Influence of Sulfurization Time on Sb2S3 Synthesis Using a New Graphite Box Design.

In recent years, antimony sulfide (Sb2S3) has been investigated as a photovoltaic absorber material due to its suitable absorber coefficient, direct band gap, extinction coefficient, earth-abundant, and environmentally friendly constituents. Therefore, this work proposes Sb2S3 film preparation by an effective two-step process using a new graphite box design and sulfur distribution, which has a high repeatability level and can be scalable. First, an Sb thin film was deposited using the RF-Sputtering technique, and after that, the samples were annealed with elemental sulfur into a graphite box, varying the sulfurization time from 20 to 50 min. The structural, optical, morphological, and chemical characteristics of the resulting thin films were analyzed. Results reveal the method's effectivity and the best properties were obtained for the sample sulfurized during 40 min. This Sb2S3 thin film presents an orthorhombic crystalline structure, elongated grains, a band gap of 1.69 eV, a crystallite size of 15.25 Å, and a nearly stoichiometric composition. In addition, the formation of a p-n junction was achieved by depositing silver back contact on the Glass/FTO/CdS/Sb2S3 structure. Therefore, the graphite box design has been demonstrated to be functional to obtain Sb2S3 by a two-step process.

In vivo behavior in rabbit radius bone defect of scaffolds based on nanocarbonate hydroxyapatite.

Bone defects treatment may require the use of biomaterials that behave as a support and promote bone regeneration. Limitations associated with the use of autografts and allografts make it necessary to design new synthetic bone substitutes. Some of the most promising biomaterials currently under investigation are based on nanocarbonate hydroxyapatite (nCHA). In this study, we studied the bone-inducing capacity of nCHA-based scaffolds alone (SAG) and enriched with osteostatin (SAGO) or with bone marrow aspirate(SAGB) after implantation for 12 weeks in a 15-mm long critical defect performed in the radius of New Zealand rabbits. Bone formation obtained was compared with a group with the unfilled defect (CE), as control group, and other with the defect filed with iliac crest autograft (GS), as gold standard. X-ray follow-up was performed at 2, 4, 6 and 12 weeks and µCT and histological studies at 12 weeks. The radiological results showed a greater increment in bone formation in the GS group (75%-100%), followed by the SAG and SAGB groups (50%-75%). µCT results showed an increase of bone volume/tissue volume values in GS group followed by SAG and SAGB groups (0.53, 0.40, and 0.31 respectively) compared with CE group (0.26). Histological results showed limited resorption of the nCHA scaffolds and partial osseointegration in the SAG and SAGB groups. However, in the SAGO group, the presence of connective tissue encapsulating the scaffold was detected. In SAG, SAGB, and increase of bone formation were observed compared with CE group, but less than the GS group. Thus, the investigated materials represent a significant advance in the design of synthetic materials for bone grafting, but further studies are needed to bring their in vivo behavior closer to autograft, the gold standard.

COVID-19 pandemic and its impact on medical interns' mental health of public and private hospitals in Guadalajara.

INTRODUCTION: Burnout syndrome is a global burden characterized by exhaustion, work detachment, and a sense of ineffectiveness. It affects millions of individuals worldwide, with a particularly high prevalence among medical students. Factors such as demanding education, exposure to suffering, and the COVID-19 pandemic have contributed to elevated stress levels. Addressing this issue is crucial due to its impact on well-being and health-care quality. MATERIALS AND METHODS: This cross-sectional survey study assessed fear of COVID-19 and burnout levels among medical student interns in hospitals in Guadalajara, Jalisco. The study used validated scales and collected data from September 2021 to September 2022. A snowball sampling method was employed and a minimum sample size of 198 participants was calculated. RESULTS: This study included 311 medical students (62.1% female and 37.9% male with a mean age of 23.51 ± 2.21 years). The majority were in their second semester of internship (60.5%) and from public hospitals (89.1%). Most students believed that the COVID-19 pandemic affected the quality of their internship (82.6%). Female students had higher personal burnout scores, while male students had higher work-related burnout scores. The mean score for fear of COVID-19 was 13.71 ± 6.28, with higher scores among women (p = 0.004) and those from public hospitals (p = 0.009). A positive weak correlation was found between COVID-19 scores and burnout subscales. CONCLUSION: Our study emphasizes the significant impact of various factors on burnout levels among medical students and health-care professionals during the COVID-19 pandemic. Prolonged exposure to COVID-19 patients, reduced staffing, and increased workload contributed to burnout, affecting well-being and quality of care. Targeted interventions and resilience-building strategies are needed to mitigate burnout and promote well-being in health-care settings.

