General Hospitalization and Intensive Care Unit-Related Factors of COVID-19 Patients in Northeastern Colombia: Baseline Characteristics of a Cohort Study.

Objective This study aims to describe demographic and clinical characteristics and the factors associated with the risk of COVID-19 general hospitalization and intensive care unit (ICU) care of patients who consulted in a third-level hospital in Santander, Colombia. Methods We used baseline data from an ambidirectional cohort study. We included all patients with positive real-time polymerase chain reaction (PCR) tests for COVID-19 who came to the emergency room (ER) for respiratory symptoms related to COVID-19. Information regarding patients' baseline characteristics and symptoms was collected through telephone interviews and review of medical records. Vital signs were extracted from medical records as well. Results We enrolled 3,030 patients, predominantly men, with a median age of 60 (interquartile range (IQR): 44-73). Symptoms of the acute phase varied between men and women. Men presented with more respiratory symptoms, and women had general symptoms. Hypertension, obesity, and diabetes were common risk factors for hospital admission. Antibiotic consumption may also play a role in hospital admission.  Conclusions Male sex, older age, hypertension, obesity, prior thrombotic events, and self-medicated antibiotics were associated with general hospitalization. Hypertension, obesity, diabetes, and cancer were associated with ICU admission. The Charlson comorbidity index (CCI) is a powerful tool for evaluate the impact of pre-existing health conditions on COVID-19 hospital admission. We highlight the importance of these findings as possible predictors in our region.

Comorbidities and clinical symptoms can modify myocardial function: a cross-sectional study with PET/CT / Comorbilidades y síntomas clínicos que pueden modificar la función miocárdica: estudio transversal con PET/TC

Abstract Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score ≥ 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse mechanical, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased left ventricular ejection fraction, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusion: The high burden of comorbidities and symptoms in our population alters myocardial function regardless of the level of ischemia.

Resumen Objetivo: La asociación de comorbilidades y síntomas cardíacos que alteran la función miocárdica podría ayudar a los médicos a identificar correctamente a poblaciones de riesgo. Métodos: Se realizó un estudio transversal en población abierta de pacientes referidos a una unidad de PET/CT en la Ciudad de México para evaluación de la función miocárdica, perfusión y circulación coronaria. La isquemia se definió como una suma de diferencia de puntuación (SDS) ≥ 2. La asociación entre las comorbilidades y los síntomas cardíacos se fundamentó mediante modelos de regresión logística y análisis de tendencias. Realizamos un análisis de interacción para evaluar la adición de cualquier síntoma acompañante a condiciones comórbidas en el deterioro de la función miocárdica. Resultados: Se incluyeron 1.273 pacientes, 66,1% del sexo masculino, con una edad media de 62,4 (± 12.7) años, 360 (28,7%) con isquemia, 925 (72,7%) con al menos una comorbilidad y 676 (53,1%) con al menos una menos un síntoma cardíaco asociado. En pacientes sin isquemia, la diabetes mellitus tipo 2, la hipertensión arterial y los síntomas cardíacos adversos se asociaron con parámetros mecánicos, de perfusión y de flujo coronario adversos. Se observó una tendencia con el número acumulado de comorbilidades y síntomas cardíacos con aumento de la isquemia y disminución del flujo coronario. Solo en la disminución de la FEVI se demostró un efecto de interacción entre el aumento de las comorbilidades y los síntomas adversos. Conclusión: La alta carga de comorbilidades y síntomas en nuestra población altera la función miocárdica independientemente del nivel de isquemia.

