Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology.

Objective: To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods: This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results: Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions: The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

[Gaps in primary mental health care in Chocó, Colombia: barriers and challengesLacunas na atenção primária à saúde mental em Chocó, Colômbia: barreiras e desafios]. / Brechas en la atención primaria en salud mental en Chocó, Colombia: barreras y desafíos.

Objective: Describe barriers and challenges in the implementation of the global Mental Health Gap Action Program (mhGAP), and determine the association between facilitators of implementation, accessibility, acceptability, and supervision, in Chocó, Colombia. Methods: Cross-sectional evaluation study, with mixed and sequential methods. Forty-one people participated: 30 health personnel and 11 administrative workers. Five focus groups were formed within the framework of the mhGAP training. The Likert scale of implementation drivers was used to determine factors affecting the strategy, such as system facilitators, accessibility of the strategy, adaptation and acceptability, and training and supervision. Semi-structured interviews were also conducted, with a subsequent thematic analysis. Results: A statistically significant correlation was found between the components of implementation. This was reaffirmed by the information from the interviews. Notable barriers include dispersion, armed conflict, difficulty in changing one's perspective on the area where they live, and administrative problems in accessing treatment. These factors are addressed in a proposed care pathway. Conclusions: With respect to mhGAP in the department of Chocó, despite adequate acceptability, access, and supervision, there are barriers and challenges at the social, geographical, political, cultural, and health administration levels, which could be overcome through implementation of locally-built intersectoral recovery routes.

Objetivo: Descrever barreiras e desafios na implementação do Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e determinar a associação entre facilitadores de implementação, acessibilidade, aceitabilidade e supervisão em Chocó, Colômbia. Métodos: Estudo avaliativo de corte transversal, com métodos mistos e sequenciais, que contou com 41 participantes (30 da equipe de saúde e 11 da equipe administrativa). Um total de cinco grupos focais foram formados como parte do treinamento do mhGAP. Utilizou-se a escala de motivadores de implementação, que determinou fatores como facilitadores do sistema para implementação, acessibilidade da estratégia, adaptação e aceitabilidade, treinamento e supervisão da estratégia. Também foram realizadas entrevistas semiestruturadas, com posterior análise temática. Resultados: Foi encontrada uma correlação estatisticamente significativa entre os componentes da implementação, o que foi reafirmado com as informações das entrevistas. Em termos das barreiras identificadas, destacam-se fatores como dispersão, conflito armado, a dificuldade de mudar a perspectiva da pessoa sobre a área em que vive e problemas administrativos no acesso ao tratamento. Esses fatores são abordados em uma proposta de via de atendimento. Conclusões: Apesar da aceitabilidade, do acesso e da supervisão adequados, há barreiras e desafios sociais, geográficos, políticos, culturais e de administração de saúde no mhGAP do departamento de Chocó que poderiam ser superados com a implementação de rotas de recuperação intersetoriais, construídas a partir do próprio território.

[Adequate, reliable and timely information in times of the COVID-19 pandemicInformación adecuada, fiable y oportuna en tiempos de la pandemia por la COVID-19]. / Informação adequada, confiável e oportuna em tempos de pandemia de COVID-19.

In times of the COVID-19 pandemic, adequate, reliable and timely information becomes even more relevant. The Pan American Health Organization/World Health Organization office in Brazil and key partners have developed initiatives to improve access, sharing and dissemination of the information and knowledge produced, translated and systematized about COVID-19 as a technical contribution to the fight against the pandemic. This article presents some of these resources. The production and synthesis of knowledge made available in a timely manner to professionals on the frontline of response to COVID-19 is essential and a basic requirement for improving response capacity. It is also important to strengthen and increase investment in the production of scientific evidence, and to recognize and build upon the tireless work of a large group of scientists and institutions that continue to respond to the COVID-19 pandemic.