Neurovascular Relationships in AGEs-Based Models of Proliferative Diabetic Retinopathy.

Diabetic retinopathy affects more than 100 million people worldwide and is projected to increase by 50% within 20 years. Increased blood glucose leads to the formation of advanced glycation end products (AGEs), which cause cellular and molecular dysfunction across neurovascular systems. These molecules initiate the slow breakdown of the retinal vasculature and the inner blood retinal barrier (iBRB), resulting in ischemia and abnormal angiogenesis. This project examined the impact of AGEs in altering the morphology of healthy cells that comprise the iBRB, as well as the effects of AGEs on thrombi formation, in vitro. Our results illustrate that AGEs significantly alter cellular areas and increase the formation of blood clots via elevated levels of tissue factor. Likewise, AGEs upregulate the expression of cell receptors (RAGE) on both endothelial and glial cells, a hallmark biomarker of inflammation in diabetic cells. Examining the effects of AGEs stimulation on cellular functions that work to diminish iBRB integrity will greatly help to advance therapies that target vision loss in adults.

Neural correlates of drinking reduction during a clinical trial of cognitive behavioral therapy for alcohol use disorder.

BACKGROUND: Cognitive behavioral therapy (CBT) is an effective treatment for alcohol use disorder (AUD). We hypothesized that the dorsolateral prefrontal cortex (DLPFC), a region implicated in cognitive control and goal-directed behavior, plays a role in behavior change during CBT by facilitating the regulation of craving (ROC). METHODS: Treatment-seeking participants with AUD (N = 22) underwent functional magnetic resonance imaging (fMRI) scanning both before and after a 12-week, single-arm trial of CBT, using an ROC task that was previously shown to engage the DLPFC. RESULTS: We found that both the percentage of heavy drinking days (PHDD) and the overall self-reported alcohol craving measured during the ROC task were significantly reduced from pre- to post-CBT. However, we did not find significant changes over time in either the ability to regulate craving or regulation-related activity in any brain region. We found a significant 3-way interaction between the effects of cue-induced craving, cue-induced brain activity and timepoint of assessment (pre- or post-CBT) on PHDD in the left DLPFC. Follow-up analysis showed that cue-induced craving was associated with cue-induced activity in the left DLPFC among participants who ceased heavy drinking during CBT, both at pre-CBT and post-CBT timepoints. No such associations were present at either timepoint among participants who continued to drink heavily. CONCLUSIONS: These results suggest that patients in whom DLPFC functioning is more strongly related to cue-induced craving may preferentially respond to CBT.

An in vitro model of the macrophage-endothelial interface to characterize CAR T-cell induced cytokine storm.

Chimeric Antigen Receptor (CAR) T-cell therapy is a highly effective treatment for B-cell malignancies but limited in use due to clinically significant hyperinflammatory toxicities. Understanding the pathophysiologic mechanisms which mediate these toxicities can help identify novel management strategies. Here we report a novel in vitro model of the macrophage-endothelial interface to study the effects of CAR T-cell-induced cytokine storm. Using this model, we demonstrate that macrophage-mediated inflammation is regulated by endothelial cell activity. Furthermore, endothelial inflammation occurs independently of macrophages following exposure to CAR T-cell products and the induced endothelial inflammation potentiates macrophage-mediated inflammatory signaling, leading to a hyperinflammatory environment. While corticosteroids, the current gold standard of care, attenuate the resulting macrophage inflammatory signaling, the endothelial activity remains refractory to this treatment strategy. Utilizing a network model, coupled to in vitro secretion profiling, we identified STAT3 programming as critical in regulating this endothelial behavior. Lastly, we demonstrate how targeting STAT3 activity can abrogate endothelial inflammation and attenuate this otherwise hyperinflammatory environment. Our results demonstrate that endothelial cells play a central role in the pathophysiology of CAR T-cell toxicities and targeting the mechanisms driving the endothelial response can guide future clinical management.

A Pragmatic, Person-Centered View of Cannabis in the United States: Pursuing Care That Transcends Beliefs.

