Linking social preferences and ocean acidification impacts in mussel aquaculture.

Ocean Acidification (OA) has become one of the most studied global stressors in marine science during the last fifteen years. Despite the variety of studies on the biological effects of OA with marine commercial species, estimations of these impacts over consumers' preferences have not been studied in detail, compromising our ability to undertake an assessment of market and economic impacts resulting from OA at local scales. Here, we use a novel and interdisciplinary approach to fill this gap. We experimentally test the impact of OA on commercially relevant physical and nutritional attributes of mussels, and then we use economic discrete choice models to assess the marginal effects of these impacts over consumers' preferences and wellbeing. Results showed that attributes, which were significantly affected by OA, are also those preferred by consumers. Consumers are willing to pay on average 52% less for mussels with evidences of OA and are willing to increase the price they pay to avoid negative changes in attributes due to OA. The interdisciplinary approach developed here, complements research conducted on OA by effectively informing how OA economic impacts can be analyzed under the lens of marginal changes in market price and consumer' welfare. Thereby, linking global phenomena to consumers' wellbeing, and shifting the focus of OA impacts to assess the effects of local vulnerabilities in a wider context of people and businesses.

Predictors of mesh infection and explantation after abdominal wall hernia repair.

BACKGROUND: The main objective was to identify predictive factors associated with prosthesis infection and mesh explantation after abdominal wall hernia repair (AWHR). METHODS: This is a retrospective review of all patients who underwent AWHR from January 2004 to May 2014 at a tertiary center. Multivariate analysis identified predictors of mesh infection and explantation after AWHR. RESULTS: From 3,470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. Steroid or immunosuppressive drugs use (odds ratio [OR] 2.22; confidence interval [CI] 1.16 to 3.95), urgent repair (OR 5.06; CI 2.21 to 8.60), and postoperative surgical site infection (OR 2.9; CI 1.55 to 4.10) were predictive of mesh infection. Predictors of mesh explantation were type of mesh (OR 3.13; CI 1.71 to 5.21), onlay position (OR 3.51; CI 1.23 to 6.12), and associated enterotomy in the same procedure (OR 5.17; CI 2.05 to 7.12). CONCLUSIONS: Immunosuppressive drugs use, urgent repair, and postoperative surgical site infection are predictive of mesh infection. Risk factors of prosthesis explantation are polytetrafluoroethylene mesh, onlay mesh position, and associated enterotomy in the same procedure.

Acetaldehyde reinforcement and motor reactivity in newborns with or without a prenatal history of alcohol exposure.

Animal models have shown that early ontogeny seems to be a period of enhanced affinity to ethanol. Interestingly, the catalase system that transforms ethanol (EtOH) into acetaldehyde (ACD) in the brain, is more active in the perinatal rat compared to adults. ACD has been found to share EtOH's behavioral effects. The general purpose of the present study was to assess ACD motivational and motor effects in newborn rats as a function of prenatal exposure to EtOH. Experiment 1 evaluated if ACD (0.35 µmol) or EtOH (0.02 µmol) supported appetitive conditioning in newborn pups prenatally exposed to EtOH. Experiment 2 tested if prenatal alcohol exposure modulated neonatal susceptibility to ACD's motor effects (ACD dose: 0, 0.35 and 0.52 µmol). Experiment 1 showed that EtOH and ACD supported appetitive conditioning independently of prenatal treatments. In Experiment 2, latency to display motor activity was altered only in neonates prenatally treated with water and challenged with the highest ACD dose. Prenatal EtOH experience results in tolerance to ACD's motor activity effects. These results show early susceptibility to ACD's appetitive effects and attenuation of motor effects as a function of prenatal history with EtOH, within a stage in development where brain ACD production seems higher than later in life.

Calidad de la atención de los síndromes coronarios agudos: implementación de una ruta crítica / Quality of care in acute coronary syndromes: a critical path implementation

Antecedentes: En los últimos años se han realizado avances importantes en el manejo del síndrome coronario agudo, lo cual se ha traducido en una disminución de la mortalidad en este grupo de pacientes. Objetivo: Describir los resultados de la implementación de una ruta crítica para el manejo de los síndromes coronarios agudos en el Servicio de Urgencias del Hospital San José de Bogotá, entre el 1 de marzo de 2012 y el 28 de febrero de 2013. Métodos: Se realizó un estudio observacional descriptivo prospectivo. La ruta crítica fue estructurada mediante el consenso de los servicios de Medicina Interna, Urgencias y Cardiología, para ser aplicada en las primeras 24 horas del tratamiento del paciente con síndrome coronario agudo definitivo. Resultados Se reclutaron 156 pacientes, de los cuales 25 correspondieron a síndrome coronario agudo con elevación del ST y 131 a síndrome sin elevación del ST. De los síndromes coronarios agudos con elevación del ST el 96% fue sometido a alguna estrategia de reperfusión; 2 (9,5%) pacientes fallecieron. En cuanto al síndrome coronario agudo sin elevación del ST, 33 (25,1%) pacientes presentaron infarto, 98 (74,9%) angina inestable, y 4 (3,2%) fallecieron. El uso de aspirina, betabloqueador, estatina e inhibidor de la enzima convertidora de angiotensina o antagonistas de los receptores de angiotensina II durante las primeras 24 horas fue superior al 90% en toda la muestra. Conclusiones: Se alcanzó un nivel superior de cumplimiento de las medidas de desempeño de la atención de los síndromes coronarios agudos después de la implementación de una ruta crítica.

