcó un hito en la sociedad limeña de la época.

ABSTRACT During the 18th century, the city of Lima was affected by a series of natural disasters and epidemics that depleted both the population and agricultural production. Next, we will analyze the case of the earth quake in Lima on October 28, 1746 and its impact on the city's health system, given the magnitude of the destruction of infrastructure and the high number of deaths it marked a milestone in Lima's society at the time.

Articulación de fones en individuos clase esqueletal I,II y III / Speech patterns in skeletal class I, II and III subjects

OBJETIVO: determinar los patrones de articulación de fones consonánticos en sujetos de habla española chilena clases I, II y III esqueletal; comparar las diferencias fonéticas que existan entre clases esqueletales. MÉTODOS: se seleccionaron 54 individuos que cumplían con los criterios de inclusión determinados mediante un examen clínico intraoral y a través del análisis de Ricketts, y se conformaron los grupos de estudio de pacientes clases esqueletales I, II y III. Se les realizó un examen fonoarticulatorio estandarizado para determinar los fones modificados y el patrón articulatorio compensatorio realizado. RESULTADOS: se observaron cambios en el punto de articulación de fones consonánticos en las tres clases esqueletales, con diferencias significativas en los grupos de fones anteriores y medios entre pacientes clases I y II, sólo en el grupo de los fones anteriores entre pacientes I y III. Entre pacientes clases II y III no se observaron diferencias significativas. Se reportan modificaciones y compensaciones cualitativamente distintas entre las clases esqueletales. CONCLUSIONES: en relación a pacientes clase I, los pacientes clase II o III, presentan distinto grado de modificación en el punto de articulación de fones consonánticos. Las diferencias observadas se relacionan con los patrones esqueletales propios de cada clase.

PURPOSE: to determine the consonant phonemes articulation patterns in Chilean skeletal class I, II and III Spanish speakers and compare their phonetic differences. METHODS: fifty-four skeletal class I, II and III subjects were selected, based on intraoral clinical examination and Ricketts cephalometric analysis, constituting the study groups. A standardized phonoarticulatory test was applied to each patient to determine the modified phonemes and their compensatory patterns. RESULTS: the findings indicate changes in articulation in all three groups. Significant differences were found in anterior and medium phonemes between skeletal class I and II and only in the anterior phonemes between skeletal class I and III. There were no significant differences between II and III skeletal groups. Qualitatively different modifications and compensations between skeletal classes are reported. CONCLUSION: different degree of modification in consonant phonemes articulation is shown in class II and III patients when compared to class I skeletal subjects. These differences are related to the skeletal patterns.

Nefrectomía radical laparoscópica en el tratamiento de tumores renales estadío T2 / Laparoscopic radical nephrectomy for the treatment of T2 renal tumors

La nefrectomía radical laparoscópica (NRL) es en la actualidad la vía de abordaje de elección para tumores renales en estadío T1 (<7 cms). Tumores en estadío T2 se presentan como un desafío para esta técnica debido al tamaño tumoral y a la posibilidad de mayores complicaciones intra operatorias. Presentamos nuestra experiencia en NRL en pacientes con tumores renales en estadío T2 (> 7cms). Material y métodos: Análisis prospectivo de 121 pacientes sometidos a NRL por cáncer renal entre julio de 2001 y agosto de 2006. De ellos 40 pacientes se encontraban con tumores renales iguales o mayores de 7 cms (T2). Correspondieron a 32 hombres y 8 mujeres, cuya edad promedio fue 61,6años. El tamaño tumoral promedio al TAC de abdomen fue de 8,84 cms (r: 7-14 cms). Fueron sometidos a NRL transperitoneal pura 36 (90 por ciento) pacientes y mano asistida 4 (10 por ciento).Resultados: Tiempo operatorio promedio: 150,9 minutos (r: 90-300), Sangrado promedio: 283 cc. (r:20-2000). Hubo 3 (7,5 por ciento) complicaciones intra operatorias y 2 (5 por ciento) conversiones. Hubo 3 (7,5 por ciento) complicaciones post operatorias menores y 2 (5 por ciento) mayores. El promedio de hospitalización fue de4,7 días. El análisis anatomopatológico informa estadío pT2 en 24 (60 por ciento) pacientes, pT1 en 5 (12,5 por ciento),pT3a en 7 (17,5por ciento ), pT3b en 3 (7,5por ciento ) y 1 (2,5 por ciento) paciente sin cáncer (Pielonefritis xantogranulomatosafocal). El seguimiento promedio es de 16,1 meses (r: 1-42). En este lapso 2 (5por ciento) pacientes presentaron recidivas locales, uno a los 8 meses post operatorio y otro al mes, este último fallece 8 meses después de la cirugía. Conclusiones: La NRL en tumores renales estadío T2 ha demostrado resultados comparables conlas realizadas en estadío T1, si bien es técnicamente más difícil, se presenta como primera opción en centros con experiencia en cirugía laparoscópica. Si bien esta es la serie más extensa en publicarse en nuestro país,...

