Predictive risk factors for pneumothorax following fluoroscopic-guided transbronchial lung biopsy.

INTRODUCTION: Fluoroscopic-guided transbronchial lung biopsy (FG-TBLB) is routinely performed via bronchoscopy to diagnose focal peripheral lesions and diffuse lung disease. Identifying the risk factors of FG-TBLB-related pneumothorax can assist the operator in taking pre-emptive measures to prepare for this potential complication. MATERIALS AND METHODS: We retrospectively analysed data from 157 patients who underwent FG-TBLB, with the primary outcome being procedure-related pneumothorax. We assessed several risk factors for pneumothorax following FG-TBLB: patient characteristics, location of biopsy, number of biopsies and computed tomography pattern. Univariate and multivariate logistic regression analyses were performed. RESULTS: One-hundred fifty-seven patients were included [mean (SD) age 57.9 (16.2) years; 60.5% male]. The most common location for FG-TBLB was the right upper lobe (n=45, 28.7%). The mean (SD) number of biopsy samples was 6.7 (2.1). Radiographic evidence of pneumothorax was reported in 12 (7.6%) patients, with 11 of those requiring intercostal chest tube intervention (mean air leak time: 5.7 days and 1 had persistent air leak requiring autologous blood patch pleurodesis. None experienced pneumothorax recurrence. Female gender and upper lobe location of the biopsy were identified as predisposing factors for pneumothorax. In the multivariable analysis, upper lobe biopsies were associated with a higher risk of pneumothorax (OR 0.120; 95% CI 0.015-0.963; p = 0.046). CONCLUSION: The overall rate of pneumothorax is low. We recognise the increased risk of pneumothorax associated with upper lobe biopsy. These findings suggest that clinicians should exercise caution when performing FGTBLB in this region and consider alternative biopsy locations whenever feasible. We suggest adequate planning and preparation should be implemented to minimise the risk of pneumothorax following FG-TBLB.

Ammonia recovery from acidogenic fermentation effluents using a gas-permeable membrane contactor.

A gas-permeable membrane (GPM) contactor was used to recover ammoniacal nitrogen from a synthetic and a biowaste fermentation broth under different pH (from 6 to 11) and temperatures (35 and 55 °C). Ammonia mass transfer constant (Km) increased as pH and temperature increased. For synthetic broth, pH 10 provided the best results, when considering the Km (9.2·10-7 m·s-1) and the reagents consumption (1.0 mol NaOH·mol-1 TAN and 0.6 mol H2SO4·mol-1 TAN). Biowaste fermentation generated a broth with a high concentration of ammoniacal nitrogen (4.9 g N·L-1) and volatile fatty acids (VFA) (41.1 g COD·L-1). Experiments using the biowaste broth showed a lower Km (5.0·10-7 m·s-1 at pH 10) than the synthetic broth, related to the solution matrix and other species interference. VFAs were not detected in the trapping solution. Overall, these results show that GPM is a suitable technology to efficiently separate ammoniacal nitrogen and VFA from fermentation broths.

COVID-19 and essential workers: Healthcare delays among organic farmers.

INTRODUCTION AND OBJECTIVE: While the overall impact of COVID-19 is still being assessed, there is strong evidence that the pandemic has greatly aggravated traditional flaws of healthcare systems around the globe. Understanding the healthcare impact of the COVID-19 pandemic is essential for emergency preparedness and the prevention of collateral damage. The food and agriculture sector is an essential service and critical to food availability and access. However, literature on the healthcare impact of COVID-19 in farmers is scarce. This study aimed to explore healthcare delays caused by the COVID-19 pandemic in certified organic producers. METHODS: An observational Cross-sectional study based on answers of an electronic self-reported survey. Participants included were United States certified organic producers listed in the Organic Integrity Database. RESULTS: Respondents represented 40 states; response rate was estimated at 11%. Analyses were conducted on 344 records. A high majority were non-Hispanic Whites with a four-year college education or more. More than 90% had health insurance. More than one-third (36.5%) of respondents reported healthcare delays. Female producers were nearly twice as likely to report non-COVID-19 related healthcare delays as their male counterparts (OR 1.95, 95% CI: 1.10-3.44). CONCLUSION: This study provides national data on healthcare delays among organic producers and their households and identifies sex differences in non-COVID-19 related healthcare delays. This study is the first to collect data on organic producers and can serve as a baseline for future studies; it may inform practice, research and policy on emergency preparedness, protection of essential workers, and healthcare services and quality.