En tiempos de la pandemia por la COVID-19, la información adecuada, fiable y oportuna se vuelve aún más relevante. La oficina de la Organización Panamericana de la Salud/Organización Mundial de la Salud en el Brasil y sus contrapartes han desarrollado iniciativas para favorecer el acceso, el intercambio y la difusión de la información y los conocimientos producidos, traducidos y sistematizados sobre la COVID-19 como contribución técnica a la lucha contra la pandemia. Este artículo presenta algunos de estos recursos. Es fundamental considerar como de máxima relevancia la producción y síntesis de conocimientos puestos a disposición de manera oportuna para los profesionales que se encuentran en la primera línea de respuesta a la COVID-19; este es un requisito básico para mejorar la capacidad de respuesta. También es importante fortalecer y aumentar la inversión en la producción de evidencia científica, y reconocer y fortalecer la labor incansable de un enorme grupo de científicos e instituciones que siguen respondiendo a la pandemia por la COVID-19.

[Mapping the implementation characteristics of new Medicine programs in Brazilian federal universitiesMapeo de las características de implementación de los nuevos programas de medicina en universidades federales brasileñas]. / Mapeamento das características da implantação de novos cursos de Medicina em universidades federais brasileiras.

OBJECTIVE: To map the implementation characteristics of Medicine programs established in Brazilian federal universities from 2013 onwards. METHODS: A qualitative and quantitative exploratory study was performed. Newly created Medicine programs were identified in federal universities, with analysis of pedagogical frameworks and interviews with students, faculty, and health care professionals from associated health care services. Data were analyzed using qualitative and quantitative methods. RESULTS: Thirty new Medicine programs were identified, of which 24 were visited. All the new programs were located outside large urban centers and capitals, across the five Brazilian macro-regions, and adopted various formative configurations in an attempt to overcome fragmentation of content with active methodologies and formative evaluations. The healthcare network is used for training as a means to meet the challenge of academic-health service-community integration, with the aim of providing critical education focused on public health. The establishment of the Medicine programs facilitated to a limited extent the retention of faculty in remote areas and promoted the access of local students and the creation of residency programs, which are powerful strategies to enhance the retention of medical professionals. CONCLUSIONS: Variations were observed among the programs in the manner of implementation and adherence to the National Curriculum Guidelines for Medicine, published in 2014. The construction of medical training models that appropriately address local specificities and the requirements of the Unified Health System in its formative role for health care may contribute to reduce health inequalities.

OBJETIVO: Mapear las características de implementación de los programas de Medicina establecidos en las universidades federales brasileñas a partir de 2013. MÉTODOS: Se realizó un estudio exploratorio cualitativo y cuantitativo. Se identificaron los programas de medicina recién creados en las universidades federales, se anlizaron los marcos pedagógicos y se entrevistaron estudiantes, profesores y profesionales de la salud de los servicios de salud asociados. Los datos fueron analizados usando métodos cualitativos y cuantitativos. RESULTADOS: Se identificaron 30 nuevos programas de medicina, de los cuales se visitaron 24. Todos los nuevos programas se ubicaron fuera de los grandes centros urbanos y capitales en las cinco macrorregiones brasileñas y adoptaron diversas configuraciones formativas en un intento de superar la fragmentación de contenido con metodologías activas y evaluaciones formativas. La red de salud se empleó para la formación como un medio para facilitar la integración entre los ámbitos académico, de servicios de salud y la comunidad, con el objetivo de proporcionar una educación crítica centrada en la salud pública. El establecimiento de los programas de medicina facilitó en cierta medida la retención del profesorado en zonas remotas y promovió el acceso de los estudiantes locales y la creación de programas de residencia, que son estrategias importantes para mejorar la retención de los profesionales médicos. CONCLUSIONES: Se observaron variaciones entre los programas en cuanto a la manera de aplicar y cumplir las Directrices Curriculares Nacionales de Medicina, publicadas en 2014. La construcción de modelos de formación médica que aborden adecuadamente las especificidades locales y los requisitos del Sistema Único de Salud en su función formativa para la atención de la salud puede contribuir a reducir las desigualdades en materia de salud.

Benefits of Cochlear Implantation for Single-Sided Deafness: Data From the House Clinic-University of Southern California-University of California, Los Angeles Clinical Trial.