Privación de libertad, riesgo suicida y depresión en mujeres de una penitenciaria / Deprivation of freedom and suicide risk in women of a penitentiary

Introducción.El suicidio es un problema clave de salud pública. La situación de privación de libertad es un riesgo aumentado para el suicidio. Hay un aumento de la prevalencia de depresión dentro de las prisiones y su identificación y tratamiento disminuye el riesgo. Objetivo. Determinar el riesgo de suicidio y depresión en mujeres privadas de libertad en una correccional. Metodología.Estudio descriptivo de corte transversal de una muestra por conveniencia de mujeres de una correccional de mujeres en Paraguay. Se utilizó un cuestionario socio-demográfico, la Escala de Suicidio de Plutchik, y el Inventario de Depresión de Beck,previa firma de consentimiento informado que explicó los objetivos del estudio y la participación voluntaria y anónima. Se analizó los datos conel paquete estadístico SPSS versión 15.0. Resultados.Participaron del estudio 108 mujeres entre 20 a 70 años de edad (media: 38 ± 12), 25,9% (n=28) alcanzó escolaridad secundaria completa u universitaria (12%). El 76,8% tenía entre 1 a 5 años de privación de libertad. El 38 % (41) del grupo tenía depresión; 36,1% (n=39) presentó riesgo suicida, 25,9% (n=28) riesgo leve, 7,4% (n=8) riesgo moderado y 2,8% (n=3) riesgo grave. Se encontró asociación altamente significativa entre la presencia de depresión y riesgo suicida (OR: 4,89 IC95% 2,1-11,4). El porcentaje de riesgo suicida fue mayor al de la población general y a cifras arrojadas por otros estudios similares en centros penitenciarios en américa latina. Palabras clave: riesgo; suicida; mujeres; privación; libertad.

Introduction.Suicide is a key public health problem. The situation of deprivation of liberty is an increased risk for suicide. There is an increased prevalence of depression within prisons and its identification and treatment decreases the risk. Objective. To determine the risk of suicide and depression in women deprived of liberty in a correctional facility. Methodology. Descriptive cross-sectional study of a convenience sample of women from a women's correctional facility in Paraguay. A socio-demographic questionnaire, the Plutchik Suicide Scale, and the Beck Depression Inventory were used, after signing an informed consent that explained the objectives of the study and voluntary and anonymous participation. The data was analyzed withthe statistical package SPSS version 15.0. Results.A total of 108 women between 20 and 70 years of age (mean: 38 ± 12) participated in the study, 25.9% (n=28) completed secondary or university education (12%). 76.8% had between 1 and 5 years of deprivation of liberty. 38% (41) of the group had depression; 36.1% (n=39) presented suicidal risk, 25.9% (n=28) mild risk, 7.4% (n=8) moderate risk, and 2.8% (n=3) severe risk. A highly significant association was found between the presence of depression and suicidal risk (OR: 4.89 CI95% 2.1-11.4). The percentage of suicidal risk was higher than that of the general population and figures reported by other similar studies in penitentiary centers in Latin America.Key words:risk; suicide; women; deprivation; liberty.

Comorbidities and cardiac symptoms can modify myocardial function regardless of ischemia: a cross-sectional study with PET/CT.

Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission computed tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score (SDS) > 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse function, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased LVEF, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusions: The high burden of comorbidities and symptoms in our population alter myocardial function regardless of the level of ischemia.

Community-based accompaniment for adolescents transitioning to adult HIV care in urban Peru: a pilot study.

We piloted a community-based intervention to improve outcomes among adolescents living with HIV who were transitioning to adult-oriented care in Lima, Peru. We assessed feasibility and potential effectiveness, including within-person changes in self-reported adherence, psychosocial metrics (NIH Toolbox), and transition readiness ("Am I on TRAC" questionnaire, "Got Transition" checklist). From October 2019 to January 2020, we enrolled 30 adolescents (15-21 years). The nine-month intervention consisted of logistical, adherence and social support delivered by entry-level health workers and group sessions to improve health-related knowledge and skills and social support. In transition readiness, we observed within-person improvements relative to baseline. We also observed strong evidence of improvements in adherence, social support, self-efficacy, and stress, which were generally sustained three months post-intervention. All participants remained in treatment after 12 months. The intervention was feasible and potentially effective for bridging the transition to adult HIV care. A large-scale evaluation, including biological endpoints, is warranted.

