A unified European hydrogen infrastructure planning to support the rapid scale-up of hydrogen production.

Hydrogen will become a key player in transitioning toward a net-zero energy system. However, a clear pathway toward a unified European hydrogen infrastructure to support the rapid scale-up of hydrogen production is still under discussion. This study explores plausible pathways using a fully sector-coupled energy system model. Here, we assess the emergence of hydrogen infrastructure build-outs connecting neighboring European nations through hydrogen import and domestic production centers with Western and Central European demands via four distinct hydrogen corridors. We identify a potential lock-in effect of blue hydrogen in the medium term, highlighting the risk of long-term dependence on methane. In contrast, we show that a self-sufficient Europe relying on domestic green hydrogen by 2050 would increase yearly expenses by around 3% and require 518 gigawatts of electrolysis capacity. This study emphasizes the importance of rapidly scaling up electrolysis capacity, building hydrogen networks and storage facilities, deploying renewable electricity generation, and ensuring coherent coordination across European nations.

Vortex Effects in Merging Black Holes and Saturons.

Vorticity has recently been suggested to be a property of highly spinning black holes. The connection between vorticity and limiting spin represents a universal feature shared by objects of maximal microstate entropy, so-called saturons. Using Q-ball-like saturons as a laboratory for black holes, we study the collision of two such objects and find that vorticity can have a large impact on the emitted radiation as well as on the charge and angular momentum of the final configuration. As black holes belong to the class of saturons, we expect that the formation of vortices can cause similar effects in black hole mergers, leading to macroscopic deviations in gravitational radiation. This could leave unique signatures detectable with upcoming gravitational-wave searches, which can thereby serve as a portal to macroscopic quantum effects in black holes.

Prospective, multicenter, uncontrolled study on the effectiveness and safety of a hyaluronic acid water-based vaginal lubricant in alleviating vaginal dryness and dyspareunia.

BACKGROUND: Vaginal dryness (VD) represents a significant concern affecting women across diverse life stages, encompassing both pre- and postmenopausal women at any age. Dyspareunia, defined by genital pain that can be experienced before, during, or after intercourse, is often associated with vaginal dryness. AIM: This study aimed to evaluate the effectiveness and safety of a water-based vaginal lubricant with hyaluronic acid to reduce sexual discomfort associated with vaginal dryness. METHODS: A prospective, multicenter, uncontrolled clinical investigation was conducted over a three-month period in women aged 18 years or older experiencing pain or difficulty during sexual intercourse for whom the use of a vaginal lubricant was recommended. RESULTS: Significant improvements were observed in the FSFI scores, indicating enhanced sexual function (p < .001). Vaginal dryness symptoms, including irritation, dryness, itching, and dyspareunia, significantly decreased after product use (p < .001). CLINICAL IMPLICATIONS: This study contributes to the limited scientific knowledge on the application of lubricants in the context of symptoms associated with VD. STRENGTHS & LIMITATIONS: In addition to the short study period, inherent limitations of the study design, and lack of placebo control, it is pertinent to acknowledge that some of the pros used in this study were not based on validated questionnaires. However, as far as we know, this study is the only one that analyzes well-being and sexual pleasure as results using a lubricant formulated with hyaluronic acid. CONCLUSION: This tested vaginal lubricant with hyaluronic acid has demonstrated efficacy in improving vaginal dryness and female sexual function, particularly in reducing pain and improving lubrication during sexual intercourse, and showed a favorable safety profile, with minimal and transient adverse events.

Transfusion-associated adverse events incidence and severity after the implementation of an active hemovigilance program with 24 h follow-up. A prospective cohort study.