OBJECTIVES: Cochlear implants (CIs) have been shown to benefit patients with single-sided deafness (SSD) in terms of tinnitus reduction, localization, speech understanding, and quality of life (QoL). While previous studies have shown cochlear implantation may benefit SSD patients, it is unclear which point of comparison is most relevant: baseline performance before implantation versus performance with normal-hearing (NH) ear after implantation. In this study, CI outcomes were assessed in SSD patients before and up to 6 mo postactivation. Benefits of cochlear implantation were assessed relative to binaural performance before implantation or relative to performance with the NH ear alone after implantation. DESIGN: Here, we report data for 10 patients who completed a longitudinal, prospective, Food and Drug Administration-approved study of cochlear implantation for SSD patients. All subjects had severe to profound unilateral hearing loss in one ear and normal hearing in the other ear. All patients were implanted with the MED-EL CONCERTO Flex 28 device. Speech understanding in quiet and in noise, localization, and tinnitus severity (with the CI on or off) were measured before implantation (baseline) and at 1, 3, 6 mo postactivation of the CI processor. Performance was measured with both ears (binaural), the CI ear alone, and the NH ear alone (the CI ear was plugged and muffed). Tinnitus severity, dizziness severity, and QoL were measured using questionnaires administered before implantation and 6 mo postactivation. RESULTS: Significant CI benefits were observed for tinnitus severity, localization, speech understanding, and QoL. The degree and time course of CI benefit depended on the outcome measure and the reference point. Relative to binaural baseline performance, significant and immediate (1 mo postactivation) CI benefits were observed for tinnitus severity and speech performance in noise, but localization did not significantly improve until 6 mo postactivation; questionnaire data showed significant improvement in QoL 6 mo postactivation. Relative to NH-only performance after implantation, significant and immediate benefits were observed for tinnitus severity and localization; binaural speech understanding in noise did not significantly improve during the 6-mo study period, due to variability in NH-only performance. There were no correlations between behavioral and questionnaire data, except between tinnitus visual analog scale scores at 6 mo postactivation and Tinnitus Functional Index scores at 6 mo postactivation. CONCLUSIONS: The present behavioral and subjective data suggest that SSD patients greatly benefit from cochlear implantation. However, to fully understand the degree and time course of CI benefit, the outcome measure and point of comparison should be considered. From a clinical perspective, binaural baseline performance is a relevant point of comparison. The lack of correlation between behavioral and questionnaire data suggest that represent independent measures of CI benefit for SSD patients.

Spectral-Temporal Modulated Ripple Discrimination by Children With Cochlear Implants.

OBJECTIVES: A postlingually implanted adult typically develops hearing with an intact auditory system, followed by periods of deafness (or near deafness) and adaptation to the implant. For an early implanted child whose brain is highly plastic, the auditory system matures with consistent input from a cochlear implant. It is likely that the auditory system of early implanted cochlear implant users is fundamentally different than postlingually implanted adults. The purpose of this study is to compare the basic psychophysical capabilities and limitations of these two populations on a spectral resolution task to determine potential effects of early deprivation and plasticity. DESIGN: Performance on a spectral resolution task (Spectral-temporally Modulated Ripple Test [SMRT]) was measured for 20 bilaterally implanted, prelingually deafened children (between 5 and 13 years of age) and 20 hearing children within the same age range. Additionally, 15 bilaterally implanted, postlingually deafened adults, and 10 hearing adults were tested on the same task. Cochlear implant users (adults and children) were tested bilaterally, and with each ear alone. Hearing listeners (adults and children) were tested with the unprocessed SMRT and with a vocoded version that simulates an 8-channel cochlear implant. RESULTS: For children with normal hearing, a positive correlation was found between age and SMRT score for both the unprocessed and vocoded versions. Older hearing children performed similarly to hearing adults in both the unprocessed and vocoded test conditions. However, for children with cochlear implants, no significant relationship was found between SMRT score and chronological age, age at implantation, or years of implant experience. Performance by children with cochlear implants was poorer than performance by cochlear implanted adults. It was also found that children implanted sequentially tended to have better scores with the first implant compared with the second implant. This difference was not observed for adults. An additional finding was that SMRT score was negatively correlated with age for adults with implants. CONCLUSIONS: Results from this study suggest that basic psychophysical capabilities of early implanted children and postlingually implanted adults differ when assessed in the sound field using their personal implant processors. Because spectral resolution does not improve with age for early implanted children, it seems likely that the sparse representation of the signal provided by a cochlear implant limits spectral resolution development. These results are supported by the finding that postlingually implanted adults, whose auditory systems matured before the onset of hearing loss, perform significantly better than early implanted children on the spectral resolution test.

Determining the minimum number of electrodes that need to be pitch matched to accurately estimate pitch matches across the array.