BACKGROUND: Rates of cannabis use are increasing in the United States, likely as a result of changes in societal attitudes and expanding legalization. Although many patients report wanting to discuss the risks and benefits of cannabis use with their clinical providers, many providers hold conflicting beliefs regarding cannabis use and often do not engage patients in discussion about cannabis. This dilemma is underscored by the limitations imposed on cannabis related research, and lack of empirically based best-practice guidelines for clinicians when addressing cannabis use with patients. OBJECTIVES: We aimed to briefly summarize clinician and patient attitudes toward cannabis use and review current clinical guidelines and provide suggestions to assist health care providers and clinicians in increasing their comfort and skill in discussing cannabis use with patients. METHODS: A narrative review on attitudes toward cannabis use and clinical guidelines was performed to summarize the literature and provide evidence-based recommendations. RESULTS: Attitudes toward cannabis use have been shaped by personal and political factors and contribute to clinician hesitance in speaking with patients about the topic. Administrative barriers have hindered the development of clearer public health guidelines that might enable the dissemination of evidence-based information on the health effects of cannabis use and might ultimately lead to better health outcomes. CONCLUSION: Not discussing cannabis use with patients may be a crucial missed opportunity for harm reduction. In the absence of empirically supported best-practice guidelines, a person-centered approach can facilitate conversations on the harms and benefits of cannabis use.

Analysis of synoptic weather patterns of heatwave events.

Heatwaves (HWs) are expected to increase both in duration and intensity in the next decades, but little is known about their synoptic and mesoscalar behavior, which is especially important in mid-latitude regions. Most climate research has focused on temperature analysis to characterize HWs. We propose that a combination of temperature and synoptic patterns is a better way to define and understand HWs because including atmospheric circulation patterns provides information about different HW structures that can irregularly affect the territory, and illustrate this approach at the regional and urban scales using the Iberian Peninsula and the Metropolitan Area of Barcelona as case studies. We first select HW events from 1950 to 2020 and apply a multivariate analysis to identify synoptic patterns based on mean sea level pressure, geopotential height at 500 hPa, and maximum daily 2 m temperature. The results indicate that four synoptic patterns reproduce at least 50% of the variance in HWs, namely, "stationary and stable", "dynamic and advective", "stationary and advective", and "dynamic, advective and undulated". Next, we apply the analysis to the Representative Concentration Pathway future scenarios (RCPs) 4.5 and 8.5 from the Coordinated Regional Climate Downscaling Experiment (CORDEX) to determine how these synoptic trends can change in the future. The analysis shows that the four synoptic patterns continue to explain 55 to 60% of the variance in HWs. Future HW events will be characterized by an increase in geopotential height at 500 hPa due to the northward shift of the anticyclonic ridge. This is especially true for RCP8.5, which simulates business as usual incrementing fossil fuel use and additionally shows an increase in atmospheric dynamism in north advections from all directions in comparison with RCP4.5. These findings point to the importance of considering the geopotential height in HW prediction, as well as the direction of advections. Supplementary Information: The online version contains supplementary material available at 10.1007/s00382-023-06828-1.

Comportamiento Mecánico de un Premolar Humano Sano Sometido a Fuerzas Funcionales y Disfuncionales en un MEF / Mechanical Behavior of a Healthy Human Premolar Subjected to Functional and Dysfunctional Forces in a FEM

El propósito de este estudio fue analizar el comportamiento mecánico de la estructura dental sana de un primer premolar inferior humano sometido a fuerzas funcionales y disfuncionales en diferentes direcciones. Se buscó comprender, bajo las variables contempladas, las zonas de concentración de esfuerzos que conllevan al daño estructural de sus constituyentes y tejidos adyacentes. Se realizó el modelo 3D de la reconstrucción de un archivo TAC de un primer premolar inferior, que incluyó esmalte, dentina, ligamento periodontal y hueso alveolar considerando tres variables: dirección, magnitud y área de la fuerza aplicada. La dirección fue dirigida en tres vectores (vertical, tangencial y horizontal) bajo cuatro magnitudes, una funcional de 35 N y tres disfuncionales de 170, 310 y 445 N, aplicadas sobre un área de la cara oclusal y/o vestibular del premolar que involucró tres contactos estabilizadores (A, B y C) y dos paradores de cierre. Los resultados obtenidos explican el fenómeno de combinar tres vectores, cuatro magnitudes y un área de aplicación de la fuerza, donde los valores de esfuerzo efectivo equivalente Von Mises muestran valores máximos a partir de los 60 MPa. Los valores de tensión máximos se localizan, bajo la carga horizontal a 170 N y en el proceso masticatorio en la zona cervical, cuando la fuerza pasa del 60 %. Sobre la base de los hallazgos de este estudio, se puede concluir que la reacción de los tejidos a fuerzas funcionales y disfuncionales varía de acuerdo con la magnitud, dirección y área de aplicación de la fuerza. Los valores de tensión resultan ser más altos bajo la aplicación de fuerzas disfuncionales tanto en magnitud como en dirección, produciendo esfuerzos tensiles significativos para la estructura dental y periodontal cervical, mientras que, bajo las cargas funcionales aplicadas en cualquier dirección, no se generan esfuerzos lesivos. Esto supone el reconocimiento del poder de detrimento estructural del diente y periodonto frente al bruxismo céntrico y excéntrico.

