Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.

BACKGROUND: Steroidal mineralocorticoid receptor antagonists reduce morbidity and mortality among patients with heart failure and reduced ejection fraction, but their efficacy in those with heart failure and mildly reduced or preserved ejection fraction has not been established. Data regarding the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with heart failure and mildly reduced or preserved ejection fraction are needed. METHODS: In this international, double-blind trial, we randomly assigned patients with heart failure and a left ventricular ejection fraction of 40% or greater, in a 1:1 ratio, to receive finerenone (at a maximum dose of 20 mg or 40 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of total worsening heart failure events (with an event defined as a first or recurrent unplanned hospitalization or urgent visit for heart failure) and death from cardiovascular causes. The components of the primary outcome and safety were also assessed. RESULTS: Over a median follow-up of 32 months, 1083 primary-outcome events occurred in 624 of 3003 patients in the finerenone group, and 1283 primary-outcome events occurred in 719 of 2998 patients in the placebo group (rate ratio, 0.84; 95% confidence interval [CI], 0.74 to 0.95; P = 0.007). The total number of worsening heart failure events was 842 in the finerenone group and 1024 in the placebo group (rate ratio, 0.82; 95% CI, 0.71 to 0.94; P = 0.006). The percentage of patients who died from cardiovascular causes was 8.1% and 8.7%, respectively (hazard ratio, 0.93; 95% CI, 0.78 to 1.11). Finerenone was associated with an increased risk of hyperkalemia and a reduced risk of hypokalemia. CONCLUSIONS: In patients with heart failure and mildly reduced or preserved ejection fraction, finerenone resulted in a significantly lower rate of a composite of total worsening heart failure events and death from cardiovascular causes than placebo. (Funded by Bayer; FINEARTS-HF ClinicalTrials.gov number, NCT04435626.).

Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ventricular ejection fraction remains less certain. METHODS: We randomly assigned 6263 patients with heart failure and a left ventricular ejection fraction of more than 40% to receive dapagliflozin (at a dose of 10 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of worsening heart failure (which was defined as either an unplanned hospitalization for heart failure or an urgent visit for heart failure) or cardiovascular death, as assessed in a time-to-event analysis. RESULTS: Over a median of 2.3 years, the primary outcome occurred in 512 of 3131 patients (16.4%) in the dapagliflozin group and in 610 of 3132 patients (19.5%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P<0.001). Worsening heart failure occurred in 368 patients (11.8%) in the dapagliflozin group and in 455 patients (14.5%) in the placebo group (hazard ratio, 0.79; 95% CI, 0.69 to 0.91); cardiovascular death occurred in 231 patients (7.4%) and 261 patients (8.3%), respectively (hazard ratio, 0.88; 95% CI, 0.74 to 1.05). Total events and symptom burden were lower in the dapagliflozin group than in the placebo group. Results were similar among patients with a left ventricular ejection fraction of 60% or more and those with a left ventricular ejection fraction of less than 60%, and results were similar in prespecified subgroups, including patients with or without diabetes. The incidence of adverse events was similar in the two groups. CONCLUSIONS: Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction. (Funded by AstraZeneca; DELIVER ClinicalTrials.gov number, NCT03619213.).

A toolkit for the dynamic study of air sacs in siamang and other elastic circular structures.

Biological structures are defined by rigid elements, such as bones, and elastic elements, like muscles and membranes. Computer vision advances have enabled automatic tracking of moving animal skeletal poses. Such developments provide insights into complex time-varying dynamics of biological motion. Conversely, the elastic soft-tissues of organisms, like the nose of elephant seals, or the buccal sac of frogs, are poorly studied and no computer vision methods have been proposed. This leaves major gaps in different areas of biology. In primatology, most critically, the function of air sacs is widely debated; many open questions on the role of air sacs in the evolution of animal communication, including human speech, remain unanswered. To support the dynamic study of soft-tissue structures, we present a toolkit for the automated tracking of semi-circular elastic structures in biological video data. The toolkit contains unsupervised computer vision tools (using Hough transform) and supervised deep learning (by adapting DeepLabCut) methodology to track inflation of laryngeal air sacs or other biological spherical objects (e.g., gular cavities). Confirming the value of elastic kinematic analysis, we show that air sac inflation correlates with acoustic markers that likely inform about body size. Finally, we present a pre-processed audiovisual-kinematic dataset of 7+ hours of closeup audiovisual recordings of siamang (Symphalangus syndactylus) singing. This toolkit (https://github.com/WimPouw/AirSacTracker) aims to revitalize the study of non-skeletal morphological structures across multiple species.