OBJECTIVE: With bilateral cochlear implant (CI) users there is typically a place mismatch between the locations stimulated by the left and right electrode arrays. This mismatch can affect performance, potentially limiting binaural benefits. One way to address this is by perceptually realigning the arrays such that a given frequency in the input stimulates perceptually matched locations in the two ears. A clinically feasible technique is needed that can determine the appropriate perceptual alignment. A pitch matching task can potentially be used for this, but only if it can be performed in a clinically feasible amount of time. The objective of this study was to determine the minimal number of electrodes that need to be pitch matched to accurately determine pitch matches across the entire array. DESIGN: A retrospective analysis of pitch matching data was conducted. Subsets of pitch matches were selected and the predicted pitch matching across the array was compared to that predicted by the full dataset. STUDY SAMPLE: 16 bilateral CI users. RESULTS: The results indicated that nine pitch matches are sufficient, which can typically be obtained in approximately 7 min. CONCLUSION: The results reveal a clinically feasible method for determining pitch matches across the array.

Interleaved Processors Improve Cochlear Implant Patients' Spectral Resolution.

OBJECTIVE: Cochlear implant patients have difficulty in noisy environments, in part, because of channel interaction. Interleaving the signal by sending every other channel to the opposite ear has the potential to reduce channel interaction by increasing the space between channels in each ear. Interleaving still potentially provides the same amount of spectral information when the two ears are combined. Although this method has been successful in other populations such as hearing aid users, interleaving with cochlear implant patients has not yielded consistent benefits. This may be because perceptual misalignment between the two ears, and the spacing between stimulation locations must be taken into account before interleaving. DESIGN: Eight bilateral cochlear implant users were tested. After perceptually aligning the two ears, 12-channel maps were made that spanned the entire aligned portions of the array. Interleaved maps were created by removing every other channel from each ear. Participants' spectral resolution and localization abilities were measured with perceptually aligned processing strategies both with and without interleaving. RESULTS: There was a significant improvement in spectral resolution with interleaving. However, there was no significant effect of interleaving on localization abilities. CONCLUSIONS: The results indicate that interleaving can improve cochlear implant users' spectral resolution. However, it may be necessary to perceptually align the two ears and/or use relatively large spacing between stimulation locations.

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries.

BACKGROUND: The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). METHODS: The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. RESULTS: This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. CONCLUSIONS: The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.

Self-supported Pd(x)Bi catalysts for the electrooxidation of glycerol in alkaline media.

Highly active self-supported PdxBi catalysts are synthesized by the sacrificial support method. Self-supported PdxBi catalysts have a porous nanostructured morphology with high surface areas (in the range from 75 to 100 m(2) g(-1)), making PdxBi a state-of-the-art catalyst. Pd4Bi displays the highest activity toward glycerol oxidation. In situ Fourier transform infrared spectroscopy highlights the unique catalytic behavior of self-supported PdxBi materials due to their particular structure and morphology. The confinement of reactants and intermediates in pores acting as nanoreactors is responsible for the high selectivity as a function of the electrode potential: aldehyde and ketone at low potentials, hydroxypyruvate at moderate potentials, and CO2 at high potentials. Moreover, the selectivity depends on the electrode history: it is different for the positive potential scan direction than for the reverse direction, where the catalyst becomes selective toward the production of carboxylates.

Loudness summation using focused and unfocused electrical stimulation.

With a cochlear implant, when stimulation from multiple channels is interleaved, the perceived loudness is greater than the loudness associated with any of the individual channels presented in isolation. This phenomenon is known as loudness summation. This study examined if loudness summation with monopolar and tripolar stimulation were equivalent at two loudnesses and two spacing configurations. Results suggest that loudness summation is similar for monopolar and tripolar modes. However, larger summation differences were observed for softer sounds and louder sounds with a larger spatial separation. The results are consistent with the idea that loudness summation is dependent on channel interaction and have implications for implementing current-focused processing strategies.

Anode catalysts for direct hydrazine fuel cells: from laboratory test to an electric vehicle.

Novel highly active electrocatalysts for hydrazine hydrate fuel cell application were developed, synthesized and integrated into an operation vehicle prototype. The materials show in both rotating disc electrode (RDE) and membrane electrode assembly (MEA) tests the world highest activity with peak current density of 16,000 A g(-1) (RDE) and 450 mW cm(-2) operated in air (MEA).