RESUMEN: Piloteamos una intervención comunitaria para mejorar los resultados de adolescentes viviendo con el VIH que se encontraban en transición a la atención de VIH orientada a adultos en Lima, Perú. Evaluamos la viabilidad y la eficacia potencial, incluidos los cambios personales en la adherencia auto-reportada, criterios psicosociales (NIH Toolbox), y preparación para la transición (cuestionario "Estoy en el TRAC", lista de verificación "Got Transition"). Desde octubre de 2019 hasta enero de 2020, enrolamos a 30 adolescentes (15 a 21 años). La intervención de nueve meses consistió en apoyo logístico, de adherencia y social brindado por técnicos de enfermería y sesiones grupales para mejorar tanto el conocimiento y las habilidades relacionados con la salud, como el apoyo social. En cuanto a la preparación para la transición, observamos mejoras comparada con el basal. También observamos una fuerte evidencia de mejoras en la adherencia, apoyo social, autoeficacia y estrés, que se mantuvieron, generalmente, tres meses después del fin de la intervención. Todos los participantes seguían en tratamiento después de 12 meses. La intervención fue factible y potencialmente efectiva para tender un puente en la transición a la atención del VIH para adultos. Esto amerita una evaluación a mayor escala y que incluya criterios clínicos.

Tratamiento farmacológico del paciente que vive con diabetes mellitus tipo 2 / Pharmacological treatment of the patient living with type 2 diabetes mellitus

Resumen Introducción: el abordaje del paciente con diabetes mellitus tipo 2 ha cambiado a lo largo del tiempo. Años anteriores el enfoque terapéutico giraba en torno al nivel de hemoglobina glicada (HbA1c); ahora, con el advenimiento de nuevas moléculas, y luego de entender que la meta terapéutica no es sólo un punto de corte de HbA1c, se ha modificado el objetivo, para estar centrado en el paciente, en sus comorbilidades macro y microvasculares, riesgo cardiovascular y falla cardíaca. En esta revisión de la literatura se exponen las preguntas que se deben resolver al momento de definir una estrategia terapéutica en el paciente con diabetes mellitus tipo 2. Métodos: valoración de guías locales e internacionales de tratamiento de diabetes mellitus tipo 2. Resultados: se valoraron las guías del tratamiento de la diabetes mellitus tipo 2 realizadas por la Asociación Colombiana de Endocrinología, Asociación Colombiana de Medicina Interna, Asociación Colombiana de Nefrología, Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes y European Society of Cardiology. Además, se revisaron los ensayos clínicos que respaldan el uso de los diferentes grupos farmacológicos disponibles para el tratamiento de los pacientes con diabetes mellitus tipo 2. Conclusión: es menester del clínico realizar el abordaje terapéutico de los pacientes con diabetes mellitus tipo 2 de forma individualizada, centrado en el riesgo cardiovascular, comorbilidades asociadas, riesgo de hipoglucemia y costos de la intervención brindada.

Abstract Introduction: the approach to the patient with diabetes has changed over the past decade. Some years ago, the primary goal of treatment was to achieve a certain level of A1c as a marker of glucose control. Now, with new molecules in the market that can modify the disease and its complications the treatment is focused on the individual patient, his micro and macrovascular complications and the risk of cardiovascular, heart failure and renal complications. In this review of the literature, we expose some questions that need to be solved when approaching the treatment of a patient with type 2 diabetes. Methods: we reviewed local and international guidelines on the treatment of type 2 diabetes. Results: we reviewed guidelines in the treatment of diabetes, local guidelines; Asociación Colombiana de Endocrinología, Asociación Colombiana de Medicina Interna, Asociación Colombiana de Nefrología, Sociedad Colombiana de Cardiología y Cirugía Cardiovascular. International guidelines; American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes y European Society of Cardiology Additionally, we revised clinical trial that support the use of the different drugs that are recommended by the guidelines as first, second- or third-line treatment. Conclusion: as clinicians we are expected to give the patient an individualized approach, based on their own comorbidities, risk of cardiovascular and renal disease and risk of hypoglycemia guided by national and international guidelines and latest clinical trial that support our approach.

