Crowdsourcing snake identification with online communities of professional herpetologists and avocational snake enthusiasts.

Species identification can be challenging for biologists, healthcare practitioners and members of the general public. Snakes are no exception, and the potential medical consequences of venomous snake misidentification can be significant. Here, we collected data on identification of 100 snake species by building a week-long online citizen science challenge which attracted more than 1000 participants from around the world. We show that a large community including both professional herpetologists and skilled avocational snake enthusiasts with the potential to quickly (less than 2 min) and accurately (69-90%; see text) identify snakes is active online around the clock, but that only a small fraction of community members are proficient at identifying snakes to the species level, even when provided with the snake's geographical origin. Nevertheless, participants showed great enthusiasm and engagement, and our study provides evidence that innovative citizen science/crowdsourcing approaches can play significant roles in training and building capacity. Although identification by an expert familiar with the local snake fauna will always be the gold standard, we suggest that healthcare workers, clinicians, epidemiologists and other parties interested in snakebite could become more connected to these communities, and that professional herpetologists and skilled avocational snake enthusiasts could organize ways to help connect medical professionals to crowdsourcing platforms. Involving skilled avocational snake enthusiasts in decision making could build the capacity of healthcare workers to identify snakes more quickly, specifically and accurately, and ultimately improve snakebite treatment data and outcomes.

Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.

OBJECTIVES: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

The Influence of Radon (Gas and Progeny) and Weather Conditions on Ambient Dose Equivalent Rate.

The purpose of this study is to identify the influence of radon (gas and progeny) on the ambient dose equivalent rate measured at the reference station ESMERALDA, where continuous measurements of the ambient dose equivalent rate (every 10 min) combined with activity concentration measurements of radon gas and radon progeny as well as meteorological parameters have been collected. This study has been performed using a correlation study based on a principal components analysis and the Spearman's rank correlation coefficient.

Design and verification of the shielding around the new Neutron Standards Laboratory (LPN) at CIEMAT.

The construction of the new Neutron Standards Laboratory at CIEMAT (Laboratorio de Patrones Neutrónicos) has been finalised and is ready to provide service. The facility is an ∼8 m×8 m×8 m irradiation vault, following the International Organization for Standardization 8529 recommendations. It relies on several neutron sources: a 5-GBq (5.8× 10(8) s(-1)) (252)Cf source and two (241)Am-Be neutron sources (185 and 11.1 GBq). The irradiation point is located 4 m over the ground level and in the geometrical centre of the room. Each neutron source can be moved remotely from its storage position inside a water pool to the irradiation point. Prior to this, an important task to design the neutron shielding and to choose the most appropriate materials has been developed by the Radiological Security Unit and the Ionizing Radiations Metrology Laboratory. MCNPX was chosen to simulate the irradiation facility. With this information the walls were built with a thickness of 125 cm. Special attention was put on the weak points (main door, air conditioning system, etc.) so that the ambient dose outside the facility was below the regulatory limits. Finally, the Radiation Protection Unit carried out a set of measurements in specific points around the installation with an LB6411 neutron monitor and a Reuter-Stokes high-pressure ion chamber to verify experimentally the results of the simulation.

Association of Toll-like receptor 10 and susceptibility to Crohn's disease independent of NOD2.

Impaired innate inflammatory response has a key role in the Crohn's disease (CD) pathogenesis. The aim of this study was to investigate the possible role of the TLR10-TLR1-TLR6 gene cluster in CD susceptibility. A total of 508 CD patients (284, cohort 1 and 224, cohort 2) and 576 controls were included. TLR10-TLR1-TLR6 cluster single-nucleotide polymorphisms genotyping, NOD2 mutations and TLR10 mRNA quantification were performed using TaqMan assays. Nucleotide-binding oligomerization domain containing 2 (NOD2) and Toll-like receptor (TLR) loci interaction was analyzed by logistic regression and multifactor-dimensionality reduction (MDR). Entropy-based analysis was used to interpret combination effects. One TLR10 haplotype (TLR10(GGGG)) was found associated with CD susceptibility in both cohorts, individuals with two copies had approximately twofold more risk of CD susceptibility than individuals having no copies (odds ratio=1.89, P-value=0.0002). No differences in the mRNA levels were observed among the genotypes. The strongest model for predicting CD risk according to the MDR analysis was a two-locus model including NOD2 mutations and TLR10(GGGG) haplotype (P(c)<0.0001). The interaction gain attributed to the combination of both genes was negative (IG=-2.36%), indicating redundancy or independent effects. Our results support association of the TLR10 gene with CD susceptibility. The effect of TLR10 would be independent of NOD2, suggesting different signaling pathways for both genes.

Response to a vaccination schedule with 4 doses of 40 microg against hepatitis B virus in cirrhotic patients evaluated for liver transplantation.