The impact of Covid-19 healthcare emergency on the psychological well-being of health professionals: a review of literature.

Introduction: The Coronavirus pandemic (Covid-19) was first identified in December 2019 in the city of Wuhan, China, and later caused a severe health crisis, causing massive disruptions to most healthcare sy-stems worldwide. The Covid-19 health emergency has seen healthcare workers in the front line facing all the difficulties related to the care burden. One of the most significant and probably underinvestigated aspects is the psychological stress of the healthcare staff managing the emergency. The aim of the paper is to analyze the literature on the impact of the Covid-19 crisis on the psychological well-being of health professionals. Methodology: We conducted a systematic review of articles published on this topic during the months from January 2020 to December 2020, searching on Pub Med, Scopus and Web of Science databases. Results: Most of the issues can be summarized into five conceptual categories: Stress, Depression and Infec-tion Anxiety, Anguish, Insomnia, Post Traumatic Stress Disorder, and Suicide. The literature identifies many factors contributing to the onset of anxiety, depression, and stress, like the fear of contracting the disease and transmitting it to family members and friends, stressful shifts, and little rest among several others. The literature highlights the needs for adequate measures, including proper psychological support. Conclusion: The conducted review suggests that the behaviours of healthcare professionals during the emer-gency phase of the Covid-19 pandemic show psychological disorders that can compromise mental health. Therefore, there is a call for those in chief like hospital managers and policymakers to take action, promoting measures like surveillance, monitoring, and psychological support among others, to increase the resilience of healthcare workers, limiting stress and anxiety and allowing them to keep their performance at work.

Is the tiger shark Galeocerdo cuvier a coastal species? Expanding its distribution range in the Atlantic Ocean using at-sea observer data.

The occurrence of tiger shark Galeocerdo cuvier in the Atlantic Ocean was assessed using at-sea observer data from multiple pelagic longline fisheries. Geographic positions of 2764 G. cuvier recorded between 1992 and 2013 and covering a wide area of the Atlantic Ocean were compared with the currently accepted distribution ranges of the species. Most records fell outside those ranges in both the Southern and Northern Hemispheres, which strongly suggests that the distribution range of G. cuvier in the open ocean is considerably larger than previously described.

A multisite community-based health literacy intervention for Spanish speakers.

The National Action Plan to Improve Health Literacy emphasizes the importance of community-based opportunities for education, such as English as a second language (ESL) programs. It recommends collaborations among the adult literacy and ESL communities. However, limited attention has been given to researching the effectiveness of community-based interventions that combine ESL and health literacy. The purpose of this study was to explore the feasibility of using different community settings for improving health literacy among adult Spanish speakers through an English language program. The study used a pre-experimental, single arm pretest-posttest design, and implemented the Health Literacy and ESL Curriculum. A collaborative was established between the community and university researchers. Participants were recruited at three distinctive sites. Health literacy was assessed using the Spanish version of the Test of Functional Health Literacy in Adults (TOFHLA). Analysis included descriptive and paired-group t test. Forty-nine participants completed the intervention and post-tests (92% retention rate). Overall--all sites--posttest scores significantly improved for total TOFHLA, raw numeracy, and reading comprehension (p < 0.0001). Similarly, all three sites yielded significantly better mean differences for the total TOFHLA score while numeracy and reading comprehension significantly improved in some sites. Results suggest that community sites are viable venues for delivering health literacy/language instruction to Spanish speaking adults. The study also points to community engagement and ESL programs as two essential components of effective health literacy interventions among Spanish speakers.

Multisyringe flow injection analysis of stable and radioactive strontium in samples of environmental interest.

