[Correlation between consultation time and patient´s satisfaction in primary care]. / Correlación entre tiempo consulta y satisfacción del paciente en primer nivel de atención.

Background: It is important to understand how consultation time relates to patient satisfaction, as these two variables have not been extensively studied together. Objective: To determine the correlation between consultation time and patient satisfaction in primary care settings in Mexico. Materials and methods: Cross-sectional, observational, and analytical study that included patients over 18 years old. Time was measured using a stopwatch, and satisfaction was assessed using the Patient Doctor Relationship Questionnaire (PDRQ-9). The correlation between both variables was analyzed using the Spearman test, and multiple linear regression was employed to associate satisfaction with the consultation. Results: A total of 115 participants were included. The average consultation duration was 12.1 minutes, and 74% of patients reported that the consultation time was adequate. A weak positive correlation (p < 0.001, r = 0.38) was found between actual consultation time and satisfaction. Multiple linear regression demonstrated that for every minute increase in consultation time, level of satisfaction increased in 0.04 units (p = 0.001, CI95%: 0.016-0.063). Conclusion: Most patients reported satisfaction with the duration of their medical consultation, and longer consultation times were associated with higher satisfaction levels.

Introducción: es importante conocer cómo el tiempo de la consulta se relaciona con la satisfacción del paciente, ya que son dos variables que no se han estudiado a profundidad de forma conjunta. Objetivo: determinar la correlación que existe entre el tiempo de consulta y la satisfacción del paciente en un primer nivel de atención en México. Material y métodos: estudio transversal, observacional y analítico que incluyó a pacientes mayores de 18 años. Se midió el tiempo con cronómetro, así como la satisfacción mediante el cuestionario Patient Doctor Relationship Questionnaire (PDRQ-9). Se analizó la correlación entre ambas variables con la prueba de Spearman y para asociar la satisfacción con la consulta se empleó regresión lineal múltiple. Resultados: se incluyeron 115 participantes. La duración media de la consulta fue de 12.1 minutos y el 74% de los pacientes indicó que el tiempo de consulta les pareció adecuado. Se encontró una correlación positiva leve (p < 0.001, r = 0.38) entre el tiempo real de la consulta y la satisfacción. Mediante la regresión lineal múltiple se demostró que, por cada minuto de aumento en la consulta, el índice de satisfacción aumentaba en un 0.04 (p = 0.001, IC95%: 0.016-0.063). Conclusión: la mayoría de los pacientes refieren estar satisfechos con la duración de la consulta médica; sin embargo, a mayor duración de la consulta los pacientes muestran mayor satisfacción.

Prevalence and associated factors of bullying in medical residents: A systematic review and meta-analysis.

OBJECTIVE: To assess the prevalence of bullying in medical residents and its associated factors. METHODS: In this systematic review and meta-analysis, articles from MEDLINE, EMBASE, Scopus, PsycInfo, Cochrane databases, and Web of Science were searched. Published and unpublished cross-sectional studies were included. Cochrane's Q test and I2 statistics were used to assess the existence of heterogeneity. Subgroup analysis and sensitivity analysis were performed on evidence of heterogeneity. Egger's test and funnel plots were performed to investigate publication bias. RESULTS: A total of 13 cross-sectional studies with a total of 44 566 study participants from different medical residencies were analyzed. The overall prevalence of bullying was 51% (95% CI 36-66). Furthermore, female residents and residents that belong to a minority group had higher odds of experiencing bullying compared to their peers. CONCLUSION: A high prevalence of bullying in medical residents exists around the world. There is a need for education, dissemination, and more effective interventions among the residents and authorities about bullying to build and promote adequate behaviors and diminish bullying prevalence.

Rol de trampas extracelulares de neutrófilos en el pronóstico de las infecciones del sistema respiratorio / Role of neutrophil extracellular traps in the prognosis of respiratory tract infections