Laparoscopic radical nephrectomy (LRP) is currently the preferred approach for T1 renal tumors. Tumors larger than 7 cm are challenging due to their increased size and elevated relation with introoperative complications. Material and methods: A total of 121 patients underwent LRN between July 2001 and August 2006. Out of these, 40 patients presented with T2 tumors (equal or larger than 7 cm). Male to female ratio was 4:1. Mean age was 61.6 years. All but 4 patients (10 percent) underwent transperitoneal LRP.Results: Mean operative time was 150.9 minutes (range 90 to 300), operative bleeding was 283 ml (range 20 to 2000). There were 3 intraoperative complications (7.5 percent) and 2 conversions to open surgery (5 percent). There were 3 (7.5 percent) minor and 2 (5percent) mayor postoperative complications. Mean hospital stay was 4.7 days. Pathological analysis revealed pT1, pT2, pT3a and pT3b in 5 (12.5 percent), 24(60 percent), 7 (17,5 percent) and 3 (7,5 percent) respectively, in 1 (2,5percent) patient there was no tumor in the surgical specimen. Mean follow up was 16.1 months (range 1 to 42). Two patients (5 percent) showed local recurrence, at 1and 8 months respectively. Conclusions: LRP in T2 tumors is technically more difficult, however in experienced hands it can be offered as a first choice. Results are comparable with T1 stage tumors. This is the larges series Publisher in our country, however longer follow-up is mandatory before definite conclusions can be drawn.

Modificaciones en la articulación de fones en pacientes con aparato ortodóncico fijo lingual / Speech changes in lingual orthodontic appliances patients

OBJETIVO: el presente trabajo pretende evaluar el efecto de los aparatos ortodóncicos fijos linguales en la articulación de los fones, en pacientes que hablen español chileno, y la adaptación a estos efectos dentro del primer mes de uso de los aparatos. MÉTODOS: la muestra consistió en 13 pacientes que acudieron para instalación de aparato ortodóncico fijo lingual. Se realizó un examen fonoarticulatorio en condiciones estandarizadas, en 5 momentos diferentes: previo a la instalación de los aparatos fijos (E0), inmediatamente después de realizada esta (E1), a las 24 horas posteriores (E2), a los 7 días (E3) y un mes después de la instalación (E4). Se determinaron los fones afectados en los distintos momentos de examen respecto a la línea base dada por el examen previo, y se analizó su resolución. RESULTADOS: se observaron cambios significativos en el punto de articulación de los fones [d], [s] y [r] Los fones [d] y [s] mostraron una resolución favorable dentro del primer mes de uso de los aparatos. El fone vibrante múltiple [r] no mostró una recuperación de la alteración una vez cumplido un mes de uso de los aparatos ortodóncicos. CONCLUSIONES: la instalación de aparato ortodóncico fijo lingual produce modificaciones en el punto de articulación de los fones consonánticos, las cuales tienden a mejorar dentro del primer mes de uso de los aparatos, con excepción del fone vibrante múltiple [r].

PURPOSE: this study evaluated the effect of lingual orthodontics appliances on speech performance in native Chilean spanish speakers, and their adaptation to these effects during the first month. METHODS: phone production was recorded in a standardized test, in 13 patients with lingual orthodontic brackets, in 5 different times: before (E0), immediately after (E1), within 24 hours after (E2), within 7 days after (E3) and 1 month after (E4) the placement of fixed orthodontic lingual appliances, for assessment by speech professionals. RESULTS: statistically significant changes were observed in the articulation of [d], [s] and [r] phones. Sounds [d] and [s] showed an improvement within first month of use of the appliances. Phone alveolar vibrant [r] did not show a significant reduce of sound impairment performance. CONCLUSION: lingual appliances placement induce impairment in sound performance but these changes show an improvement within the first month of use, with exception of alveolar vibrant [r] phone.

Tumor de células de Leydig bilateral sincrónico. ¿Es posible el tratamiento quirúrgico conservador? / Bilateral syncronic Leydig-cell tumor is a conservative treatment?

Los tumores de células de Leydig (TCL) corresponden al 1 a 3 por ciento de todos los tumores testiculares y son el tipo histológico más frecuente entre los tumores de estroma gonadal. Generalmente son unilaterales, describiéndose sólo en un 5 a 10 por ciento un desarrollo bilateral. Su frecuencia sigue una distribución bimodal, con mayor incidencia en prepúberes y entre la tercera y cuarta década de la vida. Su presentación más habitual es una masa escrotal palpable, pudiendo originar androgenización en niños o feminización en adultos.