¿La progesterona natural micronizada previene el trabajo de parto pretérmino?: Revisión sistemática de literatura / Does Natural Micronized Progesterone Prevent Preterm Labor?: Systematic Literature Review / A progesterona natural micronizada previne o trabalho de parto prematuro?: Revisão sistemática da literatura

Introducción. La progesterona es una hormona que favorece el mantenimiento del embarazo, es la protagonista de la fisiopatología del trabajo de parto pretérmino. De esta manera, se propone realizar una revisión sistemática que permita demostrar la utilidad de la progesterona natural micronizada en la mitigación de los efectos deletéreos del trabajo de parto pretérmino. Metodología. Revisión sistemática en la que se utilizaron los términos "MeSH" y "No ­ MeSH". Se empleó el programa "Publish or Perish" y bases de datos como: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus y Google Scholar. Se incluyeron artículos de revisión, meta-análisis, artículos originales (publicaciones preliminares o completas), resúmenes de congresos, seminarios publicados, libros de texto, protocolos hospitalarios regionales y consensos nacionales, en donde cada autor evaluó individualmente cada artículo y aplicó la herramienta CASPE. Resultados. En la literatura no es posible encontrar pautas concisas internacionales sobre el uso de la progesterona micronizada frente a la amenaza de trabajo de parto pretérmino (TPP). En general, para la mitigación del trabajo de parto, según lo analizado por los autores, se recomienda usar progesterona natural micronizada en cápsulas de 100 a 400 mg/día vía oral o 100 a 200 mg cada 12 a 24 horas vía vaginal. Desde la semana 16 hasta la semana 36 de gestación por vía oral y desde la semana 24 a 34 de gestación por vía vaginal. Discusión. El uso de la progesterona micronizada ha demostrado mitigar complicaciones posteriores al trabajo de parto pretérmino, sin embargo, no hay consenso sobre la dosificación y las vías de administración. Sumado a lo anterior, los estudios analizados pueden contener sesgos, por lo que se deja a elección del clínico el uso este medicamento. Conclusiones. La progesterona natural micronizada podría ser empleada para mitigar el trabajo de parto pretérmino según los artículos analizados por los autores a lo largo de la revisión. Sin embargo, se necesitan más estudios para legitimar dicha hipótesis.

Introduction. Progesterone is a hormone that favors maintaining pregnancy. It is the protagonist of the physiopathology of preterm labor. In this sense, a systematic review is proposed to demonstrate the usefulness of natural micronized progesterone in mitigating the harmful effects of preterm labor. Methodology. A systematic review in which the terms "MeSH" and "No ­ MeSH" were used. The "Publish or Perish" program was used, as well as databases, such as: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus, and Google Scholar. Review and meta-analysis articles, original articles (preliminary or complete publications), congress summaries, published seminars, textbooks, regional hospital protocols and national consensuses were included, in which each author individually assessed each article and applied the CASPE tool. Results. It was not possible to find concise international guidelines on using micronized progesterone for the threat of preterm labor (PTL) in literature. According to what the authors analyzed, for the mitigation of labor it is generally recommended the use of natural micronized progesterone in 100 to 400 mg/day capsules orally or 100 to 200 mg every 12 to 24 hours through the vagina. From week 16 to week 36 of pregnancy orally and from week 24 to 34 through the vagina. Discussion. Using micronized progesterone has demonstrated mitigating complications subsequent to preterm labor. However, there is no consensus on dosage and routes of administration. Added to the above, the analyzed studies may contain biases, reason why using this medication is left to the physician's discretion. Conclusions. Natural micronized progesterone can be used to mitigate preterm labor according to the articles the authors analyzed throughout the review. However, more studies are needed to validate this hypothesis.