Who you live with and what you duet for: a review of the function of primate duets in relation to their social organization.

Duets are one of the most fascinating displays in animal vocal communication, where two animals fine-tune the timing of their emissions to create a coordinated signal. Duetting behavior is widespread in the animal kingdom and is present in insects, birds, and mammals. Duets are essential to regulate activities within and between social units. Few studies assessed the functions of these vocal emissions experimentally, and for many species, there is still no consensus on what duets are used for. Here, we reviewed the literature on the function of duets in non-human primates, investigating a possible link between the social organization of the species and the function of its duetting behavior. In primates and birds, social conditions characterized by higher promiscuity might relate to the emergence of duetting behavior. We considered both quantitative and qualitative studies, which led us to hypothesize that the shift in the social organization from pair living to a mixed social organization might have led to the emergence of mate defense and mate guarding as critical functions of duetting behavior. Territory/resource ownership and defense functions are more critical in obligate pair-living species. Finally, we encourage future experimental research on this topic to allow the formulation of empirically testable predictions.

Manual preference, performance, and dexterity for bimanual grass-feeding behavior in wild geladas (Theropithecus gelada).

We assessed whether wild geladas, highly specialized terrestrial grass eaters, are lateralized for bimanual grass-plucking behavior. According to the literature, we expected that complex motor movements in grass feeding would favor the emergence of a population-level hand bias in these primates. In addition, we described geladas' manual behavior based on systematic observations of several individuals. Our study group included 28 individuals belonging to a population of free-ranging geladas frequenting the Kundi plateau, Ethiopia. We filmed monkeys while feeding on grass, and hand preference and performance were coded. Geladas performed more plucking movements per second with their left hand (LH) compared to the right one and preferred their LH both to start and finish collection bouts. Also, the rhythmic movements of each hand had a significant tendency toward isochrony. Finally, geladas used forceful pad-to-pad precision grips, in-hand movements, and compound grips to pluck and collect grass blades, considered the most advanced manual skills in primate species. The LH's leading role suggests an advantage of the right hemisphere in regulating geladas' bimanual grass-feeding behavior. The tactile input from the hands and/or rhythmic hand movements might contribute to explaining this pattern of laterality. Our findings highlighted the importance of adopting multiple laterality measures to investigate manual laterality. Moreover, the need to speed up the execution time of manual foraging might be a further important factor in studying the evolution of manual laterality and dexterity in primates.

Singing in the rain! Climate constraints on the occurrence of indri's song.

The study of how animals adapt their behaviors depending on weather variables has gained particular significance in the context of climate change. This exploration offers insights into endangered species' potential threats and provides information on the direction to take in conservation activities. In this context, noninvasive, cost-effective, and potentially long-term monitoring systems, such as Passive Acoustic Monitoring (PAM), become particularly appropriate. Our study investigates the relationship between weather variables and the vocal behavior of Indri indri, the sole singing lemur species, within Madagascar's Maromizaha New Protected Area. Using PAM, we explore the factors shaping the vocalization patterns of this primate species in response to some environmental factors in their natural habitat. Analysis of an extensive audio data set collected across different years revealed the differential influence of temperature and precipitation on Indri indri vocal activity. We found that rainfall negatively influenced the emission of the vocalizations while warmer temperatures correlated with a greater emission of songs. The various environmental factors we considered also affected the timing of vocal emissions, showing the same pattern. Furthermore, our study confirms, once again, the strength of PAM as a valuable tool for studying vocal animal communication quickly, giving us information about long-term behavioral patterns that would be difficult to get in other ways. This research gives us further valuable information about how indris use vocalizations in their environment and how they adjust to environmental changes.

Challenges and Advances in Interventional Cardiology for Coronary Artery Disease Management.

The development of percutaneous coronary intervention (PCI) has been one of the greatest advances in cardiology and has changed clinical practice for patients with coronary artery disease (CAD). Despite continuous improvements in operators' experience, techniques, and the development of new-generation devices, significant challenges remain in improving the efficacy of PCI, including calcification, bifurcation, multivascular disease, stent restenosis, and stent thrombosis, among others. The present review aims to provide an overview of the current status of knowledge of endovascular revascularization in CAD, including relevant trials, therapeutic strategies, and new technologies addressing particular scenarios that can impact the prognosis of this vulnerable population.