SUMMARY: The purpose of this study was to analyze the mechanical behavior of the healthy dental structure of a human mandibular first premolar subjected to functional and dysfunctional forces in different directions. It was sought to understand, under the contemplated variables, the areas of stress concentration that lead to structural damage of its constituents and adjacent tissues. The 3D model of the reconstruction of a CT file of a lower first premolar was made, which included enamel, dentin, periodontal ligament and alveolar bone considering three variables: direction, magnitude and area of the applied force. The direction was directed in three vectors (vertical, tangential and horizontal) under four magnitudes, one functional of 35 N and three dysfunctional of 170, 310 and 445 N, applied to an area of the occlusal and/or buccal face of the premolar that involved three stabilizing contacts (A, B and C) and two closing stops. The results obtained explain the phenomenon of combining three vectors, four magnitudes and an area of force application, where the values of effective equivalent Von Mises stress show maximum values from 60 MPa. The maximum tension values are located under the horizontal load at 170 N and in the masticatory process in the cervical area, when the force exceeds 60%. Based on the findings of this study, it can be concluded that the reaction of tissues to functional and dysfunctional forces varies according to the magnitude, direction, and area of application of the force. The stress values turn out to be higher under the application of dysfunctional forces both in magnitude and in direction, producing significant tensile stresses for the dental and cervical periodontal structure, while under functional loads applied in any direction, no damaging stresses are generated. This supposes the recognition of the power of structural detriment of the tooth and periodontium against centric and eccentric bruxism.

Consultas médicas per cápita en el sistema de salud del Perú, 2019. Hacia una nueva descripción del sistema de salud peruano

Introducción. El objetivo del estudio es contribuir a una nueva mirada del sistema de salud peruano a partir de la producción de bienes públicos en salud. Métodos. Se calculó el promedio de prestaciones de salud per cápita producidas por el sistema de salud peruano en niveles nacional, regional y provincial, a partir de fuentes de datos abiertos de la Superintendencia Nacional de Salud (SUSALUD), el Seguro Integral de Salud (SIS) y el Seguro Social de Salud (EsSalud) para el año 2019. Se desarrolló un análisis exploratorio de asociación entre las consultas médicas per cápita y variables socio-económicas. Resultados. Se encontró un promedio nacional de consultas médicas per cápita de 1,8, encontrándose una gran variabilidad de valores a nivel regional (2,9 a 0,8). A nivel provincias se encontró un primer cuartil superior, 50 provincias con valores entre 5,52 y 1,75 que concentran el 55% de la población peruana y el 71,3% de todas las prestaciones médicas. Un segundo cuartil agrupa 47 provincias con valores entre 1,73 - 1,33 y dos cuartiles inferiores que agrupan a 95 provincias con valores entre 1,32 y 0,08. El análisis exploratorio mostro asociación entre las consultas médicas per cápita a nivel regional y las variables analizadas, destacando la tasa de médicos por 1000 habitantes (R2: 064, valor p= 0,000) y el producto bruto interno regional per cápita (R2: 0,59, valor p=0,000). Conclusiones. La distribución por cuartiles en la producción de consultas médicas per cápita permiten identificar territorios con mejor atención, con mayor definición que los atributos de estructura del sistema (número de establecimientos, médicos por 1000 habitantes).