Introdução. A progesterona é um hormônio que favorece a manutenção da gravidez, é a protagonista da fisiopatologia do parto prematuro. Dessa forma, propõe-se a realização de uma revisão sistemática que permita demonstrar a utilidade da progesterona natural micronizada na mitigação dos efeitos deletérios do trabalho de parto prematuro. Metodologia. Revisão sistemática em que foram utilizados os termos "MeSH" e "Não­MeSH". Foram utilizados o programa "Publish or Perish" e bases de dados como: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus e Google Scholar. Foram incluídos artigos de revisão, meta-análises, artigos originais (publicações preliminares ou completas), resumos de congressos, seminários publicados, livros didáticos, protocolos hospitalares regionais e consensos nacionais, onde cada autor avaliou individualmente cada artigo e aplicou a ferramenta CASPE. Resultados. Não é possível encontrar na literatura diretrizes internacionais concisas sobre o uso de progesterona micronizada diante da ameaça de trabalho de parto prematuro (TPP). Em geral, para a mitigação do trabalho de parto, conforme analisado pelos autores, recomenda-se o uso de progesterona natural micronizada em cápsulas de 100 a 400mg/dia por via oral ou 100 a 200mg a cada 12 a 24 horas por via vaginal. Da 16ª à 36ª semana de gestação por via oral e da 24ª à 34ª semana de gestação por via vaginal. Discussão. O uso de progesterona micronizada demonstrou mitigar as complicações após o trabalho de parto prematuro, no entanto, não há consenso sobre a dosagem e as vias de administração. Além do exposto, os estudos analisados podem conter vieses, pelo que cabe ao médico escolher o uso deste medicamento. Conclusões. A progesterona natural micronizada poderia ser utilizada para mitigar o trabalho de parto prematuro de acordo com os artigos analisados pelos autores ao longo da revisão. No entanto, mais estudos são necessários para legitimar essa hipótese.

A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study.

BACKGROUND: Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru. METHODS: ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services. RESULTS: Twenty-eight (11 female, 17 male) ALWH aged 15-21 years participated; n = 20 (71%) identified as heterosexual. Most (18/28) acquired HIV at birth. Baseline PHQ-9 scores were 0-4, n = 3 (11%); 5-9, n = 9 (32%); 10-14, n = 10 (36%); 15-19, n = 4 (14%); and 20-27, n = 2 (7%). Eleven participants (40%) reported SI. Among participants with PHQ-9 > 4, 92% (23/25) were not severe. Of the 21 (75%) of participants eligible for PFA, n = 9 (32%) accepted at least one session, of which n = 3 (33%) were linked to specialized care. CONCLUSIONS: A simple care pathway operationalizing depression screening and non-specialist delivered emotional support is a first step toward integrated depression and HIV care for ALWH.

Disentangling the environmental processes responsible for the world's largest farmed fish-killing harmful algal bloom: Chile, 2016.

The dictyochophyte microalga Pseudochattonella verruculosa was responsible for the largest farmed fish mortality ever recorded in the world, with losses for the Chilean salmon industry amounting to US$ 800 M in austral summer 2016. Super-scale climatic anomalies resulted in strong vertical water column stratification that stimulated development of a dynamic P. verruculosa thin layer (up to 38 µg chl a L-1) for several weeks in Reloncaví Sound. Hydrodynamic modeling (MIKE 3D) indicated that the Sound had extremely low flushing rates (between 121 and 200 days) in summer 2016. Reported algal cell densities of 7000-20,000 cells mL-1 generated respiratory distress in fish that was unlikely due to low dissolved oxygen (permanently >4 mg L-1). Histological examination of salmon showed that gills were the most affected organ with significant tissue damage and circulatory disorders. It is possible that some of this damage was due to a diatom bloom that preceded the Pseudochattonella event, thereby rendering the fish more susceptible to Pseudochattonella. No correlation between magnitude of fish mortality and algal cell abundance nor fish age was evident. Algal cultures revealed rapid growth rates and high cell densities (up to 600,000 cells mL-1), as well as highly complex life cycle stages that can be easily overlooked in monitoring programs. In cell-based bioassays, Chilean P. verruculosa was only toxic to the RTgill-W1 cell line following exposures to high cell densities of lysed cells (>100,000 cells mL-1). Fatty acid profiles of a cultured strain showed elevated concentrations of potentially ichthyotoxic, long-chain polyunsaturated fatty acids (PUFAs) (69.7% ± 1.8%)- stearidonic (SDA, 18:4ω3-28.9%), and docosahexaenoic acid (DHA, 22:6ω3-22.3%), suggesting that lipid peroxidation may help to explain the mortalities, though superoxide production by Pseudochattonella was low (< 0.21 ± 0.19 pmol O2- cell-1 h-1). It therefore remains unknown what the mechanisms of salmon mortality were during the Pseudochattonella bloom. Multiple mitigation strategies were used by salmon farmers during the event, with only delayed seeding of juvenile fish into the cages and towing of cages to sanctuary sites being effective. Airlift pumping, used effectively against other fish-killing HABs in the US and Canada was not effective, perhaps because it brought subsurface layers of Pseudochattonella to the surface, or and it also may have lysed the fragile cells, rendering them more lethal. The present study highlights knowledge gaps and inefficiency of contingency plans by the fish farming industry to overcome future fish-killing algal blooms under future climate change scenarios. The use of new technologies based on molecular methods for species detection, good farm practices by fish farms, and possible mitigation strategies are discussed.

