Título del artículo:

Knowledge management in an engineering research group

This paper presents a diagnosis of knowledge management in a research group. This work analyzes the vision of management; knowledge management processes and coding structures. The researchers considered Nonaka; Takeuchi (1999), Perez; Loyal; Barceló; Leon (2013), Straccia (2013); and Marulanda; Lopez (2013). The research is descriptive, not experimental and transactional. The group shows strengths in management and distribution processes and knowledge creation. However, the group presents difficulties in planning and structuring of the coding structures. We recommend investing in technology and policy incentives for productivity.

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Espacios

Título del artículo:

A process innovation based on activities, types and characteristics

This paper aims the innovation at services in commercial textiles companies and health care services. The project reviews the types of innovation and the characteristics present at the both sectors. The results establish the textile trade and health care services have low dynamism in innovation activities. This work proposes a cyclical process for the development of innovation at services: analysis, focus goals, equipment, partnerships, project tracking, feedback, deployment and implementation; supported in the organizational culture. This work proposes a management tool for companies inspired by the theoretical study of characteristics of innovation and the empirical study at the service sector.

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Espacios

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Heart rate variability in young people, associated with prematurity

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Iatreia

Título del artículo:

Heart rate variability in medical students with chronic sleep deprivation

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Iatreia

Título del artículo:

Reliability of the barriers scale for cardiac rehabilitation

Introduction: The barriers scale for cardiac rehabilitation was designed to evaluate participation barriers and patient adherence to cardiac rehabilitation programs as used in Canadian studies. The cultural adaptation and validation of its contents to the Colombian context was previously evaluated before assessing its reliability. Objective: To determine the internal consistency and the test-retest reproducibility of the barriers scale for cardiac rehabilitation in a Colombian population. Methods: The study included 30 patients (66.6% male, mean age = 67.0 ± 11.0 years), who were subjected to a percutaneous revascularisation in the Bucaramanga Los Comuneros University Hospital, Colombia, completed the scale at two times, with an interval of two months between them. The Cronbach-alpha coefficients and the intra-class coefficients (ICC) were calculated. Results: The internal consistency of the Colombian version of the scale and the barriers scale for cardiac rehabilitation was good (Cronbach-alpha = 0.84). The ICC found was 0.711 (95% CI; 0.423-0.860). The reproducibility by domains was as follows: for the logistic factor (ICC: 0.76; 95% CI; 0.56-0.88); for the comorbidities/functional state (ICC: 0.73; 95% CI; 0.51-0.86); for the health perception factor (ICC: 0.66; 95% CI; 0.38-0.83; and finally for the work/time conflicts factor (ICC: 0.56; 95% CI; 0.29-0.78). The mean score per patient was 2.3 ± 0.7 and 2.0 ± 0.7 in the first and second evaluation, respectively (p =.0071). Conclusion: The barriers scale for cardiac rehabilitation has an acceptable reliability in the Colombian population evaluated. The identification of barriers using this scale will help to develop strategies to increase the participation and adherence to cardiac rehabilitation programs focused on the real needs of the patients.

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Revista Colombiana de Cardiologia

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Human predecidual stromal cells have distinctive characteristics of pericytes: Cell contractility, chemotactic activity, and expression of pericyte markers and angiogenic factors

Introduction Human decidual stromal cells (DSCs) play a key role in maternal–fetal interactions. Precursors of DSCs (preDSCs) localize around vessels in both the endometrium and decidua. Previous studies suggested a relationship between preDSCs and pericytes because these cells share a perivascular location, alpha smooth muscle actin (α-SM actin) expression and the ability to contract under the effects of cytokines. Methods To further study this relationship, we established 15 human preDSC lines and 3 preDSC clones. The preDSC lines and clones were tested by flow cytometry with a panel of 29 monoclonal antibodies, 14 of which are pericyte markers. The expression of angiogenic factors was determined by RT-PCR, chemotactic activity was studied with the migration assay, and cell contractility was evaluated with the collagen cell contraction assay. Confocal microscopy was used to study decidual sections. Results Under the effect of progesterone and cAMP, these lines decidualized in vitro: the cells became rounder and secreted prolactin, a marker of physiological DSC differentiation (decidualization). The antigen phenotype of these preDSC lines and clones was fully compatible with that reported for pericytes. PreDSC lines displayed pericyte characteristics: they expressed angiogenic factors and showed chemotactic and cytokine-induced contractile activity. Confocal microscopic examination of decidual sections revealed the expression of antigens detected in preDSC lines: α-SM actin colocalized with CD146, CD140b, MFG-E8, nestin, and STRO-1 (all of which are pericyte markers) in cells located around the vessels, a distinctive location of preDSCs and pericytes. Discussion Taken together, our results show that preDSCs are pericyte-like cells.

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Placenta

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Design and baseline characteristics of participants in the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial on the cardiovascular effects of dulaglutide

The aim was to determine the effects of dulaglutide, a synthetic once-weekly, injectable human glucagon-like peptide 1 analogue that lowers blood glucose, body weight, appetite and blood pressure, on cardiovascular outcomes. People with type 2 diabetes, aged ≥50 years, with glycated haemoglobin (HbA1c) ≤9.5%, and either a previous cardiovascular event, evidence of cardiovascular disease or ≥2 cardiovascular risk factors were randomly allocated to a weekly subcutaneous injection of either dulaglutide (1.5 mg) or placebo and followed within the ongoing Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial every 3 to 6 months. The primary cardiovascular outcome is the first occurrence of the composite of cardiovascular death or non-fatal myocardial infarction or non-fatal stroke. Secondary outcomes include each component of the primary composite cardiovascular outcome, a composite clinical microvascular outcome comprising retinal or renal disease, hospitalization for unstable angina, heart failure requiring hospitalization or an urgent heart failure visit, and all-cause mortality. Follow-up will continue until the accrual of 1200 confirmed primary outcomes. Recruitment of 9901 participants (mean age 66 years, 46% women) occurred in 370 sites located in 24 countries over a period of 2 years. The mean duration of diabetes was 10 years, mean baseline HbA1c was 7.3%, and 31% had prior cardiovascular disease. The REWIND trial\'s international scope, high proportion of women, high proportion of people without prior cardiovascular disease and inclusion of participants whose mean baseline HbA1c was 7.3% suggests that its cardiovascular and safety findings will be directly relevant to the typical middle-aged patient seen in general practice throughout the world.

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Diabetes, Obesity and Metabolism

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Design of a residential microgrid in Lagos del Cacique, Bucaramanga, Colombia

In this paper is presented a model that analyses the options to provide energy to an interconnected house in Lagos del Cacique, Bucaramanga, Colombia. Three power supplies were considered: photovoltaic, 1 kW wind turbine, and a 2.6kW gasoline generator, as well as a battery for energy storage. The variables considered for the sensitivity analysis correspond to the price of gasoline and the variation in loads. The simulation results suggest an optimal configuration of microgrids in generator-photovoltaic panel-battery. Sensitivity variables were specified in order to evaluate the effect of uncertainty. The simulation was done through the Homer software and the results of the combinations of sources are suggestions of the same.

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Journal of Physics: Conference Series

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The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study

Background Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels. Methods In this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering. Findings Between Jan 1, 2003, and Dec 31, 2010, 168 916 participants were enrolled, of whom 141 945 completed the IPAQ. Analyses were limited to the 130 843 participants without pre-existing CVD. Compared with low physical activity (<600 metabolic equivalents [MET] × minutes per week or <150 minutes per week of moderate intensity physical activity), moderate (600–3000 MET × minutes or 150–750 minutes per week) and high physical activity (>3000 MET × minutes or >750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74–0·87 and 0·65, 0·60–0·71; p<0·0001 for trend), and major CVD (0·86, 0·78–0·93; p<0·001 for trend). Higher physical activity was associated with lower risk of CVD and mortality in high-income, middle-income, and low-income countries. The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0% for mortality and 4·6% for major CVD, and for not meeting high physical activity was 13·0% for mortality and 9·5% for major CVD. Both recreational and non-recreational physical activity were associated with benefits. Interpretation Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario SPOR Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, GSK, Novartis, King Pharma, and national and local organisations in participating countries that are listed at the end of the Article.

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The Lancet

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Environmental and socio-economic determinants associated with the occurrence of cutaneous leishmaniasis in the northeast of Colombia

Background: Cutaneous leishmaniasis (CL) is a vector-borne disease that is widely distributed in most tropical regions. Colombia has experienced an important increase in its incidence during the last decade. There are CL transmission foci in the Colombian departments of Santander and Norte de Santander. Objectives: To identify environmental and socio-economic variables associated with CL incidence in the municipalities of the northeast of Colombia between 2007 and 2016. Methods: This was an ecological study of CL cases aggregated by municipality. The cases reported during the study period were analyzed with a negative binomial regression to obtain the adjusted incident rate ratio for environmental and socio-economic variables. Findings: During the study period, 10 924 cases of CL were reported, and 110 (86.6%) municipalities reported at least one CL case. The coverages of forest (aIRR 1.05, 95% CI 1.03-1.07), heterogeneous agricultural zones (aIRR 1.04, 95% CI 1.02-1.06) and permanent crops (aIRR 1.07, 95% CI 1.02-1.12) were associated with a higher incidence of CL. Conversely, urban functionality (aIRR 0.95, 95% CI 0.92-0.96), minimal-altitude above sea level (aIRR 0.84, 95% CI 0.79-0.90) and shrub coverage (aIRR 0.98, 95% CI 0.95-1.0) were negatively associated with the incidence of CL in the municipality. Main conclusions: Our results confirm the importance of environmental determinants, such as height above sea level, and coverage of forest, permanent crops and heterogeneous agricultural zones, for the occurrence of CL; these findings also suggest the importance of shrub coverage. Furthermore, urban functionality was a socio-economic determinant independently associated with CL incidence.

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Transactions of the Royal Society of Tropical Medicine and Hygiene

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Risk factors for health care–associated infection in hospitalized adults: Systematic review and meta-analysis

Background Health care–associated infections (HAIs) are a public health problem that increase health care costs. This article aimed to systematically review the literature and meta-analyze studies investigating risk factors (RFs) independently associated with HAIs in hospitalized adults. Methods Electronic databases (MEDLINE, Embase, and LILACS) were searched to identify studies from 2009-2016. Pooled risk ratios (RRs) or odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated and compared across the groups. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results Of 867 studies, 65 met the criteria for review, and the data of 18 were summarized in the meta-analysis. The major RFs independently associated with HAIs were diabetes mellitus (RR, 1.76; 95% CI, 1.27-2.44), immunosuppression (RR, 1.24; 95% CI, 1.04-1.47), body temperature (MD, 0.62; 95% CI, 0.41-0.83), surgery time in minutes (MD, 34.53; 95% CI, 22.17-46.89), reoperation (RR, 7.94; 95% CI, 5.49-11.48), cephalosporin exposure (RR, 1.77; 95% CI, 1.30-2.42), days of exposure to central venous catheter (MD, 5.20; 95% CI, 4.91-5.48), intensive care unit (ICU) admission (RR, 3.76; 95% CI, 1.79-7.92), ICU stay in days (MD, 21.30; 95% CI, 19.81-22.79), and mechanical ventilation (OR, 12.95; 95% CI, 6.28-26.73). Conclusions Identifying RFs that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.

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American Journal of Infection Control

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Secondary CV Prevention in South America in a Community Setting: The PURE Study

Background Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. Objectives This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. Methods In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. Results Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. Conclusions There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.

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Global Heart

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Reproducibility of left ventricular global longitudinal strain using two-dimensional ultrasound speckle tracking: Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction Advanced echocardiography techniques, such as the global longitudinal strain using two-dimensional ultrasound speckle tracking, have been proposed for the detection of early changes in the left ventricular systolic function. The evaluation of the reproducibility of left ventricular global longitudinal strain is essential for its clinical application in different scenarios. Objective To determine the reproducibility of left ventricular global longitudinal strain in individuals from a Brazil cohort study. Methods The reproducibility of left ventricular global longitudinal strain was evaluated by the reading and analysis of echocardiograph images of a random sample of 50 participants of the baseline Longitudinal Study of Adult Health (ELSA-Brasil). Results The mean age of the participants was 49.7 ± 7.3 years, of whom 54% were women, and the mean global longitudinal strain was –19.5% ± 1.9%. The inter-observer reproducibility of the mean global longitudinal strain, had a coefficient of variation of 7.4%, and an intra-class correlation of 0.76 (95% CI: 0.61 – 0.86). The analysis of the inter-observer agreement of the global longitudinal strain measurements using the Bland and Altman method showed a mean differences of 0.1% ± 1.4%, and upper and lower limits of agreement of 2.9 and –2.7, respectively. Conclusions There was adequate reproducibility of the left ventricular global longitudinal strain measurements in participants of the ELSA-Brasil study, and the values were similar to those reported in other longitudinal epidemiological studies. The findings reinforce the use of the global longitudinal strain as a clinical marker of myocardial deformation, capable of detecting subclinical changes in myocardial contractility.

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Revista Colombiana de Cardiologia

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Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study

Background The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. Methods We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. Findings Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5–9·3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74–1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74–1·31; ptrend=0·2033), stroke (0·92, 0·67–1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53–1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68–1·04; ptrend =0·0038), and total mortality (0·81, 0·68–0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69–0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality. Interpretation Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375–500 g/day). Funding Full funding sources listed at the end of the paper (see Acknowledgments).

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The Lancet

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Interaction between epidemiological risk factors associated with Cystoisospora suis infection in swine intensive herís

It was carried out an investigation in Venezuela during 2016 with the aim to determine statistical association between some risk factor\'s and Cystoisospora suis in swine intensive herds. Sixty-seven farms with a history of neonatal diarrhea were selected. 10% of the litters were sampled, and from each selected litter, 4 to 5 piglets were selected. A hyssop were introduced by rectal way with the purpose of causing stimulation and collect the stool sample. An epidemiological survey was applied on each farm. The stool samples were cultivated in a 2.5% potassium dichromate solution during 24 h and later processed with a concentration - flotation technique. The results indicate that C. suis was found on 55 farms (82.1%). According to the bivariate analysis, statistical association (P < 0.05) were found between negative values with respect to the type of floors, disinfection programs and Veterinary presence. The size and type of farm had no statistical effect. According to the multivariate analysis, statistical association was determined between protocol 1 applied to plastic pallet floors in farms with good hygiene, as well as the permanence of the Veterinary, which are modalities that were associated with them and with the group of farms that were negative to C. suis. It is concluded that the multivariate analysis allows to evaluate the relationship between epidemiological factors that minimize the possibilities of proliferation and dissemination of the parasite in the herd, and should be considered in the control programs.

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Revista Electronica de Veterinaria

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Management of asthmatic crisis in children with heart diseases, do we have to know what to do?

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Archivos Argentinos de Pediatria

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Key Aspects in Foramen Magnum Meningiomas: From Old Neuroanatomical Conceptions to Current Far Lateral Neurosurgical Intervention

Foramen magnum meningiomas represent a challenge for neurosurgeons. These tumors require careful surgical manipulation as they are often located in proximity to critical neurovascular structures and the cranial nerves. The far lateral approach is considered the safest neurosurgical approach for excising foramen magnum lesions. It facilitates the access to the anterior foramen magnum and reduces the retraction of vital structures. We describe key historical, epidemiological, genetic, epigenetic, clinical, and neurosurgical aspects of foramen magnum meningiomas. We emphasize the far lateral approach for lesions arising in the foramen magnum, as well as the most appropriate patient positioning for such approach. Caring for these aspects will be rewarded with the best perioperative neurosurgical outcomes.

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World Neurosurgery

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Biomass and protein production of Chlorella vulgaris Beyerinck (Chlorellales: Chlorellaceae) via the design of selective culture media

In recent years, it has become more frequent the use of alternative culture media that use phosphorus and nitrogen sources as well as microelements, instead of using the more traditional ones. Therefore, in this study two mixotrophic culture media were designed with different sodium nitrate, potassium phosphate and sodium acetate/ammonium carbonate concentrations as carbon source, to evaluate the biomass and protein production of the microalgae Chlorella vulgaris Beyerinck. A Pareto diagram and a response surface plot were generated in order to know the significant influence that the study variables have on protein production. The results showed that higher biomass production (3.72 g/L for the culture with acetate and 2.17 g/L for the one with carbonate) are directly related to sodium nitrate (1.96 mM) and potassium phosphate (2.11 mM). In addition, the maximum protein values obtained were 60% and 34% for acetate and carbonate cultures, respectively, both with 2.94 mM of sodium nitrate. Finally, the Pareto diagram showed that for the culture based on acetate there was no significant variables that influenced protein production; whereas the culture with carbonate, sodium nitrate and potassium phosphate influenced significantly the production of this metabolite.