Isochrony and rhythmic interaction in ape duetting.

How did rhythm originate in humans, and other species? One cross-cultural universal, frequently found in human music, is isochrony: when note onsets repeat regularly like the ticking of a clock. Another universal consists in synchrony (e.g. when individuals coordinate their notes so that they are sung at the same time). An approach to biomusicology focuses on similarities and differences across species, trying to build phylogenies of musical traits. Here we test for the presence of, and a link between, isochrony and synchrony in a non-human animal. We focus on the songs of one of the few singing primates, the lar gibbon (Hylobates lar), extracting temporal features from their solo songs and duets. We show that another ape exhibits one rhythmic feature at the core of human musicality: isochrony. We show that an enhanced call rate overall boosts isochrony, suggesting that respiratory physiological constraints play a role in determining the song's rhythmic structure. However, call rate alone cannot explain the flexible isochrony we witness. Isochrony is plastic and modulated depending on the context of emission: gibbons are more isochronous when duetting than singing solo. We present evidence for rhythmic interaction: we find statistical causality between one individual's note onsets and the co-singer's onsets, and a higher than chance degree of synchrony in the duets. Finally, we find a sex-specific trade-off between individual isochrony and synchrony. Gibbon's plasticity for isochrony and rhythmic overlap may suggest a potential shared selective pressure for interactive vocal displays in singing primates. This pressure may have convergently shaped human and gibbon musicality while acting on a common neural primate substrate. Beyond humans, singing primates are promising models to understand how music and, specifically, a sense of rhythm originated in the primate phylogeny.

Vocal tract shape variation contributes to individual vocal identity in African penguins.

Variation in formant frequencies has been shown to affect social interactions and sexual competition in a range of avian species. Yet, the anatomical bases of this variation are poorly understood. Here, we investigated the morphological correlates of formants production in the vocal apparatus of African penguins. We modelled the geometry of the supra-syringeal vocal tract of 20 specimens to generate a population of virtual vocal tracts with varying dimensions. We then estimated the acoustic response of these virtual vocal tracts and extracted the centre frequency of the first four predicted formants. We demonstrate that: (i) variation in length and cross-sectional area of vocal tracts strongly affects the formant pattern, (ii) the tracheal region determines most of this variation, and (iii) the skeletal size of penguins does not correlate with the trachea length and consequently has relatively little effect on formants. We conclude that in African penguins, while the variation in vocal tract geometry generates variation in resonant frequencies supporting the discrimination of conspecifics, such variation does not provide information on the emitter's body size. Overall, our findings advance our understanding of the role of formant frequencies in bird vocal communication.

Penguins perceive variations of source- and filter-related vocal parameters of species-specific vocalisations.

Animal vocalisations encode a wide range of biological information about the age, sex, body size, and social status of the emitter. Moreover, vocalisations play a significant role in signalling the identity of the emitter to conspecifics. Recent studies have shown that, in the African penguin (Spheniscus demersus), acoustic cues to individual identity are encoded in the fundamental frequency (F0) and resonance frequencies (formants) of the vocal tract. However, although penguins are known to produce vocalisations where F0 and formants vary among individuals, it remains to be tested whether the receivers can perceive and use such information in the individual recognition process. In this study, using the Habituation-Dishabituation (HD) paradigm, we tested the hypothesis that penguins perceive and respond to a shift of ± 20% (corresponding to the natural inter-individual variation observed in ex-situ colonies) of F0 and formant dispersion (ΔF) of species-specific calls. We found that penguins were more likely to look rapidly and for longer at the source of the sound when F0 and formants of the calls were manipulated, indicating that they could perceive variations of these parameters in the vocal signals. Our findings provide the first experimental evidence that, in the African penguin, listeners can perceive changes in F0 and formants, which can be used by the receiver as potential cues for the individual discrimination of the emitter.

Grey wolves (Canis lupus) discriminate between familiar and unfamiliar human voices.