Las trampas extracelulares de neutrófilos (NET, por sus siglas en inglés) han surgido recientemente como un vínculo potencial entre la inmunidad y la inflamación, que podría cumplir un papel clave en la patogénesis de las infecciones de vías respiratorias. El objetivo de esta revisión es determinar su rol como marcador pronóstico en enfermedades infecciosas de vías respiratorias. Para la elaboración de este artículo de revisión narrativa se consultaron las publicaciones disponibles a través de una búsqueda automatizada en las bases de datos de PubMed, Scopus y Embase. Las concentraciones elevadas de trampas extracelulares de neutrófilos (cfADN, complejos de mieloperoxidasas-ADN) en pacientes con cuadro clínico grave por infecciones de vías respiratorias, se relacionan con una estancia hospitalaria más larga, periodo prolongado de administración de antibióticos, aumento del riesgo de ingreso a la UCI, necesidad de ventilación mecánica, disfunción orgánica e incluso la muerte (p ≤ 0,05). A pesar de no contar con un parámetro de medición estandarizado, el exceso de trampas extracelulares de neutrófilos se corresponde con la gravedad del daño tisular observado en pacientes con infecciones de vías respiratorias, esto revela el importante rol pronóstico de la respuesta de los neutrófilos y del proceso de la NETosis en las enfermedades infecciosas pulmonares

Neutrophil extracellular traps (NET) have recently emerged as a potential link between immunity and inflammation, which could play a key role in the pathogenesis of respiratory tract infections. This review aims to determine the role of neutrophil extracellular traps as prognostic markers in respiratoria tract infectious diseases. For this article a literature review was undertaken, consulting available publications through an automated search in PubMed, Scopus, and Embase databases. High concentrations of neutrophil extracellular traps (cfDNA, Myeloperoxidase-DNA complexes) in patients with severe clinical presentation due to respiratory tract infections are related to a longer length of hospital stay, prolonged period of antibiotic administration and increased risk of admission to the ICU, need for mechanical ventilation, organ dysfunction and even death (p ≤ 0.05). Despite not having a standardized measurement parameter, the excess of neutrophil extracellular traps corresponds to the severity of tissue damage observed in patients with respiratory tract infections, revealing the important prognostic role of the neutrophil response and NETosis process in pulmonary infectious diseases

Accuracy between 2D Photography and Dual-Structured Light 3D Facial Scanner for Facial Anthropometry: A Clinical Study.

(1) Background: Facial scanners are used in different fields of dentistry to digitalize the soft tissues of the patient's face. The development of technology has allowed the patient to have a 3-dimensional virtual representation, facilitating facial integration in the diagnosis and treatment plan. However, the accuracy of the facial scanner and the obtaining of better results with respect to the manual or two-dimensional (2D) method are questionable. The objective of this clinical trial was to evaluate the usefulness and accuracy of the 3D method (a dual-structured light facial scanner) and compare it with the 2D method (photography) to obtain facial analysis in the maximum intercuspation position and smile position. (2) Methods: A total of 60 participants were included, and nine facial landmarks and five interlandmarks distances were determined by two independent calibrated operators for each participant. All measurements were made using three methods: the manual method (manual measurement), the 2D method (photography), and the 3D method (facial scanner). All clinical and lighting conditions, as well as the specific parameters of each method, were standardized and controlled. The facial interlandmark distances were made by using a digital caliper, a 2D software program (Adobe Photoshop, version 21.0.2), and a 3D software program (Meshlab, version 2020.12), respectively. The data were analyzed by SPSS statistical software. The Kolmogorov-Smirnov test revealed that trueness and precision values were normally distributed (p > 0.05), so a Student's t-test was employed. (3) Results: Statistically significant differences (p ≤ 0.01) were observed in all interlandmark measurements in the 2D group (photography) to compare with the manual group. The 2D method obtained a mean accuracy value of 2.09 (±3.38) and 2.494 (±3.67) in maximum intercuspation and smile, respectively. On the other hand, the 3D method (facial scanner) obtained a mean accuracy value of 0.61 (±1.65) and 0.28 (±2.03) in maximum intercuspation and smile, respectively. There were no statistically significant differences with the manual method. (4) Conclusions: The employed technique demonstrated that it influences the accuracy of facial records. The 3D method reported acceptable accuracy values, while the 2D method showed discrepancies over the clinically acceptable limits.

Polystyrene nanoplastics affect transcriptomic and epigenomic signatures of human fibroblasts and derived induced pluripotent stem cells: Implications for human health.