BACKGROUND: Hemovigilance (HV) is usually based on voluntary reports (passive HV). Our aim is to ascertain credible incidence, severity, and mortality of transfusion-associated adverse events (TAAEs) using an active HV program. STUDY DESIGN AND METHODS: Prospective cohort study to estimate transfusion risk after 46,488 transfusions in 5830 patients, using an active HV program with follow-up within the first 24 h after transfusion. We compared these results to those with the previously established passive HV program during the same 30 months of the study. We explored factors associated with the occurrence of TAAEs using generalized estimating equations models. RESULTS: With the active HV program TAAEs incidence was 57.3 (95% CI, 50.5-64.2) and mortality 1.1 (95% CI, 0.13-2.01) per 10,000 transfusions. Incidence with the new surveillance model was 14.0 times higher than with the passive. Most events occurred when transfusions had already finished (60.2%); especially pulmonary events (80.4%). Three out of five deaths and 50.3% of severe TAAEs were pulmonary. In the multivariate analysis surgical patients had half TAAEs risk when compared to medical patients (OR, 0.53; 95% CI, 0.34-0.78) and women had nearly twice the risk of a pulmonary event compared to men (OR, 1.84; 95% CI, 1.03-3.32). Patient's age, blood component type, or blood component shelf-life were unrelated to TAAEs risk. DISCUSSION: Active hemovigilance programs provide additional data which may lead to better recognition and understanding of TAAEs and their frequency and severity.

Producción de biomasa y caracterización química de Lentinula edodes cultivado en biorreactor bajo diferentes condiciones

La ingeniería bioquímica juega un papel importante en el desarrollo tecnológico de los procesos de obtención ya sea de cuerpos fructíferos de setas con potencial medicinal para el consumo directo, o en la fabricación de nutracéuticos y/o suplementos dietarios. Esta investigación implementó una metodología en biorreactor para el cultivo del hongo macromiceto Lentinula edodes, conocido comúnmente como Shiitake, con el objetivo de evaluar el efecto que tienen la velocidad de agitación y el flujo de aire en la producción de biomasa y de metabolitos de mediana y baja polaridad. Se determinó que el rendimiento y la productividad más altos de producción de biomasa se logra a unas condiciones de 80 rpm y 0,50 vvm obteniendo 0,0260 g/g y 0,00433 g/L*h respectivamente. Igualmente, en cuanto a la composición de esta biomasa, se concluyó que se genera un máximo contenido de proteína (33,4% del micelio liofilizado) a unas condiciones de 140 rpm y 0,75 vvm, los esteroles alcanzaron un porcentaje de 89,32% del extracto en DCM a 80 rpm y 0,5 vvm. Los resultados del análisis por GC-MS confirman la amplia variedad de compuestos que se pueden obtener a partir de un cultivo en biorreactor del hongo Lentinula edodes.

Biochemical engineering plays an important role in the technological development of the processes for obtaining either mushroom fruiting bodies with medicinal potential for direct consumption, or in the manufacture of nutraceuticals and/or dietary supplements. This research implemented a methodology in a bioreactor for the cultivation of the Lentinula edodes macromycete fungus, commonly known as Shiitake, with the aim of evaluating the effect of agitation speed and air flow on the production of biomass and metabolites of median and low polarity. Thus, it was found that the highest yield and productivity of biomass production is achieved at conditions of 80 rpm and 0,50 vvm, obtaining 0,0260 g/g and 0,00433 g/L*h respectively. Likewise, in the study of the content of metabolites it was concluded that for the protein 33,4% of the lyophilized mycelium was reached at conditions of 140 rpm and 0,75 vvm, the sterols reached a percentage of 89,32% of the extract. in DCM at 80 rpm and 0,5 vvm. The results of the GC-MS analysis confirm the wide variety of compounds that can be obtained from a bioreactor culture of the Lentinula edodes fungus.

What's inside is all that counts? The contours of everyday thinking about self-control.

