The ABC of mobility.

The use of cars in cities has many negative impacts, including pollution, noise and the use of space. Yet, detecting factors that reduce the use of cars is a serious challenge, particularly across different regions. Here, we model the use of various modes of transport in a city by aggregating Active mobility (A), Public Transport (B) and Cars (C), expressing the modal share of a city by its ABC triplet. Data for nearly 800 cities across 61 countries is used to model car use and its relationship with city size and income. Our findings suggest that with longer distances and the congestion experienced in large cities, Active mobility and journeys by Car are less frequent, but Public Transport is more prominent. Further, income is strongly related to the use of cars. Results show that a city with twice the income has 37% more journeys by Car. Yet, there are significant differences across regions. For cities in Asia, Public Transport contributes to a substantial share of their journeys. For cities in the US, Canada, Australia, and New Zealand, most of their mobility depends on Cars, regardless of city size. In Europe, there are vast heterogeneities in their modal share, from cities with mostly Active mobility (like Utrecht) to cities where Public Transport is crucial (like Paris or London) and cities where more than two out of three of their journeys are by Car (like Rome and Manchester).

Efficacy and Safety of Anticonvulsants for the Inpatient Treatment of Alcohol Withdrawal Syndrome: A Systematic Review and Meta-analysis.

AIM: To examine the efficacy and safety of antiepileptic drugs (AED) for the inpatient treatment of patients with moderate to severe alcohol withdrawal syndrome (AWS). METHODS: We searched in databases and gray literature to include randomized controlled clinical trials in adults that compare the use of AED versus placebo or any other medication. Studies that did not specify severity or were performed on an outpatient basis were excluded. The outcomes were improvement of symptoms, delirium tremens, seizures and adverse events. Two researchers independently selected the references, extracted the data and assessed the risk of bias. A qualitative synthesis was made and, when the heterogeneity was mild or moderate, a meta-analysis was performed. The quality of the evidence obtained was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: In total, 26 studies with 1709 patients were included. No benefit is described in withdrawal syndrome severity measured by scales or in the development of delirium tremens. The only possible meta-analysis showed that there are no differences in the incidence of seizures (risk ratio [RR] = 1.0; confidence interval (CI) 95% 0.76-1.33), even when compared with placebo (RR = 0.95; CI95% 0.57-1.57). There were also no differences in adverse events, although a higher proportion of some mild cases were described with the use of carbamazepine and valproic acid. CONCLUSIONS: The routine use of AED is not suggested in the treatment of patients with moderate or severe AWS unless indicated for comorbidity (weak recommendation against using moderate quality of evidence).

Lifting the Bar: A Relationship-Orienting Intervention Reduces Recidivism Among Children Reentering School From Juvenile Detention.

When children return to school from juvenile detention, they face a severe stigma. We developed a procedure to orient educators and students toward each other as positive relationship partners during this period. In Study 1, through a structured exercise, students reentering school powerfully articulated to an educator of their choosing their prosocial hopes for school as well as challenges they faced. In a preliminary field trial (N = 47), presenting this self-introduction to this educator in a one-page letter via a third-party requesting the educator's help reduced recidivism to juvenile detention through the next semester from 69% to 29%. In Study 2 (preregistered), the letter led experienced teachers (N = 349) to express greater commitment to, anticipate more success for, and feel more love and respect for a student beginning their reentry into school, potentially initiating a better trajectory. The results suggest how relationship-orienting procedures may sideline bias and make school more supportive for students facing stigma.

Tissue-type plasminogen activator protects the postsynaptic density in the ischemic brain.

Cerebral ischemia causes the presynaptic release of tissue-type plasminogen activator (tPA). The postsynaptic density (PSD) is a postsynaptic structure that provides a matrix where signaling transduction of excitatory synapses takes place. The postsynaptic density protein-95 (PSD-95) is the most abundant scaffolding protein in the postsynaptic density (PSD), where it modulates the postsynaptic response to the presynaptic release of glutamate by regulating the anchoring of glutamate receptors to the PSD. We found that tPA induces the local translation of PSD-95 mRNA and the subsequent recruitment of PSD-95 protein to the PSD, via plasminogen-independent activation of TrkB receptors. Our data show that PSD-95 is removed from the PSD during the early stages of cerebral ischemia, and that this effect is abrogated by either the release of neuronal tPA, or intravenous administration of recombinant tPA (rtPA). We report that the effect of tPA on PSD-95 is associated with inhibition of the phosphorylation and recruitment of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors to the PSD, known to amplify the effect of the excitotoxic injury, and that this is followed by TrkB-mediated protection of dendritic spines from the harmful effects of the hypoxic insult. These data reveal that tPA is a synaptic protector in the ischemic brain.

Zika virus-induced neurological critical illness in Latin America: Severe Guillain-Barre Syndrome and encephalitis.

Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection. We included 10 critically ill patients with ZIKAV infection, as diagnosed with RT-PCR, admitted to the ICU. Neurologic manifestations concordant with Guillain-Barre Syndrome (GBS) were present in all patients, although 2 evolved into an encephalitis-like picture. 2 cases died, one due to encephalitis, the other septic shock. CONCLUSIONS: Differing from what was usually reported, ZIKAV infection can result in life-threatening neurologic illness in adults, including GBS and encephalitis. Collaborative reporting to identify severe illness from an emerging pathogen can provide valuable insights into disease epidemiology and clinical presentation, and inform public health authorities about acute care priorities.