Universal loop assembly: open, efficient and cross-kingdom DNA fabrication.

Standardized type IIS DNA assembly methods are becoming essential for biological engineering and research. These methods are becoming widespread and more accessible due to the proposition of a 'common syntax' that enables higher interoperability between DNA libraries. Currently, Golden Gate (GG)-based assembly systems, originally implemented in host-specific vectors, are being made compatible with multiple organisms. We have recently developed the GG-based Loop assembly system for plants, which uses a small library and an intuitive strategy for hierarchical fabrication of large DNA constructs (>30 kb). Here, we describe 'universal Loop' (uLoop) assembly, a system based on Loop assembly for use in potentially any organism of choice. This design permits the use of a compact number of plasmids (two sets of four odd and even vectors), which are utilized repeatedly in alternating steps. The elements required for transformation/maintenance in target organisms are also assembled as standardized parts, enabling customization of host-specific plasmids. Decoupling of the Loop assembly logic from the host-specific propagation elements enables universal DNA assembly that retains high efficiency regardless of the final host. As a proof-of-concept, we show the engineering of multigene expression vectors in diatoms, yeast, plants and bacteria. These resources are available through the OpenMTA for unrestricted sharing and open access.

Do people care about pine invasions? Visitor perceptions and willingness to pay for pine control in a protected area.

Tree invasions are increasing globally, causing major problems for biodiversity, ecosystem services and human well-being. In South America, conifer invasions occur across many ecosystems and while numerous studies address the ecological consequences of these invasions, little is known about social perceptions and people's attitudes toward their control. The social perceptions on the effect of invasive conifers can include recreational, cultural and conservation dimensions. This study, conducted in the Malalcahuello National Reserve, aims to assess visitor's perception about invasive pines (Pinus spp.) and their effects on the endangered Araucaria araucana forests and determine their willingness to pay for pine control. We used a questionnaire to survey visitors to the reserve in both winter and summer (n = 138 for each season). When confronted with six images of araucaria and pine forests with and without snow, visitors consistently preferred landscapes without pines and disliked those completely dominated by pines the most. Almost half, 46.5%, of the visitors expressed their willingness to pay (WTP) for pine control and after given a brief explanation about pine impacts, this number rose to 79%. Visitors who said they were unwilling to pay argue ethical, aesthetic and pragmatic considerations relating closely to a number of social value systems and beliefs. Our study shows that there is a high variation in how people assess the threat of invasive pine species in natural areas, but education even in a very brief format can help to increase awareness of the problem and build social and financial support for its control.

Neodymium:YAG capsulotomy rates associated with femtosecond laser-assisted versus manual cataract surgery.