Does self-control require willpower? The question cuts to the heart of a debate about whether self-control is identical with some psychological process internal to the agents or not. Noticeably absent from these debates is systematic evidence about the folk-psychological category of self-control. Here, we present the results of two behavioral studies (N = 296) that indicate the structure of everyday use of the concept. In Study 1, participants rated the degree to which different strategies to respond to motivational conflict exemplify self-control. Participants distinguished between intra-psychic and externally-scaffolded strategies and judged that the former exemplified self-control more than the latter. In Study 2, participants provided various solutions to manage motivational conflict and rated their proposals on effectiveness. Participants produced substantially more intra-psychic strategies, rated them as more effective, and advised them at a higher rate than externally-scaffolded strategies. Taken together, these results suggest that while people recognize a plurality of strategies as genuine instances of self-control, purely internal exercises of self-control are considered more prototypical than their externally-scaffolded counterparts. This implies a hierarchical structure for the folk psychological category of self-control. The concept encompasses a variety of regulatory strategies and organizes these strategies along a hierarchical continuum, with purely intra-psychic strategies at the center and scaffolded strategies in the periphery. Supplementary Information: The online version contains supplementary material available at 10.1007/s13164-021-00573-2.

Moralization and self-control strategy selection.

To manage conflicts between temptation and commitment, people use self-control. The process model of self-control outlines different strategies for managing the onset and experience of temptation. However, little is known about the decision-making factors underlying strategy selection. Across three experiments (N = 317), we tested whether the moral valence of a commitment predicts how people advise attentional self-control strategies. In Experiments 1 and 2, people rated attentional focus strategies as significantly more effective for people tempted to break moral relative to immoral commitments, even when controlling for perceived temptation and trait self-control. Experiment 3 showed that as people perceived commitments to have more positive moral valence, they judged attentional focus strategies to be significantly more effective relative to attentional distraction strategies. Moreover, this effect was partly mediated by perceived differences in motivation. These results indicate that moralization informs decision-making processes related to self-control strategy selection.

TransformEHRs: a flexible methodology for building transparent ETL processes for EHR reuse.

BACKGROUND: During the COVID-19 pandemic, several methodologies were designed for obtaining electronic health record (EHR)-derived datasets for research. These processes are often based on black boxes, on which clinical researchers are unaware of how the data were recorded, extracted, and transformed. In order to solve this, it is essential that extract, transform, and load (ETL) processes are based on transparent, homogeneous, and formal methodologies, making them understandable, reproducible, and auditable. OBJECTIVES: This study aims to design and implement a methodology, according with FAIR Principles, for building ETL processes (focused on data extraction, selection, and transformation) for EHR reuse in a transparent and flexible manner, applicable to any clinical condition and health care organization. METHODS: The proposed methodology comprises four stages: (1) analysis of secondary use models and identification of data operations, based on internationally used clinical repositories, case report forms, and aggregated datasets; (2) modeling and formalization of data operations, through the paradigm of the Detailed Clinical Models; (3) agnostic development of data operations, selecting SQL and R as programming languages; and (4) automation of the ETL instantiation, building a formal configuration file with XML. RESULTS: First, four international projects were analyzed to identify 17 operations, necessary to obtain datasets according to the specifications of these projects from the EHR. With this, each of the data operations was formalized, using the ISO 13606 reference model, specifying the valid data types as arguments, inputs and outputs, and their cardinality. Then, an agnostic catalog of data was developed through data-oriented programming languages previously selected. Finally, an automated ETL instantiation process was built from an ETL configuration file formally defined. CONCLUSIONS: This study has provided a transparent and flexible solution to the difficulty of making the processes for obtaining EHR-derived data for secondary use understandable, auditable, and reproducible. Moreover, the abstraction carried out in this study means that any previous EHR reuse methodology can incorporate these results into them.

Interrogating the transmission dynamics of Trypanosoma cruzi (Trypanosomatida, Trypanosomatidae) by Triatoma venosa (Hemiptera: Reduviidae) after the elimination of vector transmission by Rhodnius prolixus in Boyacá eastern Colombia.