Plastic pollution is increasing at an alarming rate yet the impact of this pollution on human health is poorly understood. Because human induced pluripotent stem cells (hiPSC) are frequently derived from dermal fibroblasts, these cells offer a powerful platform for the identification of molecular biomarkers of environmental pollution in human cells. Here, we describe a novel proof-of-concept for deriving hiPSC from human dermal fibroblasts deliberately exposed to polystyrene (PS) nanoplastic particles; unexposed hiPSC served as controls. In parallel, unexposed hiPSC were exposed to low and high concentrations of PS nanoparticles. Transcriptomic and epigenomic signatures of all fibroblasts and hiPSCs were defined using RNA-seq and whole genome methyl-seq, respectively. Both PS-treated fibroblasts and derived hiPSC showed alterations in expression of ESRRB and HNF1A genes and circuits involved in the pluripotency of stem cells, as well as in pathways involved in cancer, inflammatory disorders, gluconeogenesis, carbohydrate metabolism, innate immunity, and dopaminergic synapse. Similarly, the expression levels of identified key transcriptional and DNA methylation changes (DNMT3A, ESSRB, FAM133CP, HNF1A, SEPTIN7P8, and TTC34) were significantly affected in both PS-exposed fibroblasts and hiPSC. This study illustrates the power of human cellular models of environmental pollution to narrow down and prioritize the list of candidate molecular biomarkers of environmental pollution. This knowledge will facilitate the deciphering of the origins of environmental diseases.

The aftermath of Covid-19: The rise of pandemic animosity among consumers and its scale development.

Consumer animosity captures negative attitudes to foreign products and impacts willingness to buy them. Existing constructs nevertheless fail to account for an emerging dimension: pandemic animosity. This article heeds recent calls to develop a pandemic animosity measurement scale. Its purpose is to: (i) extend Klein et al.'s (1998) animosity model by adding the pandemic animosity construct, (ii) provide a measurement scale for pandemic animosity, and (iii) explain how pandemic animosity impacts consumers' willingness to buy. Study 1 analyzes qualitative data from in-depth personal interviews with NVivo to identify themes and codes. An expert panel helped reach consensus of all indicators. Study 2 filters scale items using a pilot sample. Study 3 validates a 12-item scale with a larger representative sample. The results contribute to the consumer animosity literature by confirming the existence of pandemic animosity, providing an actionable measure, and confirming its negative impact on consumers' willingness to buy.

Muertes por cáncer en "Jerez de los Caballeros"(Badajoz, España) en el s. XIX: Un estudio histórico observacional de centro único / Deaths from cancer in "Jerez de losCaballeros" (Badajoz, Spain) in the 19th century. XIX. A single-center, historical observational study

Introducción:El cáncer representa un extraordinario problema para la Salud Pública mundial, suponiendo la primera causa de mortalidad global. El cáncer de pulmón es el más frecuente. El número de defunciones se ha ordenado de acuerdo a la Clasificación de Bertillon. El objetivo del estudio fue analizar las causas de mortalidad por cáncer; determinar que grupos de edad presentan más muertes y que estaciones; calcular las tasas de mortalidad.Materiales y métodos:mediante la lectura de los Libros de Defunción del Archivo Parroquial de la ciudad (APJC), se han obtenido 26.203 difuntos, 18.538 de los cuales tienen anotado el motivo de su muerte, los cuales son utilizados para su análisis posterior.Resultados:Se registraron 182 defuncionespor cáncer(1% del total), la gran mayoría adultos, 165 (90.7%), siendo las mujeres casi el doble, 121 (66.5%). La mayor mortalidad se da entre los 45 y los 74 años, 122 difuntos (67.0%). El cáncer más frecuente es el del apartado de otros órganos, con 50 defunciones (40.6%). El mes con más muertos es marzo.las papeletas de defunción solían presentar errores ortográficos o de transcripción. Estudios similares en otras poblaciones arrojan cifras dispares según el periodo analizado y la cifra de muertos. Existe una estrecha relación entre cáncer y edad.Conclusión:El cáncer de otros órganos es el más numeroso. La mortalidad difiere entre las distintas poblaciones comparadas. El número de difuntos es muy inferior al actual, debido a la falta de medios diagnósticos y conocimientos de la época y la posible existencia de un subregistro