Introduction. The objective of the study is to contribute with a new perspective about the peruvian health system, based on the production of public goods in health. Methods. For this purpose, we calculated the per capita average of health encounters produced by the peruvian health system at the national, regional and provincial levels. Information was collected on the number of medical encounters, registered at the open data sources of the National Health Superintendence (SUSALUD), the Public Health Insurance (SIS), and the Health Social Insurance (EsSalud) for year 2019. Results. The national average of medical encounters per capita was 1.8, with a great variability of values at the regional level (2.9 to 0.8). In the case of the provinces, a first upper quartile was found, which group 50 provinces with values between 5.52 and 1.75 and concentrate 55% of the Peruvian population and 71.3% of all medical encounters produced by the health system. A second quartile groups 47 provinces, with values between 1.73 - 1.33; and two lower quartiles that group 95 provinces with values between 1.32 and 0.08. We showed an association between per capita medical encounters at the regional level and the socio-economic variables analyzed, in particular the Density of Physicians per 1000 population (R2: 0.64, p-value= 0.000) and the regional gross domestic product per capita (R2: 0.59, p-value=0.000). Conclusion. Medical encounters per capita is a useful indicator, that allows us to identify better served territories, with higher definition than other structure indicators (doctors per 1000 people; number of facilities).

Posttransplant Diabetes Mellitus: Recent Developments in Pharmacological Management of Hyperglycemia.

CONTEXT: The management of solid-organ transplantation is rapidly evolving, and posttransplant diabetes mellitus (PTDM), which is increasingly common, is a barrier to transplant success, adversely impacting infection rates, allograft survival, cardiovascular disease, quality of life, and overall mortality. Currently, the management of PTDM relies primarily on intensified insulin therapy. However, emerging studies report that several noninsulin glucose-lowering agents are safe and effective in improving metabolic control and enhancing treatment adherence. More importantly, their use in PTDM can potentially transform the long-term management of these complex patients, as some glucose-lowering agents may provide benefits beyond glycemic control. For instance, glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors may offer cardiorenal protection, and pioglitazone may treat nonalcoholic fatty liver disease (NAFLD). This review will focus on the pharmacological management of PTDM and the emerging evidence for noninsulin glucose-lowering agents in this population. EVIDENCE ACQUISITION: Evidence from observational studies, randomized controlled trials, and meta-analyses. EVIDENCE SYNTHESIS: PTDM adversely affects the outcomes of infection, organ survival, cardiovascular events, and mortality. Insulin therapy has been the drug of choice but is associated with weight gain and hypoglycemia. In contrast, noninsulin agents appear safe and may provide additional benefits, such as cardiorenal protection with SGLT-2 inhibitors and GLP-1 RA, and cardiometabolic benefits with pioglitazone, in patients undergoing solid-organ transplantation. CONCLUSIONS: Optimal care of patients with PTDM requires close monitoring and the early involvement of the endocrinologist as part of a multidisciplinary team. Noninsulin glucose-lowering agents will likely play an increasing role as more long-term, controlled studies become available in this setting.

The Road Not Taken: Disconnection of a Human-Unique Cortical Pathway Underlying Naturalistic Social Perception in Schizophrenia.

Background: Efficient processing of complex and dynamic social scenes relies on intact connectivity of many underlying cortical areas and networks, but how connectivity anomalies affect the neural substrates of social perception remains unknown. Here we measured these relationships using functionally based localization of social perception areas, resting-state functional connectivity, and movie-watching data. Methods: In 42 participants with schizophrenia (SzPs) and 41 healthy control subjects, we measured the functional connectivity of areas localized by face-emotion processing, theory-of-mind (ToM), and attention tasks. We quantified the weighted shortest path length between visual and medial prefrontal ToM areas in both populations to assess the impact of these changes in functional connectivity on network structure. We then correlated connectivity along the shortest path in each group with movie-evoked activity in a key node of the ToM network (posterior temporoparietal junction [TPJp]). Results: SzPs had pronounced decreases in connectivity in TPJ/posterior superior temporal sulcus (TPJ-pSTS) areas involved in face-emotion processing (t81 = 4.4, p = .00002). In healthy control subjects, the shortest path connecting visual and medial prefrontal ToM areas passed through TPJ-pSTS, whereas in SzPs, the shortest path passed through the prefrontal cortex. While movie-evoked TPJp activity correlated with connectivity along the TPJ-pSTS pathway in both groups (r = 0.43, p = .002), it additionally correlated with connectivity along the prefrontal cortex pathway only in SzPs (rSzP = 0.56, p = .003). Conclusions: These results suggest that connectivity along the human-unique TPJ-pSTS pathway affects both the network architecture and functioning of areas involved in processing complex dynamic social scenes. These results demonstrate how focal connectivity anomalies can have widespread impacts across the cortex.