DNA double-strand break repair machinery in Penaeid crustaceans: A focus on the Non-Homologous End-Joining pathway.

DNA double-strand breaks (DSBs) are repaired through three major pathways: Non-Homologous End-Joining (NHEJ), Microhomology-Mediated End-Joining (MMEJ), and Homology-Directed Repair (HDR), each requiring a specific set of diverse proteins. Such pathways and their proteins have been studied in model organisms, including arthropods; however, DSB repair pathways are scarcely described in Crustacea, a taxon that includes the commercially valuable penaeid shrimps (Crustacea: Decapoda: Penaeidae). In this work, transcriptome and proteome databases of Penaeus vannamei and other Crustacea species were scrutinized for each protein of the NHEJ pathway. The structural and functional attributes of such proteins in penaeids were determined using bioinformatics. Additionally, the expression of the NHEJ-related Ku70, Ku80, DNA-PKcs, DNA ligase 4 (Lig4), and HDR- and MMEJ-related protein transcripts were assessed in P. vannamei gills, midgut gland, hemocytes, and muscle by RT-PCR. DSB repair protein transcripts were found expressed in the four assayed tissues, particularly in the gills and midgut gland. Among DSB repair proteins, all the analyzed transcripts of proteins related to the NHEJ pathway were present in gills. To the best of our knowledge, this is the first report on the expression of DSB repair proteins in Decapoda. Together, proteomic, transcriptomic, and expression data suggest the functionality of NHEJ, HDR, and MMEJ pathways in P. vannamei and other decapods. The information presented here contributes to understanding the response to DSB breaks in shrimps, describing possible outcomes in oxidative stress studies and also in the designing of gene editing strategies, which have not been developed in Penaeidae.

Clinical and epidemiological characteristics of mpox: A descriptive cases series in Colombia.

INTRODUCTION: Colombia is the fifth most affected country by the global monkeypox outbreak and the second in LAC after Brazil. We describe the clinical and epidemiological characteristics of 521 patients with mpox in the country. METHODS: We conducted an observational analysis of laboratory-confirmed Mpox cases between June 29 and November 16, 2022. RESULTS: Most cases were young men living with HIV. The clinical evolution was primarily benign, with two deaths reported. We found some differences between women and men regarding their BMI, presence of lymphadenopathies, localization of lesions, and the antecedent of HIV infection. CONCLUSION: Although it seems that the epidemic curve for this outbreak of Mpox is decreasing not only in Colombia but globally, it could remain endemic. Therefore, it is necessary to maintain very close surveillance.

Donación renal pareada: beneficio de este programa en la tasa de trasplantes y sobrevida del injerto.

OBJECTIVE: To demonstrate the experience since the transplant program under paired kidney donation implementation; program that increases the donation rate by 25-30% in hospitals with no inferior graft survival compared to directed living donor kidney transplantation. METHOD: Observational, analytical, longitudinal and prospective study from December 2018 to July 2021. All G5 KDIGO chronic kidney patients who were HLA or ABO incompatible with their original donors in the pretransplant protocol and who were transplanted under the paired kidney donation program, were included. RESULTS: 22 kidney transplants were performed under this program. Survival of the graft and the patient 1 year after transplantation was 100%. The post-transplant glomerular filtration rate was 72.5 ± 17 ml/min/1.73 m2 body surface. 36.3% of hypersensitized patients were successfully transplanted. The in-hospital donation rate increased by 33.33%. CONCLUSIONS: Transplantation under the kidney paired donation program constitutes a real modality of successful transplantation when there is incompatibility with the original donor. The greater use and socialization of this program can increase the country kidney transplantation rate, reducing the waiting list. Our hospital represents the largest experience published in Mexico with this transplant program.