Introduction: Cancer represents an extraordinary problem for Global Public Health and is the leading cause of global mortality. Lung cancer is the most common cancer. The number of deaths was ordered according to the Bertillon Classification. The objective of the study was to analyze the causes of mortality due to cancer, determine which age groups have the most deaths and which seasons, and calculate mortality rates.Materials and methods: By reading the Death Books of the city's Parish Archive (APJC), 26,203 deceased persons were obtained, 18,538 of whom were diagnosed with COVID-19, and these individuals were used for subsequent analysis.Results: A total of 182deaths due to cancer were recorded (1% of the total);the vast majority wereadults (165,90.7%), with nearlytwice as manywomen (121, 66.5%). The highest mortal-ity occurredbetween 45 and 74 years of age, with 122 deaths (67.0%). The most common cancer wasthat of other organs, accounting for50 deaths (40.6%). The month with the most deaths wasMarch. Death certificates often had spelling or transcription errors. Similar studies in other populations show different figures depending on the period analyzed and the number of deaths. There is a close relationship between cancer incidence and age.Conclusion: Cancer of other organs is the most common cancer. Mortality differs between the different populations compared. The number of deaths is much lower than the current numberdue to the lack of diagnostic methods, knowledge of the time,and the possibility of underrecording

First wave of SARS-CoV-2 in Santiago Chile: Seroprevalence, asymptomatic infection and infection fatality rate.

BACKGROUND: The first wave of SARS-CoV-2 infection in Chile occurred during the cold season reaching a peak by the end of June 2020, with 80 % of the cases concentrated in its capital, Santiago. The main objective of this study was to estimate the attack rate during this first wave of SARS-CoV-2 in a large, densely populated city with more than seven million inhabitants. Since the number of confirmed cases provides biased information due to individuals' potential self-selection, mostly related to asymptomatic patients and testing access, we measured antibodies against SARS-CoV-2 to assess infection prevalence during the first wave in the city, as well as estimate asymptomatic cases, and infection fatality ratio. To our knowledge this is one of the few population-based cross-sectional serosurvey during the first wave in a highly affected emerging country. The challenges of pandemic response in urban settings in a capital city like Santiago, with heterogeneous subpopulations and high mobility through public transportation, highlight the necessity of more accurate information regarding the first waves of new emerging diseases. METHODS: From April 24 to June 21, 2020, 1326 individuals were sampled from a long-standing panel of household representatives of Santiago. Immunochromatographic assays were used to detect IgM and IgG antibody isotypes. RESULTS: Seroprevalence reached 6.79 % (95 %CI 5.58 %-8.26 %) in the first 107 days of the pandemic, without significant differences among sex and age groups; this figure indicates an attack rate 2.8 times higher than the one calculated with registered cases. It also changes the fatality rate estimates, from a 2.33 % case fatality rate reported by MOH to an estimated crude 1.00 % (CI95 % 0.97-1.03) infection fatality rate (adjusted for test performance 1.66 % [CI95 % 1.61-1.71]). Most seropositive were symptomatic (81,1 %). CONCLUSIONS: Despite the high number of cases registered, mortality rates, and the stress produced over the health system, the vast majority of the people remained susceptible to potential new epidemic waves. We contribute to the understanding of the initial spread of emerging epidemic threats. Consequently, our results provide better information to design early strategies that counterattack new health challenges in urban contexts.

Aurochs roamed along the SW coast of Andalusia (Spain) during Late Pleistocene.

In the Iberian Peninsula the fossil record of artiodactyls spans over 53 million years. During the Pleistocene, wild cattle species such as Bison and especially Bos became common. In Late Pleistocene, the aurochs (Bos primigenius) was widespread and the only bovine living along the large river valleys of southern Iberia. Although commonly found in fossil sites and especially in cave bone assemblages, the trace fossil record of aurochs was known worldwide only from the Holocene. Large bovine and roe deer/caprine tracks were found in at least five horizons of the early Late Pleistocene (MIS 5) beach and eolian deposits of Cape Trafalgar (Cadiz Province, South of Spain). The large bovine tracks are formally described as Bovinichnus uripeda igen. et isp. nov. and compared with the record of aurochs tracks, large red deer tracks and steppe bison biogeographical distribution in Iberia. Aurochs were the most likely producers of the newly described Trafalgar Trampled Surface (TTS) and some of the large artiodactyl tracks in the Matalascañas Trampled Surface, representing the oldest aurochs track record known. This new evidence, together with comparisons with the record of possible aurochs tracks in the Mid-Late Pleistocene coastal deposits from the Asperillo cliff section in Matalascañas (Huelva Province, SW Spain) and bone assemblages known in Gibraltar, point to a recurrent use of the coastal habitat by these large artiodactyls in SW Iberia.