A multisyringe flow injection (MSFIA) method for the determination of stable and radioactive strontium, using a solid phase resin (Sr-Resin), has been developed. Strontium concentrations are determined by atomic emission spectroscopy and by a low background proportional counter. The method has been applied to different samples (water, milk and soil) of environmental interest. The LLD of the stable and radioactive Sr were 10 microg/l and 0.01 Bq, respectively. The standard deviation of the separation procedure is 2% (n=10).

[The tobacco industry's internal documents and smoking prevention in Spain]. / Los documentos internos de la industria tabaquera y la prevención del tabaquismo en España.

A 1998 agreement between several states in the USA and the tobacco industry made millions of pages of internal documents available to the public. Many of these documents contain information that the industry would have preferred to keep confidential. Systematic review of these internal documents constitutes a valuable resource for international tobacco control, since they are available on the Internet and can be accessed from anywhere in the world. These documents provide relevant and useful information to antismoking activists and researchers. To facilitate their use, the present article presents the electronic archives of the tobacco industry's documents, describes methods for conducting searches, and identifies the documents with information on the industry's tactics for manipulating Spanish politics and society for its own commercial interests during the 1970s, 1980s, and 1990s.

[Serum alpha-1 antitrypsin levels in patients with Cuban epidemic neuropathy]. / Niveles séricos de alfa-1 antitripsina en pacientes con neuropatía epidemica cubana.

INTRODUCTION: Cuban epidemic neuropathy is an emergent disease that due to its magnitude and health problem it was considered the most devastating outbreak of the XX century of the world. On the other hand it has been reported that the protease inhibitor, in particular alpha 1 antitrypsin has importance for the brain metabolic process and its genetic deficiency was produced peripheric neuropathy. Because of it we should decided to study the serum levels of patients suffering from this disease. PATIENTS AND METHODS: It has been studied serum alpha 1 antitripsin levels in 39 patients with peripheric Cuban epidemic neuropathy, six patients with the mixt variant of the disease and 10 patients with diabetic neuropathy. All patients has no toxic habits like alcohol and tobacco consumption. The quantification of alpha 1 antitrypsin was performed by radial immunodiffusion. RESULTS: When the median values of alpha 1 antitrypsin were compared no significant differences were obtained among the different neuropathies with a significance levels less than 0.05. There was a significant increased of apha 1 antitrypsin with the evolution time of the disease in the patients with the mixt variant and a significant correlation between alpha 1 antitrypsin levels and age with diabetic neuropathy. CONCLUSIONS: This protease inhibitor looks to be involved in the physiopathology of the Cuban epidemic neuropathy with a decreased levels during the initial time of the disease.

Niveles séricos de alfa-1-antitripsina en pacientescon neuropatía epidémica cubana / Serum alpha-1-antitrypsin levels in patients with cuban epidemic neuropathy

Introducción. La neuropatía epidémica cubana (NEC) es una enfermedad emergente que, por la magnitud y trastornos que provoca, se considera como la más devastadora del siglo XX en el mundo. Por otro lado, se ha comunicado que los inhibidores de proteasa, en particular la alfa-1-antitripsina (AAT), tienen importancia en los procesos metabólicos cerebrales y su déficit genético produce neuropatía periférica. Por todo ello, nos decidimos a estudiar los niveles en suero de AAT en pacientes afectados por esta enfermedad. Pacientes y métodos. Se estudiaron los niveles de AAT en el suero de 39 pacientes diagnosticados con NEC periférica, en seis pacientes con la variante óptica de la enfermedad y 10 pacientes con neuropatía diabética. Ningún paciente refirió poseer hábitos tóxicos como consumo de alcohol o tabaco. La cuantificación se realiza por inmunodifusión radial. Resultados. Cuando se compararon los valores medios de AAT no hubo diferencias significativas para los pacientes en distintas neuropatías para el nivel de significación menor a 0,05. Hubo una correlación significativa de aumento de la AAT con los años de evolución de la enfermedad para los pacientes con neuropatía mixta y una correlación significativa entre los niveles de AAT y la edad del paciente en la neuropatía diabética. Conclusiones. Este inhibidor de proteasa parece que se involucra en la fisiopatogenia de la NEC con una disminución en el inicio de la enfermedad (AU)

[Smoking initiation: epidemiology, research, and behavioral sciences]. / La iniciación al tabaquismo: aportaciones de la epidemiología, el laboratorio y las ciencias del comportamiento.