Background: In recent years there have been important advances in acute coronary syndrome (ACS) management, which translates into a drop in mortality in this group of patients. Objective: To describe the results of the implementation of a critical path for the management of ACS, at the emergency service of the Hospital San José in Bogotá, between March 1st, 2012 and February 28th, 2013. Methods: A prospective descriptive observational study was carried out. The critical pathway was structured upon consensus among the services of internal medicine, emergency, and cardiology. This pathway was structured to be applied within the first 24 hours of the patient's treatment with the final ACS. Results: 156 patients were selected, 25 had ST segment elevation ACS and 131 had ACS non-ST segment elevation. 96% of ST segment elevation ACS underwent some reperfusion strategy, 2 (9.5%) patients died. As far as non-ST segment elevation ACS patients are concerned, 33 (25.1%) patients exhibited infarction and 98 (74.9%) unstable angina, with a mortality of 4 (3.2%) patients. The use of aspirin, betablockers, statin, and ACEI or ARA II during the first 24 hours was above 90% in the totality of the sample. Conclusions: It is demonstrated that a higher level of fulfillment is achieved for the performance measures for ACS care upon a critical pathway implementation.

Estructuración e implementación de una ruta crítica para el manejo de pacientes con síndrome coronario agudo en el Servicio de Urgencias del Hospital San José de Bogotá / Structuring and implementation of a critical pathway for the management of patients with acute coronary syndrome in the Emergency Department of San José Hospital in Bogotá

Introducción: el síndrome coronario agudo es una patología de alto impacto clínico en nuestro medio y en el mundo. A pesar de la evidencia de un número de medidas que benefician el resultado de estos pacientes, se ha demostrado que su utilización no es la mejor. Una de las estrategias diseñadas para mejorar esta situación, es la utilización de las rutas críticas (critical pathways), que consisten en una secuencia óptima y guiada por tiempo de intervenciones realizadas por los miembros del equipo de salud, para un diagnóstico o procedimiento particular, con el objetivo de minimizar retrasos, mejorar la utilización de recursos y maximizar la calidad del cuidado de la salud. Métodos: como parte de un proceso de mejoramiento de la calidad de la atención, se decidió realizar la estructuración e implementación de una ruta crítica en el manejo del síndrome coronario agudo durante las primeras 24 horas de atención. Para su realización se tuvo en cuenta la información observada en la literatura luego de una revisión amplia del tema. Resultados: posterior al proceso de diseño, divulgación y concertación con los servicios implicados en el manejo de los eventos coronarios, y con base en las guías institucionales, se estructuró una ruta crítica que consta de tres documentos: el primero para la evaluación inicial del dolor torácico, el segundo para el manejo de los eventos coronarios con elevación del segmento ST y el tercero para eventos coronarios sin elevación del segmento ST. Conclusiones: las rutas críticas se han posicionado en el mundo como herramientas que impactan en un alto grado la calidad de la atención de los pacientes con síndrome coronario agudo, ya que minimizan los retrasos, optimizan la utilización de los recursos y controlan las variaciones de dicha atención. Se describe la estructuración e implementación de una ruta crítica para el manejo de estos pacientes en un hospital de cuarto nivel en Colombia.

Introduction: acute coronary syndrome is a disease with high clinical impact on our environment and the world. Despite the evidence of a number of measures that benefit the outcome of these patients, it has been shown that its use is not the best. One of the strategies designed to improve this situation is the use of critical pathways, which consist of an optimal sequence guided by time of interventions performed by members of the health team for a particular procedure or diagnosis, in order to minimize delays, improve the utilization of resources and maximize the quality of health care. Methods: as part of a process of improvement of the quality of care, we decided to perform the structuring and implementation of a critical pathway in the management of acute coronary syndrome during the first 24 hours of care. To achieve this, we took into account the data observed in the literature after an extensive revision of the topic. Results: posterior to the design process, disclosure and agreement with the departments involved in the management of coronary events, and based on institutional guidelines, we structured a critical pathway consisting of three documents: the first for the initial chest pain assessment, the second for the management of coronary events with ST segment elevation and the third for coronary events without ST segment elevation. Conclusions: critical pathways have been positioned in the world as tools that highly impact the quality of care of patients with acute coronary syndrome, as they minimize delays, optimize the use of resources and control variations of such attention. We describe the structuring and implementation of a critical pathway for the management of these patients in a fourth-level hospital in Colombia.