Smart Sensorization Using Propositional Dynamic Logic.

The current high energy prices pose a serious challenge, especially in the domestic economy. In this respect, one of the main problems is obtaining domestic hot water. For this reason, this article develops a heating system applied to a conventional water tank in such a way as to minimize the necessary energy supply by converting it, under certain circumstances, into atmospheric. For this purpose, the domotic system has been equipped with sensors that automate the pressurization of the compartment and solenoid valves that regulate the external water supply. This design, to which different level sensors are applied, sends the information in real time to an artificial intelligence system, by means of deductive control, which recognizes the states of the system. This work shows the introduction of an extension of propositional dynamic logic in the field of energy efficiency. Thanks to this formalism, a qualitative control of the program variables is achieved by incorporating qualitative reasoning tools. On the other hand, it solves preventive maintenance systems through the early detection of faults in the installation. This research has led to the patenting of an intelligent domestic hot water system that considerably reduces energy consumption by setting disjointed heating intervals that, powered by renewable or non-renewable sources, are controlled by a propositional dynamic logic.

[The estimated economic impact of cardiovascular and diabetes mellitus complications 2019-2028]. / Estimación del impacto económico por complicaciones cardiovasculares y de diabetes mellitus 2019-2028.

Background: In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective: To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods: The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results: From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions: Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older.

Introducción: en México la diabetes mellitus (DM) y las enfermedades cardiovasculares, registran una tendencia ascendente. Objetivo: estimar el número de complicaciones por eventos cardiovasculares (ECV) y complicaciones derivadas de la DM (CDM) acumuladas en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de 2019 a 2028, así como el gasto por prestaciones médicas y económicas en un escenario de referencia y uno de cambio en el perfil metabólico debido a la falta de seguimiento médico durante la pandemia por COVID-19. Material y métodos: se estimó el número de ECV y CDM a partir de 2019, con una proyección de riesgo a 10 años con los modelos ESC CVD Risk Calculator y United Kingdom Prospective Diabetes Study, considerando los factores de riesgo registrados en las bases de datos institucionales. Resultados: de 2019 a 2028, los casos acumulados de ECV se estimaron en 2 millones y los de CDM en 960 mil, con un impacto sobre el gasto médico de 439,523 millones de pesos y sobre las prestaciones económicas de 174,085 millones. Al considerar la pandemia por COVID-19, los eventos de ECV y de las CDM aumentaron en 589 mil, con un incremento del gasto en 93,787 millones de pesos por atención médica y en 41,159 millones por prestaciones económicas. Conclusiones: sin una intervención integral al manejo de ECV y de CDM, el gasto por ambas enfermedades seguirá incrementándose, con presiones financieras cada vez mayores.

First tracks of newborn straight-tusked elephants (Palaeoloxodon antiquus).

Tracks and trackways of newborns, calves and juveniles attributed to straight-tusked elephants were found in the MIS 5 site (Upper Pleistocene) known as the Matalascañas Trampled Surface (MTS) at Huelva, SW Spain. Evidence of a snapshot of social behaviour, especially parental care, can be determined from the concentration of elephant tracks and trackways, and especially from apparently contemporaneous converging trackways, of small juvenile and larger, presumably young adult female tracks. The size frequency of the tracks enabled us to infer body mass and age distribution of the animals that crossed the MTS. Comparisons of the MTS demographic frequency with the morphology of the fore- and hind limbs of extant and fossil proboscideans shed light into the reproductive ecology of the straight-tusked elephant, Palaeloxodon antiquus. The interdune pond habitat appeared to have been an important water and food resource for matriarchal herds of straight-tusked elephants and likely functioned as a reproductive habitat, with only the rare presence of adult and older males in the MTS. The preservation of this track record in across a paleosol surface, although heavily trampled by different animals, including Neanderthals, over a short time frame, permitted an exceptional view into short-term intraspecific trophic interactions occurring in the Last Interglacial coastal habitat. Therefore, it is hypothesized that Neanderthals visited MTS for hunting or scavenging on weakened or dead elephants, and more likely calves.

Interferon gamma release assays for detection of latent Mycobacterium tuberculosis in older Hispanic people.

