Development of Prostate Bed Delineation Consensus Guidelines for Magnetic Resonance Image-Guided Radiotherapy and Assessment of Its Effect on Interobserver Variability.

PURPOSE: The use of magnetic resonance imaging (MRI) in radiotherapy planning is becoming more widespread, particularly with the emergence of MRI-guided radiotherapy systems. Existing guidelines for defining the prostate bed clinical target volume (CTV) show considerable heterogeneity. This study aimed to establish baseline interobserver variability (IOV) for prostate bed CTV contouring on MRI, develop international consensus guidelines, and evaluate its effect on IOV. METHODS AND MATERIALS: Participants delineated the CTV on 3 MRI scans, obtained from the Elekta Unity MR-Linac, as per their normal practice. Radiation oncologist contours were visually examined for discrepancies, and interobserver comparisons were evaluated against simultaneous truth and performance level estimation (STAPLE) contours using overlap metrics (Dice similarity coefficient and Cohen's kappa), distance metrics (mean distance to agreement and Hausdorff distance), and volume measurements. A literature review of postradical prostatectomy local recurrence patterns was performed and presented alongside IOV results to the participants. Consensus guidelines were collectively constructed, and IOV assessment was repeated using these guidelines. RESULTS: Sixteen radiation oncologists' contours were included in the final analysis. Visual evaluation demonstrated significant differences in the superior, inferior, and anterior borders. Baseline IOV assessment indicated moderate agreement for the overlap metrics while volume and distance metrics demonstrated greater variability. Consensus for optimal prostate bed CTV boundaries was established during a virtual meeting. After guideline development, a decrease in IOV was observed. The maximum volume ratio decreased from 4.7 to 3.1 and volume coefficient of variation reduced from 40% to 34%. The mean Dice similarity coefficient rose from 0.72 to 0.75 and the mean distance to agreement decreased from 3.63 to 2.95 mm. CONCLUSIONS: Interobserver variability in prostate bed contouring exists among international genitourinary experts, although this is lower than previously reported. Consensus guidelines for MRI-based prostate bed contouring have been developed, and this has resulted in an improvement in contouring concordance. However, IOV persists and strategies such as an education program, development of a contouring atlas, and further refinement of the guidelines may lead to additional improvements.

Understanding the social determinants of child mortality in Latin America over the last two decades: a machine learning approach.

The reduction of child mortality rates remains a significant global public health challenge, particularly in regions with high levels of inequality such as Latin America. We used machine learning (ML) algorithms to explore the relationship between social determinants and child under-5 mortality rates (U5MR) in Brazil, Ecuador, and Mexico over two decades. We created a municipal-level cohort from 2000 to 2019 and trained a random forest model (RF) to estimate the relative importance of social determinants in predicting U5MR. We conducted a sensitivity analysis training two more ML models and presenting the mean square error, root mean square error, and median absolute deviation. Our findings indicate that poverty, illiteracy, and the Gini index were the most important variables for predicting U5MR according to the RF. Furthermore, non-linear relationships were found mainly for Gini index and U5MR. Our study suggests that long-term public policies to reduce U5MR in Latin America should focus on reducing poverty, illiteracy, and socioeconomic inequalities. This research provides important insights into the relationships between social determinants and child mortality rates in Latin America. The use of ML algorithms, combined with large longitudinal data, allowed us to evaluate the effects of social determinants on health more carefully than traditional models.

Standard Clinical Outcomes, Light Distortion, Stereopsis, and a Quality-of-Life Assessment of a New Binocular System of Complementary IOLs.

PURPOSE: To evaluate the visual outcome, light distortion index (LDI), and quality of life (QoL) of patients implanted with two complementary intraocular lenses (IOLs) to treat cataract and presbyopia. METHODS: Twenty-seven consecutive patients with cataract were treated with the implantation of the Artis Symbiose Mid (Mid) IOL (Cristalens Industrie) in the distance-dominant eye and the Artis Symbiose Plus (Plus) IOL (Cristalens Industrie) in the contralateral eye following phacoemulsification. The primary objective was to ascertain the monocular and binocular defocus curves. Secondary endpoints included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity, and distance-corrected intermediate visual acuity at 90 and 70 cm, uncorrected near visual acuity and distance-corrected visual acuity at 40 cm, contrast sensitivity, LDI with a halometer, stereopsis, and patients' QoL with the validated Visual Function Index (VF-14) questionnaire. These measurements were collected in two visits, at 4.14 ± 3.13 and 10.30 ± 3.14 months postoperatively. RESULTS: Statistically significant differences in the monocular defocus curves were found at the defocus steps of -1.00, -1.25, -1.50, -1.75, -2.50, -2.75, -3.00, -3.50 diopters and the -4.00 diopters (P < .050). The mean binocular defocus curve was 0 logMAR or better from the +0.50 to the -2.50 D defocus steps. Contrast sensitivity was within normal values. The LDI was 12.57 (6.61)% for the Mid eyes, 14.99 ± 5.70% for the Plus eyes, and 10.36 ± 4.42% binocularly. The patients' stereopsis was 40.0 (12.5) arc-seconds. The QoL score was 95.99 (7.14) at 10 months. CONCLUSIONS: The implantation of the Artis Symbiose IOLs was a safe and effective treatment for presbyopia compensation in patients with cataract. Both IOLs are complementary and may produce a binocular depth-of-field of 3.00 diopters over 0 logMAR when used together. [J Refract Surg. 2023;39(10):654-661.].

Fuel, cost, energy efficiency and CO2 emission performance of PCM integrated wood fiber composite phase change material at different climates.

Wood fiber is a great potential supportive material for creating a new composite the phase change materials (PCM) due to its beneficial qualities, including high sorption competency, low density, enviro -friendliness, economic effectiveness, and chemical inertness. The main objective of this paper is to study the effect of using the wood fiber/eutectic mixture of stearic and capric acid on the fuel, cost, and carbon emission-saving potentials for various PCM cases. Which experiences a phase transition within the thermally pleasant temperature range of buildings, used for the building's thermal energy storing purposes and consumption cost saving. The energy performance analysis was carried out for buildings incorporated with stearic and capric acid eutectic mixture of PCM with wood fiber-based insulation material (INS) in different climate regions. The results showed that the largest energy-saving capacity belongs to PCM5. The energy saving reaches 52.7% for PCM5 for a thickness of 0.1 m. The PCM1, PCM2, PCM3, PCM4 can provide energy saving rates of 23.5%, 34.3%, 44.7% and 50.5%, respectively. INS-PCM5 can provide about 1.74-, 1.5-, and 1.33 times larger cost savings than INS in 2nd, 3rd, and 4th regions for all fuels. The payback period varies between 0.37 and 5.81 years regarding the fuel and Region. Finally, the results indicate that the proposed composite provided a promising energy-saving potential in building applications by reducing.

Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: A cost-effectiveness analysis.

BACKGROUND: General anesthesia (GA) is the standard anesthetic approach for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times and to decrease post-procedural pain, all of which could result in a reduction in procedure-related costs. OBJECTIVE: The purpose of this study is to compare the cost-effectiveness of GA and TLA in patients undergoing S-ICD implantation. METHODS: The present study is a prospective, nonrandomized, controlled study of patients who underwent S-ICD implantation between 2019 and 2022. Patients were allocated to either the TLA or the GA group. We performed a cost analysis for each intervention. As an effectiveness measure, the 0-10 point Numeric Pain Rating Scale at 1, 12, and 24 hours post-implantation was analyzed and compared between the groups. A score of 0 was considered no pain; 1-5, mild pain; 6-7, moderate pain; and 8-10, severe pain. Cost-effectiveness was calculated using incremental cost-effectiveness ratios. RESULTS: Seventy patients underwent successful S-ICD implantation. The total cost of the electrophysiology laboratory was higher in the GA group than in the TLA group (median ± interquartile range US$55,824 ± US$29,411 vs US$37,222 ± US$24,293; P < .001), with a net saving of $20,821 when compared with GA for each S-ICD implantation. There was a significant decrease in post-procedural pain scores in the TLA group when compared with the GA group (repeated measures analysis of variance, P = .009; median ± interquartile range 0 ± 3 vs 0 ± 5 at 1 hour, P = .058; 3 ± 4 vs 6 ± 8 at 12 hours, P = .030; 0 ± 4 vs 2 ± 6 at 24 hours, P = .040). CONCLUSION: TLA is a more cost-effective alternative to GA for S-ICD implantation, with both direct and indirect cost reductions. Importantly, these reduced costs are associated with reduced postprocedural pain.

Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center.

Introduction: Neuromuscular blockade is an essential component of the general anesthesia as it allows for a better airway management and optimal surgical conditions. Despite significant reductions in extubation and OR readiness-for-discharge times have been associated with the use of sugammadex, the cost-effectiveness of this drug remains controversial. We aimed to compare the time to reach a train-of-four (TOF) response of ≥0.9 and operating room readiness for discharge in patients who received sugammadex for moderate neuromuscular blockade reversal when compared to neostigmine during outpatient surgeries under general anesthesia. Potential reduction in time for OR discharge readiness as a result of sugammadex use may compensate for the existing cost-gap between sugammadex and neostigmine. Methods: We conducted a single-center, randomized, double arm, open-label, prospective clinical trial involving adult patients undergoing outpatient surgeries under general anesthesia. Eligible subjects were randomized (1:1 ratio) into two groups to receive either sugammadex (Groups S), or neostigmine/glycopyrrolate (Group N) at the time of neuromuscular blockade reversal. The primary outcome was the time to reverse moderate rocuronium-induced neuromuscular blockade (TOF ratio ≥0.9) in both groups. In addition, post-anesthesia care unit (PACU)/hospital length of stay (LOS) and perioperative costs were compared among groups as secondary outcomes. Results: Thirty-seven subjects were included in our statistical analysis (Group S= 18 subjects and Group N= 19 subjects). The median time to reach a TOF ratio ≥0.9 was significantly reduced in Group S when compared to Group N (180 versus 540 seconds; p = 0.0052). PACU and hospital LOS were comparable among groups. Postoperative nausea and vomiting was the main adverse effect reported in Group S (22.2% versus 5.3% in Group N; p = 0.18), while urinary retention (10.5%) and shortness of breath (5.3%) were only experienced by some patients in Group N. Moreover, no statistical differences were found between groups regarding OR/anesthesia, PACU, and total admission costs. Discussion: Sugammadex use was associated with a significantly faster moderate neuromuscular blockade reversal. We found no evidence of increased perioperative costs associated with the use of sugammadex in patients undergoing outpatient surgeries in our academic institution. Clinical trial registration: [https://clinicaltrials.gov/] identifier number [NCT03579589].

Microalgae bioreactor for nutrient removal and resource recovery from wastewater in the paradigm of circular economy.

Every day, large quantities of wastewater are discharged from various sources that could be reused. Wastewater contains nutrients such as nitrogen or phosphorus, which can be recovered. Microalgae-based technologies have attracted attention in this sector, as they are able to bioremediate wastewater, harnessing its nutrients and generating algal biomass useful for different downstream uses, as well as having other advantages. There are multiple species of microalgae capable of growing in wastewater, achieving nutrient removal efficiencies surpassing 70%. On the other hand, microalgae contain lipids that can be extracted for energy recovery in biodiesel. Currently, there are several methods of lipid extraction from microalgae. Other biofuels can also be obtained from microalgae biomass, such as bioethanol, biohydrogen or biogas. This review also provides information on bioenergy products and products in the agri-food industry as well as in the field of human health based on microalgae biomass within the concept of circular bioeconomy.

Bacteraemia and quick Sepsis Related Organ Failure Assessment (qSOFA) are independent risk factors for long-term mortality in very elderly patients with suspected infection: retrospective cohort study.

BACKGROUND: In older adult patients, bloodstream infections cause significant mortality. However, data on long-term prognosis in very elderly patients are scarce. This study aims to assess 1-year mortality from bacteraemia in very elderly patients. METHODS: Retrospective cohort study in inpatients aged 80 years or older and suspected of having sepsis. Patients with (n = 336) and without (n = 336) confirmed bacteraemia were matched for age, sex, and date of culture, and their characteristics were compared. All-cause mortality and risk of death were assessed using the adjusted hazard ratio (aHR). RESULTS: Compared to controls, cases showed a higher 1-year mortality (34.8% vs. 45.2%) and mortality rate (0.46 vs. 0.69 deaths per person-year). Multivariable analysis showed significant risk of 1-year mortality in patients with bacteraemia (aHR: 1.31, 95% confidence interval [CI] 1.03-1.67), quick Sepsis Related Organ Failure Assessment (qSOFA) score of 2 or more (aHR: 2.71, 95% CI 2.05-3.57), and age of 90 years or older (aHR 1.53, 95% CI 1.17-1.99). CONCLUSIONS: In elderly patients suspected of sepsis, bacteraemia is associated with a poor prognosis and higher long-term mortality. Other factors related to excess mortality were age over 90 years and a qSOFA score of 2 or more.

Mapas mentales sobre tronco encefálico: su pertinencia en la dirección del trabajo independiente desde Morfofisiología / Mental maps on brainstem: its relevance in the direction of independent work from Morphology-physiology

RESUMEN Fundamento: el trabajo independiente se fortalece con el uso de medios de enseñanza, entre ellos, los mapas mentales. Objetivo: confeccionar mapas mentales sobre las configuraciones externa e interna del tronco encefálico para contribuir a la dirección del trabajo independiente desde la disciplina Morfofisiología, utilizando la tecnología móvil. Métodos: se realizó una investigación de desarrollo tecnológico en la Facultad de Estomatología de la Universidad Médica de Pinar del Río, durante el curso 2019-2020. Se utilizaron métodos teóricos: análisis-síntesis y abstracción-concreción; y empíricos: cuestionario y análisis documental para la fundamentación y recogida de información. Los mapas mentales fueron diseñados utilizando la aplicación para Android, Mindomo versión 3.0.15. Resultados: se confeccionaron los mapas mentales que permitieron representar gráficamente los contenidos relacionados con la configuración externa e interna del tronco encefálico, constituido por modelos tridimensionales y apoyados en la tecnología móvil. Conclusiones: fueron valorados por criterio de especialistas quienes consideraron como adecuadas su pertinencia, la factibilidad de aplicación del producto, y su utilidad para perfeccionar el trabajo independiente en la disciplina Morfofisiología.

ABSTRACT Background: independent work is strengthened with the use of teaching aids, including mind maps. Objective: to make mental maps on the external and internal configurations of the brain stem to contribute to the direction of independent work from the Morphology-physiology discipline, using mobile technology. Methods: a technological development investigation was carried out at Pinar del Río Faculty of Dentistry of the Medical University, during the 2019-2020 academic year. Theoretical methods were used: analysis-synthesis and abstraction-concretion; and empirical ones: questionnaire and documentary analysis for the foundation and collection of information. The mind maps were designed using the Mindomo version 3.0.15 application for Android. Results: mental maps were made that allowed to graphically represent the contents related to the external and internal configuration of the brainstem, made up of three-dimensional models and supported by mobile technology. Conclusions: their relevance, the feasibility of applying the product, and its usefulness to improve independent work in the Morphology-physiology discipline were evaluated by the criteria of specialists who considered them adequate.

A review of the adsorption-biological hybrid processes for the abatement of emerging pollutants: Removal efficiencies, physicochemical analysis, and economic evaluation.

The limited efficiency of conventional wastewater treatment plants (WWTPs) in emerging pollutants (EPs) removal encourages the development of alternative technologies for the adequate treatment of wastewater, due to its adverse effects on human health and ecosystems. The biological, physical or chemical hybrid technologies to treat EPs results interesting since they can enhance the performance of WWTPs. Among them, hybrid adsorption/biological technology could offer different possibilities that are explored in this work (PAC-MBR, PACT/GAC-CAS, BAC configurations). In this way, different variations in the adsorption process have been considered: the form of the adsorbent, the feed to the system, and the type of biological process, either conventional activated sludge (CAS), membrane bioreactor (MBR) or biofilm systems. For each combination, the removal efficiency of micropollutants, classified according to their use into pharmaceuticals, personal care products (PCPs) and other micropollutants (mainly benzotriazoles) was analysed. From reported data, it was observed a beneficial synergistic effect of dipole moment and octanol-water partition coefficient on the removal efficiency of micropollutants by adsorption/biological hybrid technology. Finally, a preliminary economic evaluation of the powdered activated carbon in a conventional activated sludge reactor (PACT), powdered activated carbon-membrane bioreactor (PAC-MBR) and biological activated carbon (BAC) hybrid systems was carried out by analysing the capital expenditure (CAPEX) of plants for capacities up to 75,000 m3d-1. Likewise, estimations of adsorbent concentration for a hypothetical plant with a capacity of 10,000 m3d-1 is presented. Among these hybrid configurations, PAC-MBR achieved the highest micropollutant elimination percentages; however, it presents the highest CAPEX and activated carbon requirements.

Plastics and sustainable purchase decisions in a circular economy: The case of Dutch food industry.

Every day, society's concern over pollution caused by plastic waste grows greater. One of the most intensive sectors for the use of plastic is the food industry. Companies in this sector face the challenge of transitioning to a more sustainable and less intensive model of plastic use, respecting the principles established for a circular economy. Accordingly, one of the questions that industries tend to ask is whether sustainability will influence the consumer's purchase decision. To respond to this, the factors that determine a consumer's sustainable purchase decision in relation to the plastic and food industry have been analyzed in this paper. For this, a regression analysis was performed on a sample of Dutch consumers. The results show that the decision of purchase of the consumer of the Food Industry is conditioned by factors such as age, sustainable behavior, knowledge of the Circular economy and the perception of usefulness of plastic.

Assessment of the tolerance to Fe, Cu and Zn of a sulfidogenic sludge generated from hydrothermal vents sediments as a basis for its application on metals precipitation.

A paramour factor limiting metal-microorganism interaction is the metal ion concentration, and the metal precipitation efficiency driven by microorganisms is sensitive to metal ion concentration. The aim of the work was to determine the tolerance of the sulfidogenic sludge generated from hydrothermal vent sediments at microcosms level to different concentrations of Fe, Cu and Zn and the effect on the microbial community. In this study the chemical oxygen demand (COD) removal, sulfate-reducing activity (SRA) determination, inhibition effect through the determination of IC50, and the characterization of the bacterial community´s diversity were conducted. The IC50 on SRA was 34 and 81 mg/L for Zn and Cu, respectively. The highest sulfide concentration (H2S mg/L) and % of sulfate reduction obtained were: 511.30 ± 0.75 and 35.34 ± 0.51 for 50 mg/L of Fe, 482.48 ± 6.40 and 33.35 ± 0.44 for 10 mg/L of Cu, 442.26 ± 17.1 and 30.57 ± 1.18 for 10 mg/L of Zn, respectively. The COD removal rates were of 71.81 ± 7.6, 53.92 ± 1.07 and 57.68 ± 10.2 mg COD/ L d for Fe (50 mg/L), Cu (40 mg/L) and Zn (20 mg/L), respectively. Proteobacteria, Firmicutes, Chloroflexi and Actinobacteria were common phyla to four microcosms (stabilized sulfidogenic and added with Fe, Cu or Zn). The dsrA genes of Desulfotomaculum acetoxidans, Desulfotomaculum gibsoniae and Desulfovibrio desulfuricans were expressed in the microcosms supporting the SRA results. The consortia could be explored for ex-situ bioremediation purposes in the presence of the metals tested in this work.

Monumental architecture at Aguada Fénix and the rise of Maya civilization.

Archaeologists have traditionally thought that the development of Maya civilization was gradual, assuming that small villages began to emerge during the Middle Preclassic period (1000-350 BC; dates are calibrated throughout) along with the use of ceramics and the adoption of sedentism1. Recent finds of early ceremonial complexes are beginning to challenge this model. Here we describe an airborne lidar survey and excavations of the previously unknown site of Aguada Fénix (Tabasco, Mexico) with an artificial plateau, which measures 1,400 m in length and 10 to 15 m in height and has 9 causeways radiating out from it. We dated this construction to between 1000 and 800 BC using a Bayesian analysis of radiocarbon dates. To our knowledge, this is the oldest monumental construction ever found in the Maya area and the largest in the entire pre-Hispanic history of the region. Although the site exhibits some similarities to the earlier Olmec centre of San Lorenzo, the community of Aguada Fénix probably did not have marked social inequality comparable to that of San Lorenzo. Aguada Fénix and other ceremonial complexes of the same period suggest the importance of communal work in the initial development of Maya civilization.

The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study.

People over 80 years old are now the fastest-growing age group. Bloodstream infections (BSI) in these patients may present with specific characteristics. The objective of this study was to analyze independent factors affecting in-hospital mortality (IHM) due to BSI in very elderly patients (≥80 years of age) and to compare the clinical presentation of BSI in patients aged 80-89 years versus those aged 90 or more. Retrospective, cross-sectional and observational study of BSI in patients aged 80 years or older. The study used IHM as the primary outcome. Stepwise multiple logistic regression models were used to identify associations between potential predictors and IHM. Of the 336 included patients, 76.8% (n = 258) were in the 80-89-year age group and 23.2% (n = 78) in the 90+ age group; 17.3% (n = 58) of patients died during admission. This outcome was independently associated with quick Sepsis Related Organ Failure Assessment (qSOFA) of 2 or more (adjusted odds ratio [aOR] 4.7, 95% confidence interval [CI] 2.3-9.4; p < 0.001). Other predictors included an origin of BSI outside the urinary tract (aOR 5.5, 95% CI 2.4-12.6; p < 0.001), thrombocytopenia (aOR 4.9, 95% CI 1.8-13.4; p = 0.002), hospital-acquired infection (aOR 3.0, 95% CI 1.2-7.5; p = 0.015), and inappropriate empiric antibiotics (aOR 2.0, 95% CI 1.1-3.9; p = 0.04). IHM was 23.1% in the 90+ age group and 15.5% in patients aged 80 to 89 (p = 0.012). However, the 90+ age group was more likely to have a score of at least 2 on the qSOFA (29.9% vs. 19.1%, p = 0.043) and Pitt bacteremia scales (44.9% vs. 30.2%; p = 0.02), as well as chronic kidney disease (56.4% vs. 36.0%; p = 0.001) and altered mental state (40.3% vs. 25.7%; p = 0.013). In conclusion: A qSOFA score of 2 or more and a BSI originating outside the urinary tract were independent predictors of IHM. The 90+ age group was at higher risk than the 80-89-year age group of having a qSOFA score and Pitt bacteremia score of 2 or more as well as an altered mental state.

Encouraging use of prenatal care through conditional cash transfers: Evidence from JUNTOS in Peru.

We use a difference-in-differences strategy to estimate the effects of JUNTOS, a conditional cash transfer program targeted to poor rural households in Peru, on use of prenatal care. Using data from the Peruvian Demographic and Health Surveys over the period 2000-2011, we find that JUNTOS increased prenatal care utilization among program-eligible women. Even more, we find positive effects of JUNTOS on the probability of receiving prenatal care delivered by a skilled professional, including specific medical checkups during the prenatal visits, and a negative effect on the probability of experiencing obstetric emergencies during labor and childbirth.

Sustainability Indicators Concerning Waste Management for Implementation of the Circular Economy Model on the University of Lome (Togo) Campus.

The circular economy aims to reduce the volume of waste generated in the world, transforming it into resources. The concept of indicator of circular economy was introduced to evaluate the improvement obtained regarding efficiency in terms of reduction, reuse and recycling of waste generated on the campus of the University of Lome (Togo). These indicators showed that 59.5% of the waste generated on the campus in 2018 could be introduced into the circular economy paradigm through composting, and 27.0% of the energy consumed could be replaced by clean energy obtained from biogas. The entire plastic fraction can be introduced into the circular economy paradigm by reusing plastic bottles and selling the rest in the port of the city. Thus, the income obtained could range from €15.5/day in 2018 to €34.5/day in 2027. Concerning old tires, 1.5% of the rubber needed to pave the entire roadway of the campus could be replaced by the waste generated by the tires currently existing there. Consequently, waste management on the campus could be controlled thanks to these indicators, and this could serve as a model for the rest of the country.

Mapping the environmental risk assessment of marinas on water quality: The Atlas of the Spanish coast.

Recreational sailing sector has an impact on water quality in marinas. This study proposes a standard procedure to assess the environmental risk of marinas on water quality. Risk is assessed through integrating environmental pressures, environmental conditions and societal responses (i.e. the Pressure-State-Response model). Pressures are estimated considering the main driving forces: navigation, port, dredging and external activities. State is estimated through combining the susceptibility, the ecological value and naturalness. Response is estimated through environmental management instruments and adopted measures. Managers and authorities can hierarchically classify marinas from a multi-scale spatial framework. This tool is particularly powerful for generating local, regional or national atlases to prioritize environmental planning actions. The method is applied to 320 marinas along the Spanish coast. This implementation confirms the usefulness, versatility and adaptability of this procedure as a tool for the environmental management of marinas.

Valoración de la imagen corporal en preescolares: Percepción de padres e hijos / Assessment of body image in preschoolers: Perception of parents and children

Resumen El objetivo de esta investigación fue conocer la percepción corporal (PC) de preescolares y compararla con la que sus padres tienen de ellos. Participaron 48 preescolares (Medad = 5 años, DE = 0.5), 21 niños y 27 niñas, y sus padres (47 papás y 48 mamás). Los niños fueron pesados y medidos, contestaron el instrumento Siete Figuras de Collins (SFC) y, con relación a éste, siete preguntas sobre alimentación, belleza y salud. A los padres se les aplicó el Cuestionario de Imagen Corporal, las Figuras de Stunkard, además de las SFC para que identificaran la figura real (FR) e ideal (FI) de sus hijos. Para describirse, los preescolares refirieron mayormente la figura normopeso, coincidiendo con sus padres. Fue mínima la proporción de preescolares que se percibieron con obesidad (presente en 29-30%); mientras que ningún padre la identificó en sus hijos. El 50% de los preescolares eligió siluetas más delgadas a su índice de masa corporal (IMC), pero no emaciadas. Como FR, la mayoría de los padres eligió la normopeso para los niños y con sobrepeso ligero para las niñas; como FI eligieron, para ambos sexos, aquélla con sobrepeso ligero. En conclusión, la PC del preescolar discrepó entre la real y la percibida, independientemente de su IMC y sexo. Los padres tampoco tuvieron una adecuada PC de sus hijos.

Abstract The objective of this research was to determine the body perception (BP) of preschoolers and compare it with the one reported by their parents. A total of 48 preschoolers participated (Mage = 5 years, SD = 0.5), 21 boys, 27 girls, and their parents (47 fathers and 48 mothers). The children were weighed and measured, also they answered the instrument Seven Figures of Collins (SFC) and seven questions about food, beauty and health. The parents answered the Body Image Questionnaire (BSQ), the Stunkard Figures, as well as the SFCs to identify the real (RF) and ideal figure (IF) of their children. When children described themselves, they mostly referred the normal figure, coinciding with their parents. A very small proportion of preschoolers perceived themselves with obesity (around 29-30%); while any parent identified their children with obesity. The 50% of preschoolers chose thinner silhouettes than their body mass index (BMI), but not emaciated. For RF, most parents chose normal weight for boys and light overweight for girls; for IF parents chose, for both sexes, the one with light overweight. In conclusion, the preschool BP disagreed between reality and perception, regardless of their BMI and gender. The parents also did not have an adequate BP for their children.