OBJETIVO: Demostrar la experiencia adquirida desde la implementación del programa de donación renal pareada, el cual aumenta un 25-30% la tasa de donación en los centros hospitalarios sin inferioridad en la sobrevida del injerto comparado con el trasplante renal de donante vivo dirigido. MÉTODO: Estudio observacional, analítico, longitudinal y prospectivo de diciembre de 2018 a julio de 2021. Se incluyeron todos los enfermos renales crónicos G5 KDIGO que en el protocolo pretrasplante resultaron HLA o ABO incompatibles con sus donantes originales y que fueron trasplantados bajo el programa de donación renal pareada. RESULTADOS: Se realizaron 22 trasplantes renales bajo este programa. La sobrevida del injerto y del paciente a 1 año postrasplante fue del 100%. La tasa de filtración glomerular postrasplante fue de 72.5 ± 17 ml/min/1.73 m2 de superficie corporal. Fueron trasplantados exitosamente el 36.3% de pacientes hipersensibilizados. La tasa de donación intrahospitalaria aumentó un 33.33%. CONCLUSIONES: El trasplante bajo programa de donación renal pareada constituye una modalidad real de trasplante exitoso cuando existe incompatibilidad con el donante original. La mayor utilización y la socialización de este programa pueden aumentar la tasa de trasplante renal nacional, disminuyendo la lista de espera. Nuestro hospital representa la mayor experiencia publicada en México con este programa de trasplante.

Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

Aerosol-derived Ni(1-x)Zn(x) electrocatalysts for direct hydrazine fuel cells.

This article reports the synthesis and performance of unsupported Ni(1-x)Zn(x) electrocatalysts for the oxidation of hydrazine in alkaline media. Characterization of these catalysts was achieved using XRD, SEM, and TEM to confirm phase compositions, crystal structures, and morphologies. High performance was observed for the α-Ni(0.87)Zn(0.13) and ß(1)-Ni(0.50)Zn(0.50) electrocatalysts with an onset potential of -0.15 V (vs. RHE) and a mass activity of 4000-3800 A g(cat)(-1) at 0.4 V (vs. RHE), respectively. Additionally, in situ IRRAS studies were conducted to understand the mechanism of oxidation. These results demonstrate the feasibility of Ni(1-x)Zn(x) catalysts for direct hydrazine anionic fuel cells.

Pitch contour identification with combined place and temporal cues using cochlear implants.

This study investigated the integration of place- and temporal-pitch cues in pitch contour identification (PCI), in which cochlear implant (CI) users were asked to judge the overall pitch-change direction of stimuli. Falling and rising pitch contours were created either by continuously steering current between adjacent electrodes (place pitch), by continuously changing amplitude modulation (AM) frequency (temporal pitch), or both. The percentage of rising responses was recorded as a function of current steering or AM frequency change, with single or combined pitch cues. A significant correlation was found between subjects' sensitivity to current steering and AM frequency change. The integration of place- and temporal-pitch cues was most effective when the two cues were similarly discriminable in isolation. Adding the other (place or temporal) pitch cues shifted the temporal- or place-pitch psychometric functions horizontally without changing the slopes. PCI was significantly better with consistent place- and temporal-pitch cues than with inconsistent cues. PCI with single cues and integration of pitch cues were similar on different electrodes. The results suggest that CI users effectively integrate place- and temporal-pitch cues in relative pitch perception tasks. Current steering and AM frequency change should be coordinated to better transmit dynamic pitch information to CI users.

Cohort study protocol of the Brazilian collaborative research network on COVID-19: strengthening WHO global data.

INTRODUCTION: With the COVID-19 pandemic, hospitals in low-income countries were faced with a triple challenge. First, a large number of patients required hospitalisation because of the infection's more severe symptoms. Second, there was a lack of systematic and broad testing policies for early identification of cases. Third, there were weaknesses in the integration of information systems, which led to the need to search for available information from the hospital information systems. Accordingly, it is also important to state that relevant aspects of COVID-19's natural history had not yet been fully clarified. The aim of this research protocol is to present the strategies of a Brazilian network of hospitals to perform systematised data collection on COVID-19 through the WHO platform. METHODS AND ANALYSIS: This is a multicentre project among Brazilian hospitals to provide data on COVID-19 through the WHO global platform, which integrates patient care information from different countries. From October 2020 to March 2021, a committee worked on defining a flowchart for this platform, specifying the variables of interest, data extraction standardisation and analysis. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee (CEP) of the Research Coordinating Center of Brazil (CEP of the Hospital Nossa Senhora da Conceicao), on 29 January 2021, under approval No. 4.515.519 and by the National Research Ethics Commission (CONEP), on 5 February 2021, under approval No. 4.526.456. The project results will be explained in WHO reports and published in international peer-reviewed journals, and summaries will be provided to the funders of the study.