Becoming a regular smoker is a process that begins even before the first cigarette, and ends in lifelong physical and psychological dependence. Various psychological and behavioral factors contribute to this process. This article discusses smoking initiation from a comprehensive perspective, including the physiological and addictive effects of nicotine, and the personal and environmental factors that lead to smoking. Because smoking usually begins in adolescence, special emphasis is placed on this developmental stage and on the situations that encourage teenagers to smoke the first cigarette. Finally, this article analyzes the importance of the initiation process in the epidemiology and prevention of smoking. This approach may prove to be particularly useful to clinicians interested in interventions aimed to curb smoking.

[A descriptive analysis of 81 patients referred to a neurology clinic for syncope]. / Análisis descriptivo de 81 pacientes remitidos por síncope a una consulta de neurología.

INTRODUCTION: Syncope is a frequent medical problem which is disabling, potentially serious and difficult to treat. Although patients with syncope are often sent to Neurology clinics for investigation we have found no published report analysing this. OBJECTIVE: To analyze the aetiology of the cases of syncope referred to a Neurology Clinic and also the diagnostic usefulness of the investigations requested, particularly those of neuroimaging, electroencephalogram (EEG) and vascular studies. PATIENTS AND METHODS: A prospective study of the patients referred for syncope to a Neurology Outpatient Clinic. The patients were classified into three groups: 1. Epileptic seizure, if the clinical history suggested the possibility of a convulsion rather than a syncope. 2. Syncope of neurological origin, when the syncope is due to a neurological disorder. 3. Non neurological cause of the syncope when the syncope was not due to neurological disease. RESULTS: We included 81 patients, who made up 4.3% of the patients seen in the Neurology Clinic. Epileptic seizures made up 10% and the other 90% were due to non neurological causes. There was 0% usefulness of neuroimaging investigations and vascular studies. The EEG showed epileptiform changes in 9% of the patients, with non neurological syncopes. CONCLUSION: In patients with syncope neurological investigations are not very useful.

Análisis descriptivo de 81 pacientes remitidos por síncopea una Consulta de Neurología / A descriptive analysis of 81 patients referred to a neurology clinic for syncope

Introducción. El síncope es un problema médico frecuente, incapacitante, potencialmente grave y difícil de diagnosticar. A pesar de que los pacientes con síncope se remiten con frecuencia a la consulta de Neurología, no hemos encontrado ninguna publicación que analice la casuística de los mismos remitidos a ese servicio, para su estudio. El objetivo del presente trabajo es analizar la etiología de los síncopes remitidos a una consulta de Neurología, así como la rentabilidad diagnóstica de las pruebas solicitadas, especialmente la de los estudios de neuroimagen, electroencefalograma (EEG) y estudio vascular. Pacientes y métodos. Estudio prospectivo de los pacientes remitidos por síncope a una consulta externa de neurología. Los pacientes se clasificaron en tres grupos: 1. Crisis epiléptica, si la historia clínica sugería un proceso comicial en lugar de un síncope; 2. Síncope de causa neurológica, cuando el síncope se debía a una enfermedad neurológica, y 3. Síncope no neurológico, cuando el síncope no se debía a una enfermedad neurológica. Resultados. Se incluyeron 81 pacientes, lo que representa el 4,3 por ciento del total de pacientes remitidos a la consulta de Neurología. El 10 por ciento se diagnosticaron de crisis epilépticas y el 90 por ciento restante de síncope no neurológico. La rentabilidad diagnóstica de las pruebas de neuroimagen y del estudio vascular fue del 0 por ciento. El EEG mostró alteraciones epileptiformes en el 9 por ciento de los pacientes, con síncopes no neurológicos. Conclusión. En los pacientes con síncope, la rentabilidad diagnóstica del estudio neurológico es muy baja (AU)

Voltammetric analysis of heterogeneity in metal ion binding by humics.