A nurse-led intervention in patients with newly diagnosed cancer and Type 2 diabetes: A pilot randomized controlled trial feasibility study.

BACKGROUND: Undiagnosed Type 2 diabetes (T2D) has been associated with advanced stage cancer at diagnosis, higher mortality, and lower long-term all-cause survival. This was a RCT pilot study to examine the feasibility of a nurse-led T2D intervention for adults with newly diagnosed cancer (≤3 months), and T2D, undiagnosed or untreated with medication, conducted at an outpatient oncology clinic affiliated with a large academic institution. METHODS: Participants needed to meet the eligibility criteria including a HbA1c level between 6.5% and 9.9%. Randomization was 1:1 to a 3-month intervention that consisted of nursing-led diabetes education and immediate initiation of metformin versus referral to primary care for usual care (control). RESULTS: Three hundred and seventy nine patients were screened using EHR, 55 agreed to participate, and 3 had eligible HbA1c levels and were randomized in the study. Primary reasons for study exclusion included life expectancy ≤2 years (16.9%), current use or inability to tolerate metformin (14.8%), and abnormal labs that contraindicated metformin use (13.9%). CONCLUSION: This study was not feasible due to recruitment inefficiencies, but acceptable to all who qualified.

Pancreatectomía izquierda laparoscópica: ¿la sistematización de la técnica es de utilidad? / Laparoscopic left pancreatectomy: is systematization of the technique useful?

RESUMEN Antecedentes: la pancreatectomía izquierda laparoscópica es un procedimiento de alta complejidad que debe ser sistematizado para reducir complicaciones y tiempos quirúrgicos. Objetivo: Describir los resultados con una técnica sitematizada de esplenopancreatectomía laparoscópica. Material y métodos: se seleccionaron pacientes candidatos a realizar esplenopancreatecomía distal en el período comprendido entre 2007 y 2022. Se excluyeron pacientes con enfermedad sistémica. La técnica quirúrgica laparoscópica consiste en ligar los vasos cortos como primer paso, luego disecar y cortar la arteria esplénica, dejando la sección de la vena como último gesto quirúrgico. Esto evita la congestión venosa del bazo. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias. Resultados: sobre un total de 155 pacientes, 90 fueron intervenidos por vía laparoscópica y 65 por vía convencional. El tiempo quirúrgico promedio fue 168 minutos. Cuando se analizó el tiempo quirúrgico en los abordajes laparoscópicos, se observó una disminución del tiempo a partir del caso número 30. La mortalidad fue del 1,12%. La incidencia de fístula pancreática total fue 41%. La necesitad de transfusión intraoperatoria ocurrió en el 10,7% de los pacientes y la tasa de conversión fue del 13,3%. Conclusión: la sistematización de la técnica de la pancreatectomía laparoscópica permite la reducción de los tiempos quirúrgicos, adquirir mayor seguridad en la disección y realizar procedimientos cada vez más complejos.

ABSTRACT Background: Laparoscopic left pancreatectomy is a high complexity procedure that should be systematized to reduce complications and operative time. Objective: To describe the results achieved with a systematized technique for laparoscopic pancreatectomy and splenectomy. Materials and methods: We selected patients who were candidates for distal pancreatectomy and splenectomy between 2007 and 2022. Patients with systemic diseases were excluded. The laparoscopic technique consists of ligating the short vessels as a first step, then dissecting and cutting the splenic artery, leaving the section of the vein as the last surgical gesture to avoid venous congestion of the spleen. Perioperative, intraoperative and postoperative variables were analyzed. Results: A total of 155 patients were analyzed, 90 underwent laparoscopy and 65 underwent conventional surgery. Mean operative time was 168 minutes The operative time in the laparoscopic approach decreased from case 30 onwards. Mortality rate was 1.12%. The incidence of pancreatic fistula was 41%. Need for intraoperative transfusion occurred in 10.7% of the patients and the conversion rate was 13.3%. Conclusion: The systematization of the technique of pancreatic laparoscopy is essential to reduce surgical times, ensure safe dissections and performe more complex procedures.

Analyzing the effect of health reforms on the efficiency of Ecuadorian public hospitals.

