Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51.437
Filtrar
1.
Hastings Cent Rep ; 51(2): 16-21, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33840101

RESUMEN

Harrowing stories reported in the media describe Covid-19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision-making by reducing available surrogate decision-makers for incapacitated patients, increases the emotional burdens of surrogate decision-makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision-making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience.


Asunto(s)
Planificación Anticipada de Atención , Salud de la Familia , Familia/psicología , Salud de las Minorías , Atención al Paciente , Planificación Anticipada de Atención/ética , Planificación Anticipada de Atención/legislación & jurisprudencia , California/epidemiología , Análisis por Conglomerados , Toma de Decisiones Conjunta , Salud de la Familia/ética , Salud de la Familia/etnología , Disparidades en el Estado de Salud , Humanos , Salud de las Minorías/ética , Salud de las Minorías/etnología , Atención al Paciente/ética , Atención al Paciente/psicología , Apoyo Social , Consentimiento por Terceros/ética
2.
Artículo en Inglés | MEDLINE | ID: mdl-33807503

RESUMEN

To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Vapeo , Adulto , California/epidemiología , Control de Enfermedades Transmisibles , Humanos , Humo , Fumadores
3.
J Prim Care Community Health ; 12: 21501327211005902, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813919

RESUMEN

OBJECTIVES: The purpose of this cohort study was to evaluate measles, mumps, rubella (MMR), and varicella immunity among a population of adult employees receiving primary care in an employer-sponsored health center. METHODS: Participants were eligible for MMR and varicella immunity screening if they were an employee receiving primary care in an employer-sponsored health center between January 1, 2019 and November 1, 2020 who could not provide proof of immunization and 1) had it recommended by their provider, 2) specifically requested immunity testing (often because they had heard of measles outbreaks in their country of origin), or 3) were seen for an immigration physical for their Green Card application. RESULTS: Overall, 3494 patients were screened for their MMR immunity. Of these, 3057 were also screened for varicella immunity. Among these patients, 13.9% lacked measles immunity, 0.83% lacked immunity to all 3 components of MMR, and 13.2% lacked varicella immunity. Among the 262 patients who presented specifically for immunity screening, the rates of lacking immunity were higher for all conditions: 22.7% lacked measles immunity and 9.2% lacked varicella immunity. CONCLUSION: Given declines in immunizations during the COVID-19 pandemic, there is reason to be concerned that measles and varicella-associated morbidity and mortality may rise. Employers, especially those with large foreign-born populations or who require international travel may want to educate their populations about common contagious illnesses and offer immunity validation or vaccinations at no or low cost.


Asunto(s)
Varicela , Sarampión , Paperas , Pandemias , Rubéola (Sarampión Alemán) , Cobertura de Vacunación , Adulto , Anticuerpos Antivirales , California , Varicela/inmunología , Varicela/prevención & control , Estudios de Cohortes , Brotes de Enfermedades , Femenino , Humanos , Masculino , Tamizaje Masivo , Sarampión/inmunología , Sarampión/prevención & control , Paperas/inmunología , Paperas/prevención & control , Servicios de Salud del Trabajador , Atención Primaria de Salud , Rubéola (Sarampión Alemán)/inmunología , Rubéola (Sarampión Alemán)/prevención & control , Vacunación
5.
Nat Commun ; 12(1): 2089, 2021 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-33828081

RESUMEN

Increasing global temperatures are predicted to stimulate soil microbial respiration. The direct and indirect impacts of warming on soil microbes, nevertheless, remain unclear. This is particularly true for understudied subsoil microbes. Here, we show that 4.5 years of whole-profile soil warming in a temperate mixed forest results in altered microbial community composition and metabolism in surface soils, partly due to carbon limitation. However, microbial communities in the subsoil responded differently to warming than in the surface. Throughout the soil profile-but to a greater extent in the subsoil-physiologic and genomic measurements show that phylogenetically different microbes could utilize complex organic compounds, dampening the effect of altered resource availability induced by warming. We find subsoil microbes had 20% lower carbon use efficiencies and 47% lower growth rates compared to surface soils, which constrain microbial communities. Collectively, our results show that unlike in surface soils, elevated microbial respiration in subsoils may continue without microbial community change in the near-term.


Asunto(s)
Calentamiento Global , Metagenoma , Microbiología del Suelo , Suelo/química , Bacterias/clasificación , Bacterias/genética , California , Carbono/metabolismo , Bosques , Microbiota , Nitrógeno/metabolismo , ARN Ribosómico 16S , Temperatura
6.
Environ Sci Technol ; 55(9): 6214-6226, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33822592

RESUMEN

As reliance on wind and solar power for electricity generation increases, so does the importance of understanding how variability in these resources affects the feasible, cost-effective ways of supplying energy services. We use hourly weather data over multiple decades and historical electricity demand data to analyze the gaps between wind and solar supply and electricity demand for California (CA) and the Western Interconnect (WECC). We quantify the occurrence of resource droughts when the daily power from each resource was less than half of the 39-year daily mean for that day of the year. Averaged over 39 years, CA experienced 6.6 days of solar and 48 days of wind drought per year, compared to 0.41 and 19 for WECC. Using a macro-scale electricity model, we evaluate the potential for both long-term storage and more geographically diverse generation resources to minimize system costs. For wind-solar-battery electricity systems, meeting California demand with WECC generation resources reduces the cost by 9% compared to constraining resources entirely to California. Adding long-duration storage lowers system costs by 21% when treating California as an island. This data-driven analysis quantifies rare weather-related events and provides an understanding that can be used to inform stakeholders in future electricity systems.


Asunto(s)
Energía Solar , Viento , California , Sequías , Electricidad , Energía Renovable
7.
Environ Sci Technol ; 55(9): 5648-5656, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33871991

RESUMEN

Although evidences showed an overall reduction in outdoor air pollution levels across the globe due to COVID-19-related lockdown, no comprehensive assessment was available for indoor air quality during the period of stay-at-home orders, despite that the residential indoor environment contributes most to personal exposures. We examined temporal and diurnal variations of indoor PM2.5 based on real-time measurements from 139 indoor-outdoor co-located low-cost PurpleAir sensor sets across California for pre-, during, and post-lockdown periods in 2020 and "business-as-usual" periods in 2019. A two-step method was implemented to systematically control the quality of raw sensor data and calibrate the sensor data against co-located reference instruments. During the lockdown period, 17-24% higher indoor PM2.5 concentrations were observed in comparison to those in the 2019 business-as-usual period. In residential sites, a clear peak in PM2.5 concentrations in the afternoon and elevated evening levels toping at roughly 10 µg·m-3 was observed, which reflects enhanced human activity during lunch and dinner time (i.e., cooking) and possibly more cleaning and indoor movement that increase particle generation and resuspension in homes. The contribution of indoor-generated PM2.5 to total indoor concentrations increased as high as 80% during and post-lockdown periods compared to before lockdown.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire Interior , Contaminantes Atmosféricos/análisis , Contaminación del Aire Interior/análisis , California , Control de Enfermedades Transmisibles , Monitoreo del Ambiente , Humanos , Tamaño de la Partícula , Material Particulado/análisis
8.
AIDS Educ Prev ; 33(2): 129-142, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33821675

RESUMEN

Pre-exposure prophylaxis (PrEP) is an effective daily prevention medicine to reduce the risks of HIV infections. Even though the number of PrEP users has been rapidly growing in the United States since 2012, only approximately 5% of the men who have sex with men (MSM) population is currently taking PrEP. This study examined PrEP uptake among MSM using the integrative model of behavioral prediction (IMBP) as the theoretical framework. The authors conducted formative elicitation interviews and a cross-sectional survey with MSM. Among the survey respondents, half of them were PrEP takers and half were not. The path modeling results showed that attitudes and norms predicted behavioral intention, and intention predicted PrEP uptake among MSM. The results also identified the strongest attitudinal predictors and normative referents of PrEP uptake. The study offers practical implications in helping professionals and scholars to understand PrEP uptake among MSM in a theoretically grounded way.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/psicología , Intención , Profilaxis Pre-Exposición/métodos , Adulto , Fármacos Anti-VIH/uso terapéutico , California , Estudios Transversales , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Motivación , New York , Investigación Cualitativa , Sexo Seguro , Apoyo Social , Encuestas y Cuestionarios
9.
Arch Environ Contam Toxicol ; 80(3): 624-633, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33740087

RESUMEN

The bioaccumulation of arsenic (As) in the muscle, liver, kidneys, and brain of the shark Sphyrna lewini was measured in 40 juvenile specimens from southeast Gulf of California. Additionally, the biomagnification factor was calculated through prey items from stomach contents of the analyzed specimens. The concentrations of As (mg kg-1, wet weight) were higher in the muscle (10.1 ± 0.3) and liver (9.4 ± 0.5) than in the brain (4.5 ± 0.3) and kidneys (4.2 ± 0.2), which may be attributed to the biological functions of each tissue. Positive correlations were found between the levels of As in muscle and liver with the biological parameters of S. lewini. Hammerhead sharks feed mainly of teleost fishes with low As values (Clupeidae fishes, 1.1 ± 0.5; Sciaenidae fishes, 1.0 ± 0.6; Scomber japonicus, 1.2 ± 0.6; and Etropus crossotus 2.1 ± 0.4) compared with the predator, indicating biomagnification. Inorganic arsenic (Asi) in muscle was estimated as 3% of the total As, although muscle consumption is unlikely to represent a risk (HQ < 1) in humans. Moreover, the probabilities of developing cancer were estimated as low (3.99 × 10-5 to 3.32 × 10-6). To avoid health risks related to As, a weekly ration must not exceed 69.3 and 484.8 g in children and adults, respectively.


Asunto(s)
Arsénico , Tiburones , Animales , California , Niño , Peces , Humanos , Alimentos Marinos
10.
Environ Sci Technol ; 55(8): 4462-4473, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33759511

RESUMEN

Nitrous oxide (N2O) is a long-lived greenhouse gas that also destroys stratospheric ozone. N2O emissions are uncertain and characterized by high spatiotemporal variability, making individual observations difficult to upscale, especially in mixed land use source regions like the San Joaquin Valley (SJV) of California. Here, we calculate spatially integrated N2O emission rates using nocturnal and convective boundary-layer budgeting methods. We utilize vertical profile measurements from the NASA DISCOVER-AQ (Deriving Information on Surface Conditions from COlumn and VERtically Resolved Observations Relevant to Air Quality) campaign, which took place January-February, 2013. For empirical constraints on N2O source identity, we analyze N2O enhancement ratios with methane, ammonia, carbon dioxide, and carbon monoxide separately in the nocturnal boundary layer, nocturnal residual layer, and convective boundary layer. We find that an established inventory (EDGAR v4.3.2) underestimates N2O emissions by at least a factor of 2.5, that wintertime emissions from animal agriculture are important to annual totals, and that there is evidence for higher N2O emissions during the daytime than at night.


Asunto(s)
Contaminantes Atmosféricos , Óxido Nitroso , Agricultura , Contaminantes Atmosféricos/análisis , Aeronaves , Animales , California , Metano/análisis , Óxido Nitroso/análisis
11.
J Prim Care Community Health ; 12: 21501327211000235, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729044

RESUMEN

BACKGROUND: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. DESIGN: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. SETTING: Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. INTERVENTION: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. MEASUREMENTS: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. RESULTS: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. CONCLUSION: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Geriatría/organización & administración , Telemedicina/organización & administración , Servicios de Salud para Veteranos/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Demencia/terapia , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Estudios de Casos Organizacionales , Atención Primaria de Salud/organización & administración , Investigación Cualitativa , Teléfono , Comunicación por Videocoferencia
13.
Zootaxa ; 4938(2): zootaxa.4938.2.1, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33756977

RESUMEN

Sea spiders (Class Pycnogonida Latreille, 1810) are chelicerate arthropods, with an extraordinarily reduced body armed with eight to twelve elongated legs. A literature review of taxonomic and ecological studies of pycnogonids from Mexico identified 49 nominal species (~3.6% out of 1,335 species described worldwide). This low species richness is likely caused by limited taxonomic research and intermittent sampling and research efforts initially carried out by foreign scientists (1893-1996) and later by Mexican scientists. The present study investigates the latitudinal gradient of species richness of the pycnogonids associated with nine marine docks located between Cabo San Lucas (22°53'N) and Santa Rosalía (26°58'N) along the west coast of the Gulf of California, 22°53'N Mexico and provides a detailed morphological re-description of each nominal species using light and scanning electron microscopy. Nine nominal pycnogonid species and one unidentified species in the genus Tanystylum were collected and identified from the biological samples collected between 2011-2017. The highest pycnogonid species richness was recorded at Bahía de La Paz (seven species, 24°14'N) and the lowest species richness at Cabo San Lucas (one species) without an evident latitudinal species richness gradient. Anoplodactylus californicus Hall, 1912 and Ammothella spinifera Cole, 1904 were the most abundant species (52% of the total number of individuals). Tanystylum occidentale (Cole, 1904) and Nymphon apheles Child, 1979 were new geographical records for Mexico and Ammothella symbia Child, 1979 and A. californicus were new records for Baja California Sur state. Adding these new geographical records of pycnogonids increased the species richness previously recorded at Baja California Sur from 20 to 24 nominal species and for Mexico, the species richness increased from 49 to 51 nominal species.


Asunto(s)
Artrópodos , Animales , California , Geografía , México
14.
PLoS One ; 16(3): e0248617, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33770088

RESUMEN

BACKGROUND: Wildfires in California have become more deadly and destructive in recent years, and four of the ten most destructive fires occurred in 2017 and 2018. Through interviews with service providers, this article explores how these recent wildfires have impacted surrounding communities and the role various recovery resources have played in responding to the short- and long-term health and social needs of survivors. METHODS: Using a purposive sampling methodology, we interviewed 21 health and social service personnel who assisted in wildfire recovery efforts in California in 2017 and 2018. The study participants worked or volunteered in medical facilities, social services agencies and philanthropy/nonprofit organizations located in communities affected by wildfires. Participants were asked about three common, overarching themes that fire-impacted communities navigate post-disaster: health issues, social issues, and response and recovery resources. Inductive coding was used to identify common subthemes. RESULTS: The two most frequently discussed social issues during interviews were housing and employment access. Mental and emotional well-being and access to health resources were identified as being the most challenging health concerns that survivors face post-disaster. Participants also identified the following private and public recovery resources that survivors use to attempt to restabilize following the fire: community support, county agencies, the Federal Emergency Management Agency (FEMA,) insurance companies and philanthropic organizations. However, participants noted that the cumulative impacts of these efforts still leave many of their patients and clients without the resources needed to restabilize emotionally, financially and physically. Finally, participants spoke about the community-wide, downstream impacts of wildfires, noting that "survivors" are not only those whose health is immediately compromised by the disaster. CONCLUSION: Given the worsening wildfire seasons in California, we must increase our understanding of both the scope of the health and social issues that survivors navigate following a disaster, as well as the effectiveness and sustainability of recovery resources available to survivors. We must also understand the "ripple effect" that wildfires have on surrounding communalities, impacting housing access, social services, and health care access. More research and support, especially during the current COVID-19 pandemic, is urgently needed to improve our ability to support the health and social needs of wildfire survivors in the future.


Asunto(s)
Personal de Salud/psicología , Trabajadores Sociales/psicología , Incendios Forestales , California , Emociones , Empleo , Vivienda , Humanos , Entrevistas como Asunto , Salud Mental , Apoyo Social , Factores Socioeconómicos
15.
Vaccine ; 39(16): 2295-2302, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33771391

RESUMEN

BACKGROUND: Multiple candidates of COVID-19 vaccines have entered Phase III clinical trials in the United States (US). There is growing optimism that social distancing restrictions and face mask requirements could be eased with widespread vaccine adoption soon. METHODS: We developed a dynamic compartmental model of COVID-19 transmission for the four most severely affected states (New York, Texas, Florida, and California). We evaluated the vaccine effectiveness and coverage required to suppress the COVID-19 epidemic in scenarios when social contact was to return to pre-pandemic levels and face mask use was reduced. Daily and cumulative COVID-19 infection and death cases from 26th January to 15th September 2020 were obtained from the Johns Hopkins University Coronavirus resource center and used for model calibration. RESULTS: Without a vaccine (scenario 1), the spread of COVID-19 could be suppressed in these states by maintaining strict social distancing measures and face mask use levels. But relaxing social distancing restrictions to the pre-pandemic level without changing the current face mask use would lead to a new COVID-19 outbreak, resulting in 0.8-4 million infections and 15,000-240,000 deaths across these four states over the next 12 months. Under this circumstance, introducing a vaccine (scenario 2) would partially offset this negative impact even if the vaccine effectiveness and coverage are relatively low. However, if face mask use is reduced by 50% (scenario 3), a vaccine that is only 50% effective (weak vaccine) would require coverage of 55-94% to suppress the epidemic in these states. A vaccine that is 80% effective (moderate vaccine) would only require 32-57% coverage to suppress the epidemic. In contrast, if face mask usage stops completely (scenario 4), a weak vaccine would not suppress the epidemic, and further major outbreaks would occur. A moderate vaccine with coverage of 48-78% or a strong vaccine (100% effective) with coverage of 33-58% would be required to suppress the epidemic. Delaying vaccination rollout for 1-2 months would not substantially alter the epidemic trend if the current non-pharmaceutical interventions are maintained. CONCLUSIONS: The degree to which the US population can relax social distancing restrictions and face mask use will depend greatly on the effectiveness and coverage of a potential COVID-19 vaccine if future epidemics are to be prevented. Only a highly effective vaccine will enable the US population to return to life as it was before the pandemic.


Asunto(s)
/administración & dosificación , Máscaras , /epidemiología , California , Florida , Humanos , Modelos Teóricos , New York , Texas , Estados Unidos/epidemiología
18.
J Prim Care Community Health ; 12: 2150132721995450, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33648364

RESUMEN

IMPORTANCE: Social media is widely used by various segments of society. Its role as a tool of communication by the Public Health Departments in the U.S. remains unknown. OBJECTIVE: To determine the impact of the COVID-19 pandemic on social media following of the Public Health Departments of the 50 States of the U.S. DESIGN, SETTING, AND PARTICIPANTS: Data were collected by visiting the Public Health Department web page for each social media platform. State-level demographics were collected from the U.S. Census Bureau. The Center for Disease Control and Prevention was utilized to collect information regarding the Governance of each State's Public Health Department. Health rankings were collected from "America's Health Rankings" 2019 Annual report from the United Health Foundation. The U.S. News and World Report Education Rankings were utilized to provide information regarding the public education of each State. EXPOSURE: Data were pulled on 3 separate dates: first on March 5th (baseline and pre-national emergency declaration (NED) for COVID-19), March 18th (week following NED), and March 25th (2 weeks after NED). In addition, a variable identifying the total change across platforms was also created. All data were collected at the State level. MAIN OUTCOME: Overall, the social media following of the state Public Health Departments was very low. There was a significant increase in the public interest in following the Public Health Departments during the early phase of the COVID-19 pandemic. RESULTS: With the declaration of National Emergency, there was a 150% increase in overall public following of the State Public Health Departments in the U.S. The increase was most noted in the Midwest and South regions of the U.S. The overall following in the pandemic "hotspots," such as New York, California, and Florida, was significantly lower. Interesting correlations were noted between various demographic variables, health, and education ranking of the States and the social media following of their Health Departments. CONCLUSION AND RELEVANCE: Social media following of Public Health Departments across all States of the U.S. was very low. Though, the social media following significantly increased during the early course of the COVID-19 pandemic, but it still remains low. Significant opportunity exists for Public Health Departments to improve social media use to engage the public better.


Asunto(s)
Agencias Gubernamentales , Conducta en la Búsqueda de Información , Pandemias , Salud Pública , Medios de Comunicación Sociales , California , Comunicación , Urgencias Médicas , Florida , Humanos , New York , Estados Unidos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...