BACKGROUND: Interferon gamma release assays (IGRAs) are used to detect latent Mycobacterium tuberculosis (M.tb) infection (LTBI) in adults, but their performance in older people is not well-established. We evaluated IGRAs for LTBI detection in older Hispanic recent TB contacts (ReC) or community controls (CoC). METHODS: Cross-sectional assessment of LTBI with T-SPOT.TB and/or QuantiFERON-Gold in-tube or -Plus assay in older (≥60 years) and adult (18-50 years) Hispanic people. RESULTS: We enrolled 193 CoC (119 adults, 74 older persons) and 459 ReC (361 adults, 98 older persons). LTBI positivity increased with age in CoC (19%-59%, P<0.001), but was similar in ReC (59%-69%, P=0.329). Older people had lower concordance between IGRAs (kappa 0.465 vs 0.688 in adults) and more inconclusive results (indeterminate/borderline 11.6% vs 5.8% in adults, P=0.012). With simultaneous IGRAs, inconclusive results were resolved as positive or negative with the other IGRA. The magnitude of response to M.tb peptides in IGRAs was similar among age groups, but responsiveness to mitogens was lower in older people. CONCLUSIONS: IGRAs are suitable for LTBI detection in older people. Discordant and inconclusive findings are more prevalent in older people, but results are resolved when IGRA is repeated with a different IGRA test.

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor.

BACKGROUND: Aging increases the risk of tuberculosis (TB) and its adverse outcomes, but most studies are based on secondary analyses, and few are in Hispanics. Diabetes is a risk factor for TB in adults, but its contribution in the elderly is unknown. We aimed to identify the role of diabetes and other risk factors for TB in elderly Hispanics. METHODS: Cross-sectional study among newly-diagnosed TB patients, recent contacts (ReC), or community controls (CoC) totaling 646 participants, including 183 elderly (>60 years; 43 TB, 80 ReC, 60 CoC) and 463 adults (18 to 50 years; 80 TB, 301 ReC and 82 CoC). Host characteristics associated with TB and latent Mycobacterium tuberculosis infection (LTBI) were identified in the elderly by univariable and confirmed by multivariable logistic regression. RESULTS: LTBI was more prevalent among the elderly CoC (55% vs. 23.2% in adults; p<0.001), but not in ReC (elderly 71.3% vs. adult 63.8%); p = 0.213). Risk factors for TB in the elderly included male sex (adj-OR 4.33, 95% CI 1.76, 10.65), smoking (adj-OR 2.55, 95% CI 1.01, 6.45) and low BMI (adj-OR 12.34, 95% CI 4.44, 34.33). Unexpectedly, type 2 diabetes was not associated with TB despite its high prevalence (adj-OR 0.38, 95% CI 0.06, 2.38), and BCG vaccination at birth was protective (adj-OR 0.16, 95% CI 0.06, 0.45). CONCLUSIONS: We report novel distinctions in TB risk factors in the elderly vs. adults, notably in diabetes and BCG vaccination at birth. Further studies are warranted to address disparities in this vulnerable, understudied population.

Where myth and archaeology meet: Discovering the Gorgon Medusa's Lair.

Here we report the discovery of ceramic fragments that form part of a Gorgoneion, a ceramic image representation of the Gorgon Medusa. The fragments were found in a deep part of Gorham's Cave, well known to ancient mariners as a natural shrine, between the 8th and 2nd century BCE. We discuss the context of this discovery, both within the inner topography of the cave itself, and also the broader geographical context. The discovery is situated at the extreme western end of the Mediterranean Sea, where it meets the Atlantic Ocean. The location was known to ancient mariners as the northern Pillar of Herakles, which marked the end of the known world. We relate the discovery, and its geographical and chronological context, to Greek legends that situated the lair of the Gorgon sisters at a location which coincides with the physical attributes and geographical position of Gorham's Cave. We thus provide, uniquely, a geographical and archaeological context to the myth of Perseus and the slaying of the Gorgon Medusa.

Electronic Health Records and Pulmonary Function Data: Developing an Interoperability Roadmap. An Official American Thoracic Society Workshop Report.

A workshop "Electronic Health Records and Pulmonary Function Data: Developing an Interoperability Roadmap" was held at the American Thoracic Society 2019 International Conference. "Interoperability" is defined as is the ability of different information-technology systems and software applications to directly communicate, exchange data, and use the information that has been exchanged. At present, pulmonary function test (PFT) equipment is not required to be interoperable with other clinical data systems, including electronic health records (EHRs). For this workshop, we assembled a diverse group of experts and stakeholders, including representatives from patient-advocacy groups, adult and pediatric general and pulmonary medicine, informatics, government and healthcare organizations, pulmonary function laboratories, and EHR and PFT equipment and software companies. The participants were tasked with two overarching Aobjectives: 1) identifying the key obstacles to achieving interoperability of PFT systems and the EHR and 2) recommending solutions to the identified obstacles. Successful interoperability of PFT data with the EHR impacts the full scope of individual patient health and clinical care, population health, and research. The existing EHR-PFT device platforms lack sufficient data standardization to promote interoperability. Cost is a major obstacle to PFT-EHR interoperability, and incentives are insufficient to justify the needed investment. The current vendor-EHR system lacks sufficient flexibility, thereby impeding interoperability. To advance the goal of achieving interoperability, next steps include identifying and standardizing priority PFT data elements. To increase the motivation of stakeholders to invest in this effort, it is necessary to demonstrate the benefits of PFT interoperability across patient care and population health.

Location of sources in reaction-diffusion equations using support vector machines.

The reaction-diffusion equation serves to model systems in the diffusion regime with sources. Specific applications include diffusion processes in chemical reactions, as well as the propagation of species, diseases, and populations in general. In some of these applications the location of an outbreak, for instance, the source point of a disease or the nest of a vector spreading a virus is important. Also important are the environmental parameters of the domain where the process diffuses, namely the space-dependent diffusion coefficient and the proliferation parameter of the process. Determining both, the location of a source and the environmental parameters, define an inverse problem that in turn, involves a partial differential equation. In this paper we classify the values of these parameters using Support Vector Machines (SVM) trained with numerical solutions of the reaction-diffusion problem. Our set up has accuracy of classifying the outbreak location above 90% and 77% of classifying both, the location and the environmental parameters. The approach presented in our analysis can be directly implemented by measuring the population under study at specific locations in the spatial domain as function of time.

Causas de mortalidad por enfermedades puerperales en Jerez de los Caballeros (Badajoz, España) durante el siglo XIX / Mortality caused by postpartum diseases in Jerez de los Caballeros (Badajoz, Spain) during the 19th century

Resumen Introducción. Las causas de mortalidad por enfermedades puerperales halladas en Jerez de los Caballeros durante el siglo XIX han sido agrupadas según la clasificación de Bertillon. Objetivo. Estudiar las causas de mortalidad por enfermedades del estado puerperal en Jerez de los Caballeros (Badajoz, España) en el siglo XIX. Materiales y métodos. Se consultaron los libros de defunción y se reunieron 26 203 muertes; para el análisis se utilizaron los 18 538 registros en los que constaba la causa de fallecimiento y se excluyeron los 7 665 restantes. Resultados. Se encontraron 168 de casos de muerte en estado puerperal, en las cuales el sobreparto y la fiebre fueron las causas de fallecimiento más frecuentes. El año con más muertes fue 1875 con 7 muertes, la franja de edad de 25-34 años arrojó mayor mortalidad con 77 defunciones (45.9%) y los meses de mayor mortalidad fueron agosto y noviembre con 22 difuntas (13.1%) cada uno. Conclusiones. El sobreparto fue la causa más frecuente de defunción en estado puerperal con un 35.1% de las muertes. La fiebre en esta etapa alcanzó las cifras más elevadas en la última década del siglo XIX, lo cual quizá se debe a errores de diagnóstico o de interpretación.

Abstract Introduction: The causes of death related to puerperal diseases in Jerez de los Caballeros during the 19th century have been categorized according to the Bertillon classification. Objective: To study the causes of death by puerperal diseases in Jerez de los Caballeros (Badajoz, Spain) in the 19th century. Materials and methods: Death books were consulted and 26 203 deaths were recorded. In total, 18 538 records reporting the cause of death were used for the analysis, while the remaining 7 665 were excluded. Results: Death in the puerperal period was confirmed in 168 cases, and the most common causes of death were postpartum complications and puerperal fever. The year with the highest number of deaths was 1875 with 7 deaths. The highest mortality rate was found in the 25-34 years age group with 77 deaths (45.9%). The months with the highest mortality rates are August and November with 22 deaths (13.1%). Conclusions: Postpartum complications was the most common cause of death with 35.1%. In Jerez, puerperal fever reached its highest levels in the last decade of the 19th century, probably due to misdiagnosis or misinterpretation.