This study aims to assess whether Ecuadorian health reforms carried out since 2008 have affected the efficiency performance of public hospitals in the country. We contribute to the literature by shedding new light on the effects on public healthcare efficiency for developing countries when policies move toward health equity and universal coverage. We follow a two-stage approach, wherein the first stage we make use of factor and cluster analysis to obtain three clusters of public hospitals based on their technological endowment; we exploit Data Envelopment Analysis for panel data in the second stage to estimate robust efficiency measures over time. Our innovative empirical strategy considers the heterogeneity of healthcare institutions in the analysis of their efficiency performance. The results show a significant decrease in the average efficiency of low and intermediate technology hospitals after the new constitution was adopted in 2008. The decline in efficiency coincides with the two reforms of 2010 and 2011 that brought on higher social security coverage.

Results of treatment with alemtuzumab in a Spanish cohort of patients with multiple sclerosis in the real world: The RealMS study.

Background: Alemtuzumab (ALZ) is a humanized monoclonal antibody approved for the treatment of patients with highly active relapsing-remitting multiple sclerosis (RRMS) administered in two annual courses. The objective of this study was to describe the effectiveness and safety data of ALZ and to report the health resource utilization in patients receiving this treatment. Methods: In this retrospective, non-interventional study, information was retrieved from patients' medical charts at one center in Spain. Included patients were ≥18 years old, and ALZ treatment was initiated between 1 March 2015 and 31 March 2019, according to routine clinical practice and local labeling. Results: Of 123 patients, 78% were women. The mean (standard deviation, SD) age of patients at diagnosis was 40.3 (9.1) years, and the mean time since diagnosis was 13.8 (7.3) years. Patients were previously treated with a median (interquartile range; IQR) number of two (2.0-3.0) disease-modifying treatments (DMTs). Patients were treated with ALZ for a mean (SD) of 29.7 (13.8) months. ALZ reduced the annualized relapse rate (ARR) (1.5 before vs. 0.05 after; p < 0.001) and improved the median EDSS (4.63 before vs. 4.00 after; p < 0.001). Most (90.2%) patients were relapse-free while receiving ALZ. The mean number of gadolinium-enhancing [Gd+] T1 lesions was reduced (1.7 before vs. 0.1 after; p < 0.001), and the mean number of T2 hyperintense lesions was maintained (35.7 before vs. 35.4 after; p = 0.392). A total of 27 (21.9%) patients reported 29 autoimmune diseases: hyperthyroidism (12), hypothyroidism (11), idiopathic thrombocytopenic purpura (ITP) (3), alopecia areata (1), chronic urticaria (1), and vitiligo (1). The mean number of health resources (outpatient visits, emergency room visits, hospital admissions, and tests performed in the hospital) used while patients were treated with ALZ progressively decreased from year 1 to year 4, except for a slight increase at year 2 of outpatient visits. Conclusion: The ReaLMS study provides real-world evidence that ALZ can promote clinical and magnetic resonance imaging disease remission, as well as disability improvement in patients with MS, despite several prior DMT failures. The ALZ safety profile was consistent with data available from clinical trials and other real-world studies. Healthcare resource use was reduced throughout the treatment period.

A clinician-to-clinician universal electronic consultation programme at the cardiology department of a Galician healthcare area improves healthcare accessibility and outcomes in elderly patients.

Aims: We aimed to assess longer-term results (accessibility, hospital admissions, and mortality) in elderly patients referred to a cardiology department (CD) from primary care using e-consultation in outpatient care. Methods and results: We included 9963 patients >80 years from 1 January 2010 to 31 December 2019. Until 2012, all patients attended an in-person consultation (2010-2012). In 2013, we instituted an e-consult programme (2013-2019) for all primary care referrals to cardiologists that preceded a patient's in-person consultation when considered. We used an interrupted time series (ITS) regression approach to investigate the impact of e-consultation on (i) cardiovascular hospital admissions and mortality. We also analysed (ii) the total number and referral rate (population-adjusted referred rate) in both periods, and (iii) the accessibility was measured as the number of consultations and variation according to the distance from the municipality and reference hospital. During e-consultation, the demand for care increased (12.8 ± 4.3% vs. 25.5 ± 11.1% per 1000 inhabitants, P < 0.001) and referrals from different areas were equalized. After the implementation of e-consultation, we observed that the increase in hospital admissions and mortality were stabilized [incidence rate ratio (iRR): 1.351 (95% CI, 0.787, 2.317), P = 0.874] and [iRR: 1.925 (95% CI: 0.889, 4.168), P = 0.096], respectively. The geographic variabilities in hospital admissions and mortality seen during the in-person consultation were stabilized after e-consultation implementation. Conclusions: Implementation of a clinician-to-clinician e-consultation programme in outpatient care was associated with improved accessibility to cardiology healthcare in elderly patients. After e-consultations were implemented, hospital admissions and mortality were stabilized.