The complexation of Cd, Pb, and Cu by fulvic acids at a fixed pH and ionic strength is studied by means of different voltammetric techniques at any metal-to-ligand ratio. When using Reverse Pulse Polarography (RPP) the complex species are electrochemically labile and not subject to significant electrodic adsorption. RPP titrations of fulvic acid with metal ions are interpreted on the basis of a recently proposed analytical expression for limiting currents valid for fully labile heterogeneous complexation. The voltammetric data are transformed into the corresponding binding curve, i.e., the fraction of occupied sites vs free metal concentration. Finally, the competition between metal ions and protons in their interaction with the fulvic binding sites as well as the concomitant polyelectrolytic effects are analyzed in terms of the NICCA-Donnan model. The results show that voltammetric techniques can be applied to the studies of heterogeneous complex systems in a broad range of metal-to-ligand ratios.

Physical constraints in the synthesis of glycogen that influence its structural homogeneity: a two-dimensional approach.

Several aspects of glycogen optimization as an efficient fuel storage molecule have been studied in previous works: the chain length and the branching degree. These results demonstrated that the values of these variables in the cellular molecule are those that optimize the structure-function relationship. In the present work we show that structural homogeneity of the glycogen molecule is also an optimized variable that plays an important role in its metabolic function. This problem was studied by means of a two-dimensional approach, which allowed us to simplify the very complicated structure of glycogen. Our results demonstrate that there is a molecular size limit that guarantees the structural homogeneity, beyond which the structure of the molecule degenerates, as many chains do not grow. This strongly suggests that such a size limit is precisely what the molecule possesses in the cell.

Hispanics and worksite health promotion: review of the past, demands for the future.

During the last 15 years, reports, books, and published papers have demonstrated the positive health benefits of comprehensive health promotion and disease prevention interventions at the worksite. Although the progress made in worksite health promotion should not be understated, experts agree that it is time to step forward and address the new demands of the changing labor force. One area of intervention that needs to be more aggressively addressed is that of minority populations. Because work force projections show the high participation rate that Hispanics will have in the future labor force, the Hispanic population should be one of the targets of worksite health promotion. This paper reviews how employee health promotion programs have addressed Hispanic workers in the past and establishes directions for the future.

[The health belief model. A theoretical approach to the prevention of AIDS]. / El modelo de creencias de salud. Un enfoque teórico para la prevención del SIDA.

Despite recent drug developments, the best available strategy we have today against HIV/AIDS is still preventive education. Since a voluntary behavioral change is difficult to achieve, even under the best possible conditions, preventive-education interventions should consider any strategy that facilitates the process of change. Although the final objective is to adopt a specific behavior, theoretical models that include cognitive-perceptive components can be useful in achieving that objective. It has been proven that a certain amount of information, even if not sufficient for sustaining behavior change, is an important predisposing component of initiating behavior changes. This paper examines the role of the Health Belief Model (HBM) as an educational tool for HIV/AIDS preventive interventions, and supports the use of social-cognitive theories in health education.

Quantitative electrophysiological characteristics and subtyping of schizophrenia.

Quantitative descriptors of resting electroencephalogram (EEG) (QEEG) and event-related potentials (QERP) to visual and auditory stimuli were obtained from normal subjects and 94 chronic schizophrenic patients on medication, 25 chronic schizophrenics off medication, and 15 schizophrenics with no history of medication. These schizophrenic groups showed a high incidence of neurometric features that were significantly deviant from normative values. Multivariate discriminant analysis using these features successfully separated the schizophrenic patients from normals with high accuracy in independent replication. The data from the medicated group were subjected to cluster analysis. Newly developed algorithms were used for objective selection of the most effective set of variables for clustering and the optimum number of clusters to be sought. Five clusters were obtained, containing roughly equivalent proportions of the sample with markedly different QEEG profiles. The whole sample was then classified into these clusters. Each cluster contained patients both on and off medication, but patients who had never been medicated were classified into only three of these clusters. No significant clinical or demographic differences were found between members of the five clusters; however, clear differences in QERP profiles were seen. These results are described in detail and possible physiological and pharmacological implications are discussed.