The ability to discriminate between different individuals based on identity cues, which is important to support the social behaviour of many animal species, has mostly been investigated in conspecific contexts. A rare example of individual heterospecific discrimination is found in domestic dogs, who are capable of recognising their owners' voices. Here, we test whether grey wolves, the nearest wild relative of dogs, also have the ability to distinguish familiar human voices, which would indicate that dogs' ability is not a consequence of domestication. Using the habituation-dishabituation paradigm, we presented captive wolves with playback recordings of their keepers' and strangers' voices producing either familiar or unfamiliar phrases. The duration of their response was significantly longer when presented with keepers' voices than with strangers' voices, demonstrating that wolves discriminated between familiar and unfamiliar speakers. This suggests that dogs' ability to discriminate between human voices was probably present in their common ancestor and may support the idea that this is a general ability of vertebrates to recognise heterospecific individuals. Our study also provides further evidence for familiar voice discrimination in a wild animal in captivity, indicating that this ability may be widespread across vertebrate species.

Singing more, singing harsher: occurrence of nonlinear phenomena in a primate' song.

Nonlinear phenomena (NLP) in animal vocalizations arise from irregularities in the oscillation of the vocal folds. Various non-mutually exclusive hypotheses have been put forward to explain the occurrence of NLP, from adaptive to physiological ones. Non-human primates often display NLP in their vocalizations, yet the communicative role of these features, if any, is still unclear. We here investigate the occurrence of NLP in the song of a singing primate, the indri (Indri indri), testing for the effect of sex, age, season, and duration of the vocal display on their emission. Our results show that NLP occurrence in indri depends on phonation, i.e., the cumulative duration of all the units emitted by an individual, and that NLP have higher probability to be emitted in the later stages of the song, probably due to the fatigue indris may experience while singing. Furthermore, NLP happen earlier in the vocal display of adult females than in that of the adult males, and this is probably due to the fact that fatigue occurs earlier in the former because of a greater contribution within the song. Our findings suggest, therefore, that indris may be subjected to physiological constraints during the singing process which may impair the production of harmonic sounds. However, indris may still benefit from emitting NLP by strengthening the loudness of their signals for better advertising their presence to the neighboring conspecific groups.

"The song remains the same": not really! Vocal flexibility in the song of the indris.

In studying communicative signals, we can think of flexibility as a necessary correlate of creativity. Flexibility enables animals to find practical solutions and appropriate behaviors in mutable situations. In this study, we aimed to quantify the degree of flexibility in the songs of indris (Indri indri), the only singing lemur, using three different metrics: Jaro Distance, normalized diversity, and entropy. We hypothesized that the degree and the co-variation of the flexibility of indris singing together would vary according to their status and sex. We found that dominant females were more flexible than dominant males when concatenating elements into strings (element concatenation). The number of different elements in a song contribution normalized by the contribution length (contribution diversity) of dominant individuals positively co-varied for seven duetting pairs. Non-dominant individuals were more variable in element concatenation than dominant individuals, and they were more diverse in phrase type than dominant females. Independently from sex and status, individual contributions did not differ in entropy (a measure of the predictability of contributions). These results corroborate previous findings regarding the dimorphism by sex and by status of individual contributions to songs. Thus, they shed light on the presence and expression of flexibility in the behavior of a non-human primate species. Indeed, they potentially show an effect of social features in shaping vocal flexibility, which underlies many communication systems, including human language. We speculate that this degree of flexibility may account for creativity.

Dapagliflozin for heart failure according to body mass index: the DELIVER trial.

AIMS: Obesity is common and associated with unique phenotypic features in heart failure with preserved ejection fraction (HFpEF). Therefore, understanding the efficacy and safety of new therapies in HFpEF patients with obesity is important. The effects of dapagliflozin were examined according to body mass index (BMI) among patients in the Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure trial. METHODS AND RESULTS: Body mass index was analysed by World Health Organization (WHO) categories and as a continuous variable using restricted cubic splines. Body mass index ranged from 15.2 to 50 kg/m2 with a mean value of 29.8 (standard deviation ± 6.1) kg/m2. The proportions, by WHO category, were: normal weight 1343 (21.5%); overweight 2073 (33.1%); Class I obesity 1574 (25.2%); Class II obesity 798 (12.8%); and Class III obesity 415 (6.6%). Compared with placebo, dapagliflozin reduced the risk of the primary outcome to a similar extent across these categories: hazard ratio (95% confidence interval): 0.89 (0.69-1.15), 0.87 (0.70-1.08), 0.74 (0.58-0.93), 0.78 (0.57-1.08), and 0.72 (0.47-1.08), respectively (P-interaction = 0.82). The placebo-corrected change in Kansas City Cardiomyopathy Questionnaire total symptom score with dapagliflozin at 8 months was: 0.9 (-1.1, 2.8), 2.5 (0.8, 4.1), 1.9 (-0.1, 3.8), 2.7 (-0.5, 5.8), and 8.6 (4.0, 13.2) points, respectively (P-interaction = 0.03). The placebo-corrected change in weight at 12 months was: -0.88 (-1.28, -0.47), -0.65 (-1.04, -0.26), -1.42 (-1.89, -0.94), -1.17 (-1.94, -0.40), and -2.50 (-4.4, -0.64) kg (P-interaction = 0.002). CONCLUSIONS: Obesity is common in patients with HFpEF and is associated with higher rates of heart failure hospitalization and worse health status. Treatment with dapagliflozin improves cardiovascular outcomes across the spectrum of BMI, leads to greater symptom improvement in patients with obesity, compared with those without, and has the additional benefit of causing modest weight loss.