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Corpoica Ciencia y Tecnologia Agropecuaria

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Spontaneous perforation of the bile duct in a neonate. An unexpected finding. Case report

Introduction: Spontaneous extrahepatic bile duct perforation is rare in newborns. It is a surgical cause of jaundice in this period and the acute presentation is unusual. Objective: To report a case of spontaneous bile duct perforation in a newborn due to its serious complications if an early and timely diagnosis is not performed. Clinical case: A 10-day-old newborn who developed food rejection, fever and abdominal distension without jaundice, acolia, or coluria two days prior of admission. The laboratory tests showed leukopenia, thrombocytosis, increased C-reactive protein, and normal hepatic function. The abdominal x-ray showed pneumoperitoneum, and the diagnosis of necrotizing enterocolitis was made. Laparotomy was performed; extrahepatic bile duct perforation and biliary peritonitis were noted. Intraoperative cholangiography demonstrated rescatable proximal bile duct and dilated cystic duct. Hepatic-jejunostomy was performed with Roux-en-Y and cholecystectomy. In the postoperative study portal thrombosis was found, so he received anticoagulant treatment. At 8 months of age, the patient had enteral feeding tolerance and adequate weight gain. Conclusions: Biliary perforation is a rare entity and more in the neonatal period, a condition that makes it a diagnostic and therapeutic challenge. The prognosis will depend on early intervention and intraoperative findings.

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Revista Chilena de Pediatria

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Risk of bias and confounding of observational studies of Zika virus infection: A scoping review of research protocols

Introduction Given the severity and impact of the current Zika virus (ZIKV) outbreak in the Americas, numerous countries have rushed to develop research studies to assess ZIKV and its potential health consequences. In an effort to ensure that studies are comprehensive, both internally and externally valid, and with reliable results, the World Health Organization, the Pan American Health Organization, Institut Pasteur, the networks of Fiocruz, the Consortia for the Standardization of Influenza Seroepidemiology (CONSISE) and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) have generated six standardized clinical and epidemiological research protocols and questionnaires to address key public health questions on ZIKV. Methods We conducted a systematic search of ongoing study protocols related to ZIKV research. We analyzed the content of protocols of 32 cohort studies and 13 case control studies for systematic bias that could produce erroneous results. Additionally we aimed to characterize the risks of bias and confounding in observational studies related to ZIKV and to propose ways to minimize them, including the use of six newly standardized research protocols. Results Observational studies of ZIKV face an array of challenges, including measurement of exposure and outcomes (microcephaly and Guillain-Barré Syndrome). Potential confounders need to be measured where known and controlled for in the analysis. Selection bias due to non-random selection is a significant issue, particularly in the case-control design, and losses to follow-up is equally important for the cohort design. Conclusion Observational research seeking to answer key questions on the ZIKV should consider these restrictions and take precautions to minimize bias in an effort to provide reliable and valid results. Utilization of the standardized research protocols developed by the WHO, PAHO, Institut Pasteur, and CONSISE will harmonize the key methodological aspects of each study design to minimize bias at different stages of the study. Biases need to be considered by researchers implementing the standardized protocols as well as by users of observational epidemiological studies of ZIKV.

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PLoS ONE

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Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study

Background Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTER-CHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. Methods We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. Findings We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Interpretation Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. Funding The study was supported by Novartis.

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The Lancet Global Health

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The Relationship between Socioeconomic Status, Family Income, and Measures of Muscular and Cardiorespiratory Fitness in Colombian Schoolchildren

Objective To determine the associations between socioeconomic status (SES) and physical fitness in a sample of Colombian youth. Study design Prueba SER is cross-sectional survey of schoolchildren in Bogota, Colombia. Mass, stature, muscular fitness (standing long-jump, handgrip), and cardiorespiratory fitness (20-m shuttle run) were measured in 52 187 schoolchildren 14-16 years of age. Area-level SES was categorized from 1 (very low) to 4 (high) and parent-reported family income was categorized as low, middle, or high. Results Converting measures into z scores showed stature, muscular, and cardiorespiratory fitness were significantly (z = 0.3-0.7) below European values. Children in the mid- and high SES groups jumped significantly further than groups with very low SES. Differences were independent of sex but became nonsignificant when adjusted for anthropometric differences. Participants in the mid-SES and high-SES groups had better handgrip scores when adjusted for body dimension. There were, however, no significant between-group differences in cardiorespiratory fitness, which was strongly clustered by school and significantly greater in students from private schools. Conclusions Area-level SES is associated with measures of muscular fitness in Colombian schoolchildren. These associations were largely explained by the large differences in body dimensions observed between SES groups. When area-level SES is considered, there was no evidence that family income influenced fitness. The clustering of outcomes reaffirms the potential importance of schools and area-level factors in promoting fitness through opportunities for physical activity. Interventions implemented in schools, can improve academic attainment; a factor likely to be important in promoting the social mobility of children from poorer families.

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Journal of Pediatrics

Título del artículo:

Cyclic Vomiting Syndrome is characterized by altered functional brain connectivity of the insular cortex: A cross-comparison with migraine and healthy adults

Cyclic Vomiting Syndrome (CVS) has been linked to episodic migraine, yet little is known about the precise brain-based mechanisms underpinning CVS, and whether these associated conditions share similar pathophysiology. We investigated the functional integrity of salience (SLN) and sensorimotor (SMN) intrinsic connectivity networks in CVS, migraine and healthy controls using brain functional Magnetic Resonance Imaging. CVS, relative to both migraine and controls, showed increased SLN connectivity to middle/posterior insula, a key brain region for nausea and viscerosensory processing. In contrast, this same region showed diminished SMN connectivity in both CVS and migraine. These results highlight both unique and potentially shared pathophysiology between these conditions, and suggest a potential target for therapeutics in future studies.

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Neurogastroenterology and Motility

Título del artículo:

DNA secondary structure formation by DNA shuffling of the conserved domains of the Cry protein of Bacillus thuringiensis

Background: The Cry toxins, or δ-endotoxins, are a diverse group of proteins produced by Bacillus thuringiensis. While DNA secondary structures are biologically relevant, it is unknown if such structures are formed in regions encoding conserved domains of Cry toxins under shuffling conditions. We analyzed 5 holotypes that encode Cry toxins and that grouped into 4 clusters according to their phylogenetic closeness. The mean number of DNA secondary structures that formed and the mean Gibbs free energy Δ G $$ \\left(\\overline(\\varDelta G)\\right) $$ were determined by an in silico analysis using different experimental DNA shuffling scenarios. In terms of spontaneity, shuffling efficiency was directly proportional to the formation of secondary structures but inversely proportional to ΔG. Results: The results showed a shared thermodynamic pattern for each cluster and relationships among sequences that are phylogenetically close at the protein level. The regions of the cry11Aa, Ba and Bb genes that encode domain I showed more spontaneity and thus a greater tendency to form secondary structures (<ΔG). In the region of domain III; this tendency was lower (>ΔG) in the cry11Ba and Bb genes. Proteins that are phylogenetically closer to Cry11Ba and Cry11Bb, such as Cry2Aa and Cry18Aa, maintained the same thermodynamic pattern. More distant proteins, such as Cry1Aa, Cry1Ab, Cry30Aa and Cry30Ca, featured different thermodynamic patterns in their DNA. Conclusion: These results suggest the presence of thermodynamic variations associated to the formation of secondary structures and an evolutionary relationship with regions that encode highly conserved domains in Cry proteins. The findings of this study may have a role in the in silico design of cry gene assembly by DNA shuffling techniques.

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BMC Biophysics

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Technological surveillance of aromatic species: From research to the consolidation of the productive chain in Colombia

The sector of aromatic, medicinal and seasoning herbs brings together a wide variety of native and introduced species with agroindustrial potential. In order to contribute to the technological assessment of the sector in Colombia and provide elements of strategic planning towards higher levels of development and internationalization. We prioritized certain aromatic species in this article and a technological surveillance was made during 2004-2014. A searching scientific articles and patents was made in eight national, iberoamericanand worldwide databases according prioritized issues. Data processing was performed using Microsoft Excel, EndNote, Vantage Point (2014) Thomson Data Analyzer programs. At National level, the planting material and breeding has been the main researched topic; whereas in iberoamerica and the world was biocidal effect. The leading countries in research on the monitored aromatic plants were Brazil, Colombia and Cuba. Internationally, the scientific leaders according to PubMed and Scopus were India, USA, Brazil and Colombia. The global trend in the field of patents has increased, whose main focus is: \"Current needs of life\". This technological surveillance gives an overview of developments and trends in research and technological development in different subject areas within the aromatic plants, besides identifying possible allied research and the scientific production trends over time.

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Corpoica Ciencia y Tecnologia Agropecuaria