We conducted a retrospective study to evaluate the response to recombinant hepatitis B vaccine after 4 intramuscular doses (40 microg) administered at 0, 1, 2, and 6 months in 157 cirrhotic patients who were liver transplant candidates. Seventeen nonresponders were revaccinated with the same schedule. We studied the association between the following variables and the vaccine response: age, gender, etiology of cirrhosis, diabetes, severity of liver disease (Child-Pugh class and Model for End-Stage Liver Disease [MELD] score), and the number of administered doses. The response rates were: 1 dose, 40% (2/5); 2 doses, 0% (0/7); 3 doses, 32.7% (16/49); and 4 doses, 31.3% (30/96) of patients. The median hepatitis B surface antibody (anti-HBs) titer was 45 mU/mL (range, 11-620 mU/mL). The response rate to revaccination was 41.2% (median anti-HBs titer, 88 mU/mL; range, 18-190 mU/mL). Diabetics showed a lower response rate than nondiabetic patients (17.2% vs 35.3%; P = .046). No association was observed between the response rate to vaccine and the other variables. In conclusion, the response rate to hepatitis B vaccine reached a little more than 30% in cirrhotic patients who received 3 or 4 doses. No higher response rate was observed among patients who received 4 doses. Diabetes was associated with a lower response rate. Anti-HBs seroconversion rates were not associated with the other variables. Revaccination may significantly increase the response rate to hepatitis B vaccine in cirrhotic patients, and may be considered in nonresponders after the third dose. Early vaccination against HBV should be considered in such patients.

Prevalence of hepatitis A and B markers and vaccine indication in cirrhotic patients evaluated for liver transplantation in Spain.

Vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is generally recommended for patients with chronic liver disease and those evaluated for liver transplantation in the absence of immunity. HAV and HBV infections after liver transplantation are frequent and associated with a worse prognosis. The data suggest that the number of patients with chronic liver disease without naturally acquired immunity against HAV and HBV is substantial, and that new vaccination strategies are needed. The aim of this study was to determine the level of immunity from hepatitis A and B infections and the need for HBV and HAV vaccination among cirrhotic patients evaluated for liver transplantation. We studied HBV and HAV serological markers (HbsAg, anti-HBc, anti-HBs, IgG anti-HAV) in 451 cirrhotic patients evaluated for liver transplantation to investigate the association with gender, age, and etiology of cirrhosis. Negative HBV markers were observed in 57% of patients with 43% displaying one positive HBV marker: HBsAg (+), 9.5%; anti-HBc (+)/anti-HBs (-), 11.5%; anti-HBc (-)/anti-HBs(+), 4.2%; anti-HBc(+)/anti-HBs(+), 17.7%. HBV vaccine indication established in 68.5% of patients was greater among women and hepatitis C virus-negative patients. No differences were observed in age or cause of cirrhosis. HAV vaccination indicated in 6.7% of patients (IgG anti-HVA-negative) was greater among patients with negative HBV markers (9.3% vs 3.3%, P = .018) and younger patients (25.3% of patients

[Intravenous proton-pump inhibitor for acute peptic ulcer bleeding--is profound acid suppression beneficial to reduce the risk of rebleeding?]. / Inhibidores de la bomba de protones por vía intravenous en la hemorragia por úlcera péptica: es necesaria la supresión ácida máxima para disminuir el resangrado?

OBJECTIVE: To compare two regimens of pantoprazole administered intravenously in patients with ulcerative gastrointestinal bleeding (UGB), and a high risk of presenting with persitent or recurrent hemorrhage. MATERIAL AND METHOD: Patients were randomized into two groups: group 0--treatment with a 80 mg bolus of pantoprazole administered intravenously, followed by continuous infusion of 8 mg/h for 72 hours; group 1--treatment with 40 mg of pantoprazole administered intravenously on a daily basis. The percentage of hemorrhagic persistence/recurrence in both groups was analyzed, as were transfusion requirements, need for surgery, and mortality resulting from the hemorrhagic episode. RESULTS: There were 20 patients in group 0 and 21 in group 1. No differences were found between groups in terms of gender, age, smoking habits, use of NSAIDs, presence of hemodynamic instability or stigmata in ulcer crater (Forrest Ia: 5 vs. 14.3%, p = 0.322; Forrest Ib: 30 vs. 33.3%, p = 0.819; Forrest IIa: 60 vs. 50.1%, p = 0.753). In group 0, 90% of patients received endoscopic treatment, versus 100% in group 1, p = 0.232. In group 0, 50% of patients had a transfusion, as compared to 52.4% in group 1, p = 0.879. In group 0, 2 patients (10.5%) presented with recurrent hemorrhage, versus 3 patients (14.3%) in group 1. Surgery was required by 1 person from each group, and 1 patient in group 0 died. CONCLUSIONS: Maximum acid inhibition with a bolus and then a continuous infusion of pantoprazole does not yield better results than treatment with conventional doses in acute hemorrhagic episodes.

Inhibidores de la bomba de protones por vía intravenosa en la hemorragia por úlcera péptica: ¿es necesaria la supresión ácida máxima para disminuir el resangrado? / No disponible

Objetivo: comparar dos pautas de pantoprazol por vía intravenosaen pacientes con hemorragia digestiva alta (HDA) ulcerosade alto riesgo para presentar persistencia o recidiva hemorrágica.Material y método: se randomizaron los pacientes en dosgrupos: grupo 0: tratamiento con bolo de 80 mg i.v. de pantoprazoly perfusión continua a 8 mg/h durante 72 horas; grupo 1: tratamientocon 40 mg i.v. de pantoprazol diarios. Se analizó el porcentajede persistencia/recidiva hemorrágica entre ambos grupos,requerimientos transfusionales, necesidad de cirugía y mortalidaddel episodio hemorrágico.Resultados: se incluyeron 20 pacientes en el grupo 0 y 21en el grupo 1. No se encontraron diferencias entre ambos gruposen cuanto al sexo, edad, hábito tabáquico, consumo de AINE,presencia de inestabilidad hemodinámica, estigma sobre el nichoulceroso (Forrest Ia 5 vs. 14,3%, p = 0,322; Forrest Ib 30 vs.33,3%, p = 0,819; Forrest IIa 60 vs. 50,1%, p = 0,753). El 90%de los pacientes del grupo 0 recibió tratamiento endoscópico vs.el 100% del grupo 1, p = 0,232. El 50% de los pacientes del grupo0 recibió transfusión vs. el 52,4% del grupo 1, p = 0,879. Dospacientes (10,5%) del grupo 0 presentaron recidiva hemorrágicavs. 3 pacientes (14,3%) del grupo 1, precisando cirugía 1 pacientede cada grupo y falleciendo 1 paciente del grupo 0.Conclusiones: la inhibición ácida máxima de la secreción ácidagástrica mediante bolo e infusión continua de pantoprazol noofrece resultados superiores al tratamiento con dosis convencionalesen el episodio hemorrágico agudo

Objective: to compare two regimens of pantoprazole administeredintravenously in patients with ulcerative gastrointestinalbleeding (UGB), and a high risk of presenting with persitent or recurrenthemorrhage.Material and method: patients were randomized into twogroups: group 0 - treatment with a 80 mg bolus of pantoprazoleadministered intravenously, followed by continuous infusion of 8mg/h for 72 hours; group 1 - treatment with 40 mg of pantoprazoleadministered intravenously on a daily basis. The percentageof hemorrhagic persistence/recurrence in both groups was analyzed,as were transfusion requirements, need for surgery, andmortality resulting from the hemorrhagic episode.Results: there were 20 patients in group 0 and 21 in group1. No differences were found between groups in terms of gender,age, smoking habits, use of NSAIDs, presence of hemodynamicinstability or stigmata in ulcer crater (Forrest Ia: 5 vs. 14.3%, p =0.322; Forrest Ib: 30 vs. 33.3%, p = 0.819; Forrest IIa: 60 vs.50.1%, p = 0.753). In group 0, 90% of patients received endoscopictreatment, versus 100% in group 1, p = 0.232. In group0, 50% of patients had a transfusion, as compared to 52.4% ingroup 1, p = 0.879. In group 0, 2 patients (10.5%) presentedwith recurrent hemorrhage, versus 3 patients (14.3%) in group 1.Surgery was required by 1 person from each group, and 1 patientin group 0 died.Conclusions: maximum acid inhibition with a bolus and athen a continuous infusion of pantoprazole does not yield betterresults than treatment with conventional doses in acute hemorrhagicepisodes

Hemangioma de esófago superior tratado con éxito mediante láser / Upper esophageal hemangioma succesfully treated by laser

No disponible

[Changes in the etiology, outcome, and characteristics of patients with acute gastrointestinal bleeding between 1999 and 2005]. / Cambios en la etiología, resultados y características de los pacientes con hemorragia digestiva aguda grave a lo largo del perido 1999-2005.

OBJECTIVES: To analyze the evolution of the following variables in patients admitted to a Blood Unit for gastrointestinal bleeding throughout 1999-2005: etiology, comorbid diseases, use of NSAIDs/anticoagulants, and mortality. MATERIAL AND METHODS: We analyzed the evolution of the following causes of GIB that required admission to the Blood Unit from 1999 to 2005: duodenal ulcer (DU), gastric ulcer (GU), portal hypertension (PHT), and others. We also analyzed changes in the percentage of patients admitted with comorbid disease, use of NSAIDs/anticoagulants, and mortality. RESULTS: 1,611 Patients with a mean age of 60.45 years (59.7-61.2) were included in this study; 76.41% were males (74.3-78.5). DU was the cause of bleeding in 22.20% of cases (20.2-24.3), GU in 18.40% of cases (16.6-20.4), and PHT in 33.60% of cases (31.3-36.0). In all, 34.5% (32.6-37.3) of patients were taking NSAIDs, 7.1% (6.0-8.6) were receiving anticoagulant therapy, 72.6% (70.4-74.8) presented with comorbid disease, and overall mortality was 6.27% (5.16-7.59). Throughout the 1999-2005 period there was an increase in the number of patients with comorbid diseases (p < 0.02), and a decrease in cases of DU (p < 0.04), without significant differences in the remaining variables. CONCLUSIONS: DU, GU and PHT account for three quarters of admissions to our Blood Unit. Over the last seven years, there has been a decrease in cases due to DU, and an increase in patients with comorbid disease; overall mortality rates have remained stable.

Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital.

OBJECTIVES: 1. To study transfusion requirements in the Department of Gastroenterology of a Tertiary Referral Hospital, and their evolution over the last seven years. 2. To analyze risk factors associated with greater erythrocyte transfusion requirements. PATIENTS AND METHODS: erythrocyte transfusion requirements were compared for patients admitted to the Department of Gastroenterology at Hospital Virgen del Rocío, Seville, from 1999 to 2005. Clinical data of interest have been analyzed in order to determine factors associated with greater transfusion requirements. RESULTS: 1,611 patients with a mean age of 60.45 years (59.7-61.2) were included in this study; 76.41% were males. Gastric ulcers were the cause of bleeding in 18.4% of cases (with 69% requiring transfusions); duodenal ulcers caused 22.2% of cases (with 52.9% requiring transfusions), and portal hypertension caused 33.6% of cases (with 90.2% requiring transfusions). Upper and lower gastrointestinal bleeding of unknown origin requires transfusions in 88.9 and 96.2% of cases, respectively.A multivariate logistic regression analysis showed that clinical presentations such as hematemesis (odds ratio = 3.12), hematochezia (odds ratio = 33.17), gastrointestinal hemorrhage of unknown origin (odds ratio = 6.57), and hemorrhage as a result of portal hypertension (odds ratio = 3.43) were associated with greater transfusion requirements for erythrocyte concentrates. No significant differences were observed between the percentages of patients who received transfusions from 1999 to 2005. CONCLUSIONS: 1. No differences have been observed between the percentages of patients who received transfusions over the last seven years at our Department of Gastroenterology. 2. Patients presenting with hematemesis or hematochezia, in addition to those with bleeding of unknown origin or from portal hypertension, are prone to have greater transfusion requirements.

Hemorragia por varices ectópicas periostomales: una rara complicación de la hipertensión portal / Hemorrhage due to peristomal ectopic varices: an infrequent complication of portal hypertension

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Reproductive biology of Oreochromis niloticus (Perciformes: Cichlidae) at Emiliano Zapata dam, Morelos, Mexico

The reproductive season of tilapia was studied by monthly samplings at Emiliano Zapata dam, Morelos State, Mexico. From February 1999 through February 2000 a sample of 50 fish was taken from the commercial catch (castnet, 6.5 cm of mesh size). The observed sex ratio was 1:1.29 (females:males) (2=10.26; p<0.05). The tilapia reached maturity at 151.3 mm (females) and 152.0 mm (males) of total length. Rainy (August) and dry (February) seasons were determined as the breeding period. Fecundity variation was better correlated with length (r=0.7473; p<0.002) than with weight (r=0.7395; p<0.002). The fecundity ranged between 243 and 847 oocytes per fish, with egg diameter from 300 to 3 700 µm. Intensive breeding activity in August and February coincide with phytoplankton biomass increase

Se analizó la biología reproductiva de la tilapia en la presa Emiliano Zapata, Morelos, México. Para esto se realizaron muestreos de febrero 1999 a febrero 2000. Se tomaron 50 organismos mensuales de la captura comercial obtenidos con una atarraya de 6.5 cm de luz de malla. La proporción sexual fue de1:1.29 hembras:machos (2=10.26; p<0.05). La madurez sexual se alcanza a los 151.3 mm (hembras) y a los 152.0 mm (machos) de longitud total. Se detectaron dos épocas de reproducción para la especie: durante la estación lluviosa (agosto) y durante la estación de secas (febrero). La fecundidad relativa presentó mayor correlación con la longitud (r=0.7473; p<0.002) que con el peso (r=0.7395; p<0.002). Por otra parte, el intervalo para la fecundidad osciló entre 243 y 847 ovocitos por pez, con diámetros de 300 a 3 700 µm. Asimismo, la actividad reproductiva de la especie en Agosto y Febrero, coincide con el incremento de biomasa fitoplanctónica