Chagas disease (CD) is a parasitic zoonosis (Trypanosoma cruzi) that is endemic in Colombia. Vector control of Rhodnius prolixus, the main domestic T. cruzi vector, has been achieved in a large part of the area with historically vector transmission of CD. It is necessary to understand the ecological behavior characteristics of local native vectors to ensure sustainability of the vector control programs. To evaluate the long-term success of a recent vector control campaign in the Boyacá department (Colombia), we used a combined strategy of entomological surveillance with co-existing canine surveillance from ten rural villages within six municipalities of the Tenza valley region (Boyacá, Colombia): Chinavita, Garagoa, Guateque, Somondoco, Sutatenza and Tenza, with historical reports of R. prolixus and secondary vectors. Collected triatomines and canine whole blood were analyzed for T. cruzi infection and genotyping. Triatomine bugs specimens were evaluated for blood meal source. Canine serology was performed using two distinct antibody assays. In total, 101 Triatoma venosa were collected by active search in domestic and peridomestic habitats. A natural infection prevalence of 13.9% (14/101) and four feeding sources were identified: human, dog, rat, and hen. A frequency infection of 46.5% (40/87) was observed from two independent serological tests and T. cruzi DNA was detected in 14 dogs (16.4%). Only TcIsylvatic DTU was detected. The results suggest that T. venosa present eco-epidemiological characteristics to maintain the transmission of T. cruzi in Tenza valley. This species has reinfested the intervened households and it has an active role in domestic and peridomestic transmission of T. cruzi due to their infection rates and feeding behavior. Therefore, this species should be considered as epidemiologically relevant for vector control strategies. Moreover, there is a need for human serological studies to have a close up of risk they are exposed to.

Will-powered: Synchronic regulation is the difference maker for self-control.

Philosophers, psychologists, and economists have reached the consensus that one can use two different kinds of regulation to achieve self-control. Synchronic regulation uses willpower to resist current temptation. Diachronic regulation implements a plan to avoid future temptation. Yet this consensus may rest on contaminated intuitions. Specifically, agents typically use willpower (synchronic regulation) to achieve their plans to avoid temptation (diachronic regulation). So even if cases of diachronic regulation seem to involve self-control, this may be because they are contaminated by synchronic regulation. We therefore developed a novel multifactorial method to disentangle synchronic and diachronic regulation. Using this method, we find that ordinary usage assumes that only synchronic--not diachronic--regulation counts as self-control. We find this pattern across four experiments involving different kinds of temptation, as well as a paradigmatic case of diachronic regulation based on the classic story of Odysseus and the Sirens. Our final experiment finds that self-control in a diachronic case depends on whether the agent uses synchronic regulation at two moments: when she (1) initiates and (2) follows-through on a plan to resist temptation. Taken together, our results strongly suggest that synchronic regulation is the sole difference maker in the folk concept of self-control.

Making EHRs Trustable: A Quality Analysis of EHR-Derived Datasets for COVID-19 Research.

One approach to verifying the quality of research data obtained from EHRs is auditing how complete and correct the data are in comparison with those collected by manual and controlled methods. This study analyzed data quality of an EHR-derived dataset for COVID-19 research, obtained during the pandemic at Hospital Universitario 12 de Octubre. Data were extracted from EHRs and a manually collected research database, and then transformed into the ISARIC-WHO COVID-19 CRF model. Subsequently, a data analysis was performed, comparing both sources through this convergence model. More concepts and records were obtained from EHRs, and PPV (95% CI) was above 85% in most sections. In future studies, a more detailed analysis of data quality will be carried out.

Building an i2b2-Based Population Repository for COVID-19 Research.

Reuse of Electronic Health Records (EHRs) for specific diseases such as COVID-19 requires data to be recorded and persisted according to international standards. Since the beginning of the COVID-19 pandemic, Hospital Universitario 12 de Octubre (H12O) evolved its EHRs: it identified, modeled and standardized the concepts related to this new disease in an agile, flexible and staged way. Thus, data from more than 200,000 COVID-19 cases were extracted, transformed, and loaded into an i2b2 repository. This effort allowed H12O to share data with worldwide networks such as the TriNetX platform and the 4CE Consortium.

Diagnosis and management of delirium in hospital oncology services.