PURPOSE: To compare the neodymium:YAG posterior capsulotomy rates after cataract surgery performed using a femtosecond laser system versus manual techniques. SETTING: Pacific Hills Surgery Center, Laguna Hills, and La Veta Surgery Center, Orange, California, USA. DESIGN: Retrospective case study. METHODS: After surgeries were completed between August 2011 and August 2014. A corrected distance visual acuity (CDVA) of 20/25 or better 1 to 3 months after surgery was identified in a chart review and analyzed. Intraocular lens (IOL) type and power were recorded. Capsulotomies were recorded with the date of the procedure and the precapsulotomy CDVA. Capsulotomy rates related to manual capsulorhexis and capsulorhexis with a femtosecond laser system were compared, with consideration of IOL design and material. RESULTS: There was no statistically significant difference in posterior capsule opacification grade between surgery groups (P = .13). Capsulotomy rates were significantly lower in the femtosecond laser-assisted cataract surgery group than in the manual group (P = .04). The time between surgery and capsulotomy was statistically significantly lower in the femtosecond laser-assisted cataract surgery group (P < .01), which appeared to be a function of the higher ratio of multifocal IOLs in that group. There was a lower overall capsulotomy rate with hydrophobic acrylic IOL material than with hydrophilic IOL material. CONCLUSIONS: Neodymium:YAG capsulotomy rates were lower with femtosecond laser-assisted cataract surgery than with manual cataract surgery. The differences were more apparent in IOL material and design groups in which overall capsulotomy rates were lower. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Violencia intrafamiliar en pacientes en edad pediátrica que recibe atención psicológica. frecuencia, factores predisponentes y consecuencias / Domestic violence in a pediatric population receiving psychological care. frequency, predisposing factors and consequences

El objetivo del estudio fue determinar la frecuencia y factores asociados a violencia intrafamiliar en pacientes en edad pediátrica. Estudio descriptivo de corte transversal en el que se incluyeron 119 pacientes en edad pediátrica que recibían atención psicológica en el Servicio Ambulatorio de la Cátedra de Psiquiatría de la Universidad Nacional de Asunción, Paraguay del 2010 al 2012. El 55,5% (n=66) de los 119 pacientes era del sexo femenino, 54,7% (n=65) tenía edades entre 12 y 18 años, y el 54,6% (n=65) era residente de Asunción. El 74,8% (n=89) de los pacientes sufrió uno o varios tipos de violencia, siendo la violencia psicológica la más frecuente (n=62, 69,7%); seguida de violencia física (n=57, 64%). El abuso sexual se observó en 14 pacientes (15,7%), el cual fue significativamente (p<0,001) mayor en el sexo femenino. La violencia por abandono o negligencia que estuvo presente en 6 pacientes, fue mayor en los varones pero la diferencia no alcanzó significancia estadística (p=0,08). La violencia entre padres se observó en 54 casos, la cual se asoció significativamente (p<0,00001) con la violencia hacia los pacientes. En 82 pacientes se observaron problemas escolares, siendo su frecuencia mayor en aquellos víctimas de algún tipo de violencia pero no alcanzó significancia estadística (p=0,08). Este estudio resalta la necesidad de intervenciones psico-educativas en servicios ambulatorios sobre las consecuencias de la violencia doméstica en la salud de estos pacientes para su desarrollo y salud física y mental. Además, son necesarios otros estudios que profundicen la temática para intervenciones prontas y oportunas.

The objective was to determine the frequency of domestic violence and associatedfactors in a pediatric population. This descriptive and cross-sectional study includedpediatric patients receiving psychological care at the Outpatient Service of the Departmentof Psychiatry of the National University of Asuncion, Paraguay between 2010 and 2012.One hundred and forty five clinical records were studied. The 55.5% (66) was women, 7%(65) was between 12 and 18 years old and 54.6% (65) was from Asuncion. The 74.8% (89) suffered one or more types of violence being the psychological violence the mostfrequent 69.7% (62) followed by physical violence 64% (57). Sexual abuse was observedin 14 patients (15.7%) which was significantly high in women (p<0.001). Violence byabandonment or neglect was present in 6 patients and higher in male patients but thedifference was not significant (p=0.08). Violence between parents was found in 54 caseswhich was significantly associated with violence towards the patients (p<0.00001). In 82patients, school problems were observed being its frequency higher in those who werevictims of some type of violence but it was not significant (p=0.08). This study highlightsthe need for psycho-educational interventions in outpatient services on the consequencesof domestic violence on the health of these patients for their physical and psychologicaldevelopment. Besides, other studies are necessary to deepen in this area for prompt andtimely interventions.