Evaluation of entropy and fractal dimension as biomarkers for tumor growth and treatment response using cellular automata.

Cell-based models provide a helpful approach for simulating complex systems that exhibit adaptive, resilient qualities, such as cancer. Their focus on individual cell interactions makes them a particularly appropriate strategy to study cancer therapies' effects, which are often designed to disrupt single-cell dynamics. In this work, we propose them as viable methods for studying the time evolution of cancer imaging biomarkers (IBM). We propose a cellular automata model for tumor growth and three different therapies: chemotherapy, radiotherapy, and immunotherapy, following well-established modeling procedures documented in the literature. The model generates a sequence of tumor images, from which a time series of two biomarkers: entropy and fractal dimension, is obtained. Our model shows that the fractal dimension increased faster at the onset of cancer cell dissemination. At the same time, entropy was more responsive to changes induced in the tumor by the different therapy modalities. These observations suggest that the prognostic value of the proposed biomarkers could vary considerably with time. Thus, it is essential to assess their use at different stages of cancer and for different imaging modalities. Another observation derived from the results was that both biomarkers varied slowly when the applied therapy attacked cancer cells scattered along the automatons' area, leaving multiple independent clusters of cells at the end of the treatment. Thus, patterns of change of simulated biomarkers time series could reflect on essential qualities of the spatial action of a given cancer intervention.

Neural correlates of drinking reduction during cognitive behavioral therapy for alcohol use disorder.

Cognitive behavioral therapy (CBT) is an effective treatment for alcohol use disorder (AUD). We hypothesized that the dorsolateral prefrontal cortex (DLPFC), a brain region implicated in cognitive control and goal-directed behavior, plays a role behavior change during CBT by facilitating regulation of craving. To examine this, treatment-seeking participants with AUD (N=22) underwent functional MRI scanning both before and after a 12-week single-arm trial of CBT, using a regulation of craving (ROC) fMRI task designed to measure an individual's ability to control alcohol craving and previously shown to engage the DLPFC. We found that both the number of heavy drinking days (NHDD, the primary clinical outcome) and the self-reported alcohol craving measured during the ROC paradigm were significantly reduced from pre- to post-CBT [NHDD: t=15.69, p<0.0001; alcohol craving: (F(1,21)=16.16; p=0.0006)]. Contrary to our hypothesis, there was no change in regulation effects on self-reported craving over time (F(1,21)=0.072; p=0.79), nor was there was a significant change in regulation effects over time on activity in any parcel. Searching the whole brain for neural correlates of reductions in drinking and craving after CBT, we found a significant 3-way interaction between the effects of cue-induced alcohol craving, cue-induced brain activity and timepoint of assessment (pre- or post-CBT) on NHDD in a parcel corresponding to area 46 of the right DLPFC (ß=-0.37, p=0.046, FDR corrected). Follow-up analyses showed that reductions in cue-induced alcohol craving from pre- to post-CBT were linearly related to reductions in alcohol cue-induced activity in area 46 only among participants who ceased heavy drinking during CBT (r=0.81, p=0.005) but not among those who continued to drink heavily (r=0.28, p=0.38). These results are consistent with a model in which CBT impacts heavy drinking by increasing the engagement of the DLPFC during cue-induced craving.

Social and structural determinants of COVID-19 vaccine uptake among racial and ethnic groups.

Latino, Black, American Indian/Alaska Native (AI/AN), and Native Hawaiian or Other Pacific Islander people have the highest hospitalizations and death rates from COVID-19. Social inequalities have exacerbated COVID-19 related health disparities. This study examines social and structural determinants of COVID-19 vaccine uptake. Results from logistic regressions suggest Latino and Black people were less likely to be vaccinated. People that did not have health insurance, a primary care doctor and were unemployed were more than 30% less likely to be vaccinated for COVID-19. Greater perceived health inequalities in one's neighborhood and perceived racial/ethnic discrimination were associated with a decreased odds in being vaccinated. People that suffered the loss of a household member from COVID-19 were three times more likely to have been vaccinated. Establishing policies that will increase access to health insurance and create jobs with living wages may have lasting impacts. Furthermore, collaboration with local and national community organizations can enhance the development of sustainable solutions.