The diagnosis of delirium in oncologic services is a challenge; nowadays, there is very little evidence-based information available to guide the medical personnel in the diagnosis and decision taking regarding delirium in the oncologic patient. This article provides an updated review of the literature with extensive information on delirium in patients with cancer; the subject includes its definition, clinical features, precipitating and triggering factors, the frequency of delirium in oncological patients, its consequences, its treatment, and prognosis.

The skill of self-control.

Researchers often claim that self-control is a skill. It is also often stated that self-control exertions are intentional actions. However, no account has yet been proposed of the skillful agency that makes self-control exertion possible, so our understanding of self-control remains incomplete. Here I propose the skill model of self-control, which accounts for skillful agency by tackling the guidance problem: how can agents transform their abstract and coarse-grained intentions into the highly context-sensitive, fine-grained control processes required to select, revise and correct strategies during self-control exertion? The skill model borrows conceptual tools from 'hierarchical models' recently developed in the context of motor skills, and asserts that self-control crucially involves the ability to manage the implementation and monitoring of regulatory strategies as the self-control exercise unfolds. Skilled agents are able do this by means of flexible practical reasoning: a fast, context-sensitive type of deliberation that incorporates non-propositional representations (including feedback signals about strategy implementation, such as the feeling of mental effort) into the formation and revision of the mixed-format intentions that structure self-control exertion. The literatures on implementation intentions and motivation framing offer corroborating evidence for the theory. As a surprising result, the skill of self-control that allows agents to overcome the contrary motivations they experience is self-effacing: instead of continuously honing this skill, expert agents replace it with a different one, which minimizes or prevents contrary motivations from arising in the first place. Thus, the more expert you are at self-control, the less likely you are to use it.

Intentional mind-wandering as intentional omission: the surrealist method.

Mind-wandering seems to be paradigmatically unintentional. However, experimental findings have yielded the paradoxical result that mind-wandering can also be intentional. In this paper, we first present the paradox of intentional mind-wandering and then explain intentional mind-wandering as the intentional omission to control one's own thoughts. Finally, we present the surrealist method for artistic production to illustrate how intentional omission of control over thoughts can be deployed towards creative endeavors.

Aspectos epidemiológicos, clínicos y paraclínicos del accidente escorpiónico en el Hospital Universitario de Neiva, Colombia / Epidemiological, clinical and paraclinical aspects of the scorpion accident at the University Hospital of Neiva, Colombia

RESUMEN Objetivo: describir las características sociodemográficas, clínicas y paraclínicas de los pacientes atendidos en el Hospital Universitario de Neiva, entre los años 2014 y 2018 e identificar los factores de riesgo que se asocien con la mortalidad. Materiales y métodos: estudio observacional analítico retrospectivo. Se calcularon las medias, la desviación estándar, frecuencias absolutas y relativas. Se realizó un análisis de normalidad con el Test de Shapiro-Wilk. Se evaluó la asociación de diferentes variables sociodemográficas y clínicas con el riesgo de mortalidad usando regresión logística. Resultados: se registraron 305 eventos, predominantemente leves (117 casos). El 2018 fue el año con mayor número de reportes (35,45 %). La mayoría eran personas jóvenes con una edad media de 17 años, principalmente de los 0 a 11 años (61 %). Más del 90% eran pacientes residentes del departamento Huila y más de la mitad (67 %) pertenecían al régimen subsidiado. La mayoría de las picaduras ocurrieron durante el día, siendo las extremidades la ubicación más frecuentemente reportada (82 %). Se encontró una asociación estadísticamente significativa entre un cuadro grave y la mayor necesidad de UCI. Conclusiones: el escorpionismo es un problema de salud pública infravalorado en Colombia. La población pediátrica tiene mayor riesgo de desarrollar complicaciones y síntomas graves en la escorpiotoxicosis. Un cuadro grave en cualquier edad aumenta la probabilidad de ingreso a una UCI, requerimiento frecuente de soporte hídrico e inotrópico y la necesidad de antihipertