Health-related quality of life in women aged 20-64 years with urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) in women is a frequent and invisible clinical situation that affects several aspects in the lives of patients. The aim of this study is to assess the impact of urinary incontinence on different dimensions of quality of life. METHODS: Cross-sectional observational study. The sample brings together 381 women living in the Metropolitan Region of Chile, who answered a survey between June 2020 and June 2021, with questions about the sociodemographic situation, obstetric history and the EQ5D-3L questionnaire Chilean version and urinary incontinence variables. For the analysis of association between variables were used a correlation coefficient and logistic regressions. RESULTS: The mean age of the sample was 39.9 (SD: 12.6) years, with 68.5% of multiparous women and 42.5% had a history of vaginal delivery. Fifty percent of the respondents belong to a medium-high socioeconomic level according to the health insurance proxy. The analysis adjusted for age, health insurance and obstetrics variables showed that women with a frequency of moderate/severe urine loss had a 72% greater probability of suffering from moderate/severe pain/discomfort compared to women with nothing/little urine loss. In turn, the self-perception of affectation of urine loss was significantly associated with problems in the dimensions of mobility, anxiety/depression and health status. CONCLUSIONS: This research contributes with evidence that makes visible the affectation on physical and psychological dimensions in women with urinary incontinence, allowing decision-makers to prioritize resources and design health programs that include clinical management.

Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain.

INTRODUCTION AND OBJECTIVES: The optimal timing of coronary angiography in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. METHODS: This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. RESULTS: Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). CONCLUSIONS: In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

Diagnostic accuracy of left ventricular hypertrophy in patients with myocardial infarction by computer-assisted electrocardiography (ELECTROPRES).

BACKGROUND: Information is limited about the classification accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in the presence of myocardial infarction (MI). METHODS: We evaluated LVH classification accuracy for a set of 16 ECG criteria and some combinations derived from them in 1642 patients (105 with MI) suspected of coronary heart disease with two-dimensional echocardiography evaluation and a standard 12-lead ECG recorded at the same time. Patients with left bundle branch block had previously been excluded. Measures of classification accuracy included sensitivity, specificity, likelihood ratios, and positive and negative predictive values. RESULTS: Diagnostic accuracy varied widely for different LVH criteria. The criteria with the best overall performance had highest sensitivity in the presence of MI and sensitivities of approximately 30% with relatively low specificities ranging from 72% to 78%. However, the classification accuracy for them was similar to that for patients without MI. The prevalence of LVH in patients with MI was higher (56%) than in those with no MI (31%). Classification accuracy of the best single previously published LVH criteria was comparable to that of the best combinations of any three of them. CONCLUSIONS: The classification accuracy of LVH criteria in the presence of MI is comparable to that in patients without MI, in part possibly due to the higher LVH prevalence in the MI group. The presence of a well-validated computer database facilitates comparative evaluation of ECG-LVH criteria and derivation of optimal combinations of criteria for any given clinical application.

Evaluation of the impact of the intensive exploitation of groundwater and the mega-drought based on the hydrochemical and isotopic composition of the waters of the Chacabuco-Polpaico basin in central Chile.

A hydrogeochemical and isotopic study has been carried out to understand the hydrogeological functioning of a small alluvial aquifer in central Chile in a context of mega-drought and intensive exploitation of its waters. Additionally, two mine tailings dams from porphyry copper mining are situated in the area. The prolonged mega-drought, which has lasted for over thirteen years, has resulted in a significant decrease in rainfall recharge and a drop of up to 50 m in piezometric levels, although no serious groundwater contamination problems have yet been detected, except for a rise in nitrate contents (ranging between 23 and 45 mg/L NO3) attributed to return irrigation. Groundwaters are calcium-bicarbonate and calcium-sodium-bicarbonate in composition. The values of δ18O and δ2H of the alluvial aquifer indicate fractionation by evaporation that would be explained by the recirculation of water that occurs in the agricultural areas of the basin, where the excess irrigation water that go back to the aquifer presents fractionation by evaporation. The δ34S and δ18O of dissolved sulfate point to pyrite oxidation, which could be related to the pyrite present in the copper porphyry and recognized in the Andes Cordillera. The 87Sr/86Sr isotopic values of the alluvial aquifer waters are close to the isotopic fingerprint of the volcanic rocks of the Abanico Formation. However, the water from the wells located further downstream in the basin and close to the tailing dams show δ34S and δ18O of dissolved sulfate and 87Sr/86Sr consistent with Miocene intrusive mineralogies of the copper porphyry type. The groundwater chemistry does not show water seepage from the tailings dam. Therefore, a minor contribution of minerals related to the intrusive rocks is proposed, which would originate from the movement of fine particles by the wind from the dams to the valley floor. The 14C activities indicate that groundwater is recent.

Modeling of the fracture energy on the finite element simulation in Ti6Al4V alloy machining.

One of the main problems that exists when working with Finite Element Methods (FEM) applied to machining processes is the lack of adequate experimental data for simulating the material properties. Moreover, for damage models based on fracture energy, the correct selection of the energy value is critical for the chip formation process. It is usually difficult to obtain the fracture energy values and requires complex tests. In this work, an analysis of the influence of this fracture energy on the cutting force and the chip generation process has been carried out for different sets of cutting parameters. The aim is to present an empirical relationship, that allows selecting the fracture energy based on the cutting force and cutting parameters. The work is based on a FEM model of an orthogonal turning process for Ti6Al4V alloy using Abaqus/Explicit and the fracture energy empirical relation. This work shows that it is necessary to adjust the fracture energy for each combination of cutting conditions, to be able to fit the experimental results. The cutting force and the chip geometry are analyzed, showing how the developed model adapts to the experimental results. It shows that as the cutting speed and the feed increase, the fracture energy value that best adapts to the model decreases. The evolution shows a more pronounced decrease related to the feed increment and high cutting speed.

The origin of solutes in groundwater in a hyper-arid environment: A chemical and multi-isotope approach in the Atacama Desert, Chile.

The major ion and the multi-isotopic composition (87Sr/86Sr, δ11B, δ34S(SO4) and δ18O(SO4)) of groundwater from the Central Depression in northern Chile is investigated to identify the origin of groundwater solutes in the hyper-arid core of the Atacama Desert. The study area is between the Cordillera de Domeyko and the Central Depression, at latitudes 24-25°S, and is characterized by near-zero air moisture conditions, rare precipitation and very limited runoff. Groundwater composition varies from Ca-HCO3 to Ca, Na-SO4 type below elevations of 3400 m a.s.l. The rCl/rBr ratio of meteoric waters and groundwater overlap, but significantly increase in the aquifer as salinity goes up due to evapoconcentration far from the Domeyko Cordillera. The wind-displaced dust originating in the Central Depression (87Sr/86Sr: 0.706558-0.710645; δ34S(SO4): 0 to +4‰) affects the precipitation composition in the highest parts of the Domeyko Cordillera (87Sr/86Sr: 0.706746-0.709511; δ34S(SO4): +1 to +6‰), whose δ34S(SO4) and δ11B values are greatly different from marine aerosols, discarding its contribution to dust at this distance inland. Sr and S isotopic values in groundwater indicate a strong relation with three main geological units: i) Paleozoic rocks contribute high radiogenic strontium isotope ratios to groundwater (0.707011-0.714862), while sulphate isotopic composition is probably acquired from atmospheric dust (>- 1.4‰), ii) Jurassic marine limestones contribute low-radiogenic strontium isotopic ratios to groundwater (<0.70784), while sulphate can be related to oxidized sulphides that change the isotopic signatures of sulphur (<-1.2‰), and iii) mixed salts in the Atacama Gravels contribute lower radiogenic strontium isotopic ratios and sulphate to groundwater (87Sr/86Sr: <0.707324; δ34S(SO4): +0.1 to +7.7). These three processes reflect water-rock interactions. The δ11B of groundwater generally up to +13‰, does not increase along the regional groundwater flow path, discarding fractionation by interaction with clays. These results improve the understanding of the groundwater evolution in hyper-arid systems through a new conceptual model.

2D-3D Digital Image Correlation Comparative Analysis for Indentation Process.

Nowadays, localized forming operations, such as incremental forming processes, are being developed as an alternative to conventional machining or forming techniques. An indentation process is the main action that takes places in these forming activities, allowing small, localized deformations. It is essential to have the knowledge of the material behavior under the punch and the transmitted forces to achieve correct control of the entire procedure. This paper presents the work carried out with the digital image correlation (DIC) technique applied to the study of the material flow that takes place under an indentation process. The material flow analysis is performed under 2D and 3D conditions, establishing the methodology for the calibration and implementation for each alternative. Two-dimensional DIC has been proven to be a satisfactory technique compared with the 3D method, showing results in good agreement with experimental tests and models developed by the finite element method. Notwithstanding, part of the indented material flows under the punch, emerging on the front surface and generating a dead zone that can only be addressed with a 3D technique. So, the main objective is to carry out a comparison between the 2D and 3D techniques to identify if the 3D application could be mandatory for this type of process. Also, a 2D-3D mix analysis is proposed for study cases in which it is necessary to know the material flow in that specific area of the workpiece.

Experimental Parametric Relationships for Chip Geometry in Dry Machining of the Ti6Al4V Alloy.

The Ti6Al4V alloy is included in the group of difficult-to-cut materials. Segmented chips are generated for a wide range of cutting parameters. This kind of chip geometry leads to the periodic variation of machining forces, tool vibrations, and work part-tolerance inaccuracies. Therefore, the analysis of chip morphology and geometry becomes a fundamental machinability criterion. However, few studies propose experimental parametric relationships that allow predicting chip-geometry evolution as a function of cutting parameters. In this work, an experimental analysis of the influence of cutting speed and feed rate on various chip-geometric parameters in dry machining of the Ti6Al4V alloy was carried out. In addition, the chip morphology and chip microstructure were studied. A clear dependence of certain chip-geometric parameters on the cutting parameters studied was found. From the experimental data, several parametric relationships were developed. These relationships were able to predict the evolution of different geometric parameters as a function of cutting speed and feed, within the tested range of values. The differences between the proposed models and the experimental data were also highlighted. These parametric equations allowed quantifying the value of parameters in which the trend was clear.

Groundwater origin and recharge in the hyperarid Cordillera de la Costa, Atacama Desert, northern Chile.

The Cordillera de la Costa is located along the coastline of northern Chile, in the hyperarid Atacama Desert area. Chemical and isotopic analyses of several small coastal springs and groundwater reservoirs between 22.5 °S and 25.5 °S allow understanding groundwater origin, renewal time and the probable timing of recharge. The aquifers are mostly in old volcanic rocks and alluvial deposits. All spring waters are brackish, of the sodium chloride type due to intensive concentration of precipitation due aridity and for deep groundwater to additional water-rock interaction in slowly renewed groundwater and mixing with deep seated brines. The heavy δ18O and δ2H values in spring water are explained by recharge by the arrival of moist air masses from the Pacific Ocean and the originally lighter values in the deep wells can be associated to past recharge by air masses coming from the Atlantic Ocean. Current recharge is assumed almost nil but it was significant in past wetter-than-present periods, increasing groundwater reserves, which are not yet exhausted. To explain the observed chloride content and radiocarbon (14C) activity, a well-mixed (exponential) flow model has been considered for aquifer recharge. The average residence time of groundwater feeding the springs has been estimated between 1 and 2kyr, up to 5kyr and between 7 and 13kyr for deep well water, assuming that current recharge is much less than during the previous wetter period. The recharge period feeding the coastal springs could have been produced 1 to 5kyr BP, when the area was already inhabited, and recharge in the Michilla mine was produced during the 10 to 14.5kyr BP CAPE (Central Andean Pluvial Event) pluvial events of the central Andes. The approximate coincidence of turnover time with the past wet periods, as revealed by paleoclimate data, points to significant recharge during them.

Groundwater flow in a closed basin with a saline shallow lake in a volcanic area: Laguna Tuyajto, northern Chilean Altiplano of the Andes.

Laguna Tuyajto is a small, shallow saline water lake in the Andean Altiplano of northern Chile. In the eastern side it is fed by springs that discharge groundwater of the nearby volcanic aquifers. The area is arid: rainfall does not exceed 200mm/year in the rainiest parts. The stable isotopic content of spring water shows that the recharge is originated mainly from winter rain, snow melt, and to a lesser extent from some short and intense sporadic rainfall events. Most of the spring water outflowing in the northern side of Laguna Tuyajto is recharged in the Tuyajto volcano. Most of the spring water in the eastern side and groundwater are recharged at higher elevations, in the rims of the nearby endorheic basins of Pampa Colorada and Pampa Las Tecas to the East. The presence of tritium in some deep wells in Pampa Colorada and Pampa Las Tecas indicates recent recharge. Gas emission in recent volcanoes increase the sulfate content of atmospheric deposition and this is reflected in local groundwater. The chemical composition and concentration of spring waters are the result of meteoric water evapo-concentration, water-rock interaction, and mainly the dissolution of old and buried evaporitic deposits. Groundwater flow is mostly shallow due to a low permeability ignimbrite layer of regional extent, which also hinders brine spreading below and around the lake. High deep temperatures near the recent Tuyajto volcano explain the high dissolved silica contents and the δ(18)O shift to heavier values found in some of the spring waters. Laguna Tuyajto is a terminal lake where salts cumulate, mostly halite, but some brine transfer to the Salar de Aguas Calientes-3 cannot be excluded. The hydrogeological behavior of Laguna Tuyajto constitutes a model to understand the functioning of many other similar basins in other areas in the Andean Altiplano.

Intervención en salud oral para modificar la calidad de vida en mujeres vulnerables / Oral health intervention to modify the quality of life in vulnerable women

Introducción: La evaluación de un programa odontológico debe considerar, además de los resultados clínicos, la percepción del paciente en relación a cambios físicos, psicológicos y sociales. En este contexto, la calidad de vida relacionada con salud oral constituye un importante indicador de impacto sanitario y de eficacia de un tratamiento. Objetivo: Evaluar el impacto de la salud oral en la calidad de vida de mujeres que recibieron intervención odontológica en centros de atención primaria de salud de la Región de los Ríos, Chile. Métodos: Estudio cuasi experimental con diseño antes-después de una intervención odontológica en 3907 mujeres, de 15 o más años, en condición de vulnerabilidad con problemas dentales que afectan su calidad de vida relacionada con su salud oral. Se midió a través del cuestionario Perfil de Impacto en Salud Oral (OHIP-7sp). Resultados: Se obtuvo una muestra representativa del 5 por ciento de las participantes (n =137), edad media 48,1 ± 16,1 años. Un 96,4 por ciento percibió que la salud bucal afecta su calidad de vida, valor que desciende a 51,8 por ciento después de la intervención. La variación porcentual fue de 46,3 por ciento. Se evidenció la relación entre calidad de vida y la edad de las participantes. Conclusión: la intervención odontológica tiene un impacto positivo en la calidad de vida relacionada con salud oral de las mujeres, e indirectamente ayuda a mejorar la empleabilidad, porque contribuye, con una mejor salud oral, a fortalecer su autoestima y sus relaciones sociales(AU)

Introduction: The assessment of a dental program should consider, in addition to the clinical results, the perception of the patient in relation to physical, psychological and social changes. In this context, quality of life related to oral health is an important indicator of the health impact and efficacy of a treatment. Objective: To assess the impact of oral health in the quality of life of women who received a dental intervention in primary healthcare centers in the Region of Los Ríos, Chile. Methods: Quasi-experimental study with a before-after design of a dental intervention in 3,907 women aged 15 years or more in vulnerable conditions with dental problems that affect their life quality related to oral health. It was measured by means of the questionnaire Profile of Impact in Oral Health (OHIP-7sp) with previous informed consent, before and after the dental intervention. Results: A representative sample of 5 percent of the participants (n = 137), average age 48.1 ± 16.1 years was obtained. 96,4 percent perceived that oral health affects their quality of life, a value that drops to 51,8 percent after the intervention. The percentage variation was of 46,3 percent being a positive result indicator of program evaluation. It was evidenced a relationship between life quality and the age of the participants. Conclusion: The odontological intervention has a positive impact in quality of life related to women's oral health, and indirectly meets with improving the employability of the beneficiaries by contributing to better oral health, strengthening their self-esteem and social relationships(AU)

Calidad de vida del personal de salud y su relación con el ausentismo / Quality of life of health personnel and their relationship to absenteeism

OBJETIVO: Evaluar la relación entre la calidad de vida del personal de salud y el ausentismo en un hospital de Chile. MÉTODOS: Estudio de corte transversal. La población de estudio corresponde a funcionarios del Hospital de Nueva Imperial. Se aplicó el instrumento de Calidad de Vida Profesional (CVP-35) y se recolectaron características demográficas, condiciones de empleo e índices de ausentismo por licencias médicas. Se realizó un modelo logístico para identificar qué factores se asocian al ausentismo. Un modelo de binomial negativo cero inflado para evaluar factores asociados con la frecuencia de licencias médicas y al número de días generados. Los modelos se ajustaron por sexo y edad, y las dimensiones del CVP- 35. RESULTADOS: El porcentaje de respuesta del CVP-35 fue de 63,6%. Un 67,4% corresponde a mujeres con edad media de 39,1 años. De los 352 trabajadores, 149 presentaron ausentismo por licencia médica. La mediana en los días de ausentismo es de 15 días. Presentar bastante o mucha carga de trabajo aumenta la chance de ausentarse, OR 1,29 IC95% (1,01-1,64). La edad es un factor que se encuentra asociado a los tres índices de ausentismo evaluados, aumentando sus resultados. DISCUSIÓN Y CONCLUSIONES: Existe una relación entre la calidad de vida del personal de salud y el ausentismo. El ausentismo laboral es un claro síntoma de problemas en la gestión de los recursos humanos dentro de una organización.

OBJECTIVE: To evaluate the relationship between the quality of life of health personnel and absenteeism in a hospital in Chile. METHODS: Cross-sectional study. The population corresponds to health person nel of the Hospital of Nueva Imperial. The instrument of Quality of Professional Life (CVP-35) was applied and demographic character istics, employment conditions and absenteeism indexes for medical licenses were collected. A logistic model was developed to identify which factors are associated with absenteeism. A zero-inflated nega tive binomial model to evaluate factors associated with the fre quency of medical licenses and the number of days generated. The models were adjusted by sex and age, and the dimensions of the CVP-35. RESULTS: The response rate of CVP-35 was 63.6%. 67.4% were women with a mean age of 39.1 years. Of the 352 workers, 149 were absent from medical leave. The median on absentee days is 15 days. Presenting a lot or a lot of workload increases the chance of being absent, OR 1.29 95% CI (1.01-1.64)". Age is a factor that is associated with the three absenteeism indices evaluated, increasing their results. DISCUSSION AND CONCLUSIONS: There is a relationship between the quality of life of health personnel and absenteeism. Absenteeism at work is a clear symptom of problems in the manage ment of human resources within an organization.

Factores asociados al dolor musculoesquelético en población trabajadora chilena / Factors associated with musculoskeletal pain in Chilean working population

OBJETIVO: Identificar factores asociados al reporte de dolor atribuido al trabajo en la población chilena. MÉTODOS: Se realizó un análisis utilizando la Primera Encuesta Nacional de Condiciones de Empleo, Trabajo, Salud y Calidad de vida de trabajadores en Chile 20092010. La variable resultado fue el número de localizaciones con reporte de dolor atribuido al trabajo. Se incluyeron en el análisis factores demográficos y socioeconómicos, condiciones de trabajo, conductas de salud y factores personales. Se utilizó regresiones de Poisson cero-inflado para estimar la contribución de los distintos factores sobre el dolor reportado. RESULTADOS: Uno de cada dos trabajadores reporta dolor. Ser mujer se asocia a un mayor reporte de dolor (RP: 1,47), disminuyendo en trabajadoras de edad avanzada (RP: 1,37). Los trabajadores expuestos a demandas físicas reportan 64% más localizaciones con dolor. La demanda psicológica, el bajo apoyo socio-laboral y la baja autonomía en el trabajo se asocian a mayor reporte de dolor (RP: 1,29, RP: 1,13, RP: 1,23, respectivamente). DISCUSIÓN Y CONCLUSIONES: El género y la edad son factores relevantes en el reporte del dolor asociado a trabajo. Este efecto es independiente de las distintas condiciones laborales, identificando importantes diferencias entre los distintos grupos de edad.

OBJECTIVE: Identify factors associated to pain due to work related activities, reported by chilean workers. METHODS: We conducted an analysis of the First National Survey of Work Conditions, Work, Health and workers' Quality of Life, conducted in Chile in 2009-2010. The result variable was the reported number of body parts with pain due to work. The analysis included sociodemographic variables, working conditions, health behaviors, and personal variables. We conducted zero inflated Poisson regressions to estimate the contribution of the factors on reported pain. RESULTS: One of every two workers reported pain. Women reported more pain than men (PR: 1.47), but this relationship diminished as age increased (PR: 1.37). Workers that were exposed to physicmands reported pain in 64% more body parts. Psychological demand, low social support in work, and low work autonomy were associated to more pain report (PR: 1.29, PR: 1.13, PR: 1.23 respectively). CONCLUSIONS: Gender and age are relevant factors associated to pain report due to work, even when adjusted for working conditions. Significant differences between age groups were identified.

Targeted transcript mapping for agronomic traits in potato.

A combination of cDNA-amplified fragment length polymorphism (AFLP) and bulked segregant analysis (BSA) was used to identify genes co-segregating with earliness of tuberization in a diploid potato population. This approach identified 37 transcript-derived fragments with a polymorphic segregation pattern between early and late tuberizing bulks. Most of the identified transcripts mapped to chromosomes 5 (19 markers) and 12 (eight markers) of the paternal map. Quantitative trait locus (QTL) mapping of tuberization time also identified earliness QTLs on these two chromosomes. A potato bacterial artificial chromosome (BAC) library was screened with four of the markers linked to the main QTL. BAC contigs containing the markers showing the highest association with the trait have been identified. One of these contigs has been anchored to chromosome 5 on an ultradense genetic map of potato, which could be used as a starting point for map-based cloning of genes associated with earliness.

Unravelling enzymatic discoloration in potato through a combined approach of candidate genes, QTL, and expression analysis.

Enzymatic discoloration (ED) of potato tubers was investigated in an attempt to unravel the underlying genetic factors. Both enzyme and substrate concentration have been reported to influence the degree of discoloration and as such this trait can be regarded as polygenic. The diploid mapping population C x E, consisting of 249 individuals, was assayed for the degree of ED and levels of chlorogenic acid and tyrosine. Using this data, Quantitative Trait Locus (QTL) analysis was performed. Three QTLs for ED have been found on parental chromosomes C3, C8, E1, and E8. For chlorogenic acid a QTL has been identified on C2 and for tyrosine levels, a QTL has been detected on C8. None of the QTLs overlap, indicating the absence of genetic correlations between these components underlying ED, in contrast to earlier reports in literature. An obvious candidate gene for the QTL for ED on Chromosome 8 is polyphenol oxidase (PPO), which was previously mapped on chromosome 8. With gene-specific primers for PPO gene POT32 a CAPS marker was developed. Three different alleles (POT32-1, -2, and -3) could be discriminated. The segregating POT32 alleles were used to map the POT32 CAPS marker and QTL analysis was redone, showing that POT32 coincides with the QTL peak. A clear correlation between allele combinations and degree of discoloration was observed. In addition, analysis of POT32 gene expression in a subset of genotypes indicated a correlation between the level of gene expression and allele composition. On average, genotypes having two copies of allele 1 had both the highest degree of discoloration as well as the highest level of POT32 gene expression.