Vocal accommodation in penguins (Spheniscus demersus) as a result of social environment.

The ability to vary the characteristics of one's voice is a critical feature of human communication. Understanding whether and how animals change their calls will provide insights into the evolution of language. We asked to what extent the vocalizations of penguins, a phylogenetically distant species from those capable of explicit vocal learning, are flexible and responsive to their social environment. Using a principal components (PCs) analysis, we reduced 14 vocal parameters of penguin's contact calls to four PCs, each comprising highly correlated parameters and which can be categorized as fundamental frequency, formant frequency, frequency modulation, and amplitude modulation rate and duration. We compared how these differed between individuals with varying degrees of social interactions: same-colony versus different-colony, same colony over 3 years and partners versus non-partners. Our analyses indicate that the more penguins experience each other's calls, the more similar their calls become over time, that vocal convergence requires a long time and relative stability in colony membership, and that partners' unique social bond may affect vocal convergence differently than non-partners. Our results suggest that this implicit form of vocal plasticity is perhaps more widespread across the animal kingdom than previously thought and may be a fundamental capacity of vertebrate vocalization.

Documento de consenso sobre el uso de iSGLT2 en pacientes con enfermedad renal crónica y diabetes.

La enfermedad renal crónica (ERC) del paciente diabético es frecuentemente una consecuencia directa de la diabetes mellitus (DM) de larga evolución y se la conoce como nefropatía diabética. En México cerca del 50% de los pacientes en terapia sustitutiva de la función renal tienen ERC por DM, y este porcentaje podría aumentar en los próximos años. Nuevas opciones terapéuticas, combinadas con cambios en el estilo de vida, han mejorado el control de la glucemia y pueden contribuir sustancialmente a retrasar la aparición o la progresión a estadios avanzados de la ERC. Las sociedades científicas internacionales han elaborado guías clínicas para el diagnóstico y manejo de la nefropatía diabética, sin embargo, en algunos puntos estas recomendaciones no se adaptan a la realidad mexicana. Se presentan las conclusiones de un consenso realizado por especialistas mexicanos sobre diabetes y ERC, con especial énfasis en el uso de los inhibidores del cotransportador de sodio-glucosa.Chronic kidney disease (CKD) in the diabetic patient is mainly a consequence of long-term diabetes mellitus itself. In Mexico approximately 50% of patients on dialysis are diabetics and this will could increase in the coming years. New therapeutic options available, combined with lifestyle changes, have improved glycemic control and may contribute to delay the onset as well as the progression of CKD. International scientific societies have developed clinical guidelines for the diagnosis and management of CKD in diabetics, although in some points, these recommendations are not adapted to the Mexican reality. We hereby present the conclusions of the consensus reached by Mexican specialists on diabetic nephropathy.

Cross-modal individual recognition in the African penguin and the effect of partnership.

An animal's ability to recognize another individual by matching their image to their voice suggests they form internal representations of other individuals. To what extent this ability, termed cross-modal individual recognition, extends to birds other than corvids is unknown. Here, we used an expectancy violation paradigm to determine whether a monogamous territorial seabird (Spheniscus demersus) can cross-modally recognize familiar conspecifics (partners or colony-mates). After pairs of penguins spent time together in an isolated area, one of the penguins was released from the area leaving the focal penguin alone. Subsequently, we played contact calls of the released penguin (congruent condition) or a different penguin (incongruent condition). After being paired with a colony-mate, focal penguins' response latency to the auditory stimulus was faster in the incongruent compared to congruent condition, indicating the mismatch violated their expectations. This behavioural pattern was not observed in focal penguins after being paired with their partner. We discuss these different results in the light of penguins' natural behaviour and the evolution of social communication strategies. Our results suggest that cross-modal individual recognition extends to penguins and reveals, in contrast with previously thought, that social communication between members of this endangered species can also use visual cues.

Allometric escape and acoustic signal features facilitate high-frequency communication in an endemic Chinese primate.

The principle of acoustic allometry-the larger the animal, the lower its calls' fundamental frequency-is generally observed across terrestrial mammals. Moreover, according to the Acoustic Adaptation Hypothesis, open habitats favor the propagation of high-frequency calls compared to habitats with complex vegetational structures. We carried out playback experiments in which the calls of the Guizhou snub-nosed monkey (Rhinopithecus brelichi) were used as stimuli in sound attenuation and degradation experiments to test the hypothesis that propagation of Guizhou snub-nosed monkey calls is favored above vs through the forest floor vegetation. We found that low-pitched Guizhou snub-nosed monkey vocalizations suffered less attenuation than its high-pitched calls. Guizhou snub-nosed monkeys were observed emitting high-pitched calls from 1.5 to 5.0 m above the ground. The use of high-pitched calls from these heights coupled with the concomitant behavior of moving about above the understory may provide a signal for receivers which maximizes potential transmission and efficacy. Our results support the Acoustic Adaptation Hypothesis and suggest that by uncoupling its vocal output from its size, this monkey can produce a high-pitched call with a broad spectral bandwidth, thereby increasing both its saliency and the frequency range over which the animal may more effectively communicate in its natural habitat.

STEMI telemedicine for 100 million lives.

BACKGROUND: Developing countries struggle to diagnose and treat ST-segment elevation myocardial infarction (STEMI) patients in a timely manner, and subsequent outcomes are suboptimal. METHODS: The Latin America Telemedicine Network (LATIN) functioned between 2013 to present in four countries-Brazil, Colombia, Mexico, and Argentina. A Hub and Spoke platform was developed to expand access to >100 million population for STEMI care. Patients were triaged at spokes that included small clinics and primary health care centers in remote South American locations. Three telemedicine command sites provided immediate 24/7 electrocardiogram diagnosis and teleconsultation of the STEMI process at 355 centers in four countries. RESULTS: LATIN Spokes (n = 313) screened up to 30,000 patients per month, and a total of 780,234 patients over the study period. Telemedicine experts diagnosed 8395 (1·1%) with STEMI, of which a total of 3872 (46·1%) were urgently treated at 47 Hubs. A total of 3015 patients (78%) were reperfused with percutaneous coronary intervention. Time-to-telemedicine diagnosis averaged 3·5 min. Average door-to-balloon time improved from 120 to 48 min during the study period and overall STEMI mortality was 5·2%. INTERPRETATION: Telemedicine transcends boundaries and enables access to millions of patients for STEMI care. With this initiative, LATIN has created a template for reducing disparities in STEMI management between developed and developing countries.

Long-term stability of vocal individuality cues in a territorial and monogamous seabird.

The stability of individual acoustic features is fundamental in social species, and more importantly in monogamous and territorial species, showing long-term fidelity both to the partner and the breeding site. In this study, the stability over time of two discrete vocal types was investigated in the African penguin (Spheniscus demersus), a monogamous and territorial seabird. Contact calls and ecstatic display songs were recorded from an ex situ colony in 2017 and in 2020. For each vocalisation, we measured 14 spectral and temporal acoustic parameters related to both source and filter components. Two separate leave-one-out cross-validated Discriminant Function Analyses (DFA) were then performed, generating the discriminant functions from the vocalisations collected in 2017 to classify those recorded in 2020. The DFA correctly classified 62% of the contact calls (10 subjects) and 80.9% of the ecstatic display songs (seven subjects) according to the correct emitter, showing that acoustic cues to individuality encoded in both vocal types remained unchanged over four consecutive breeding seasons. We suggest that, in this monogamous and territorial bird species, individual acoustic stability could be selected for to identify groupmates and neighbours over the years and to help couples to reunite in consecutive breeding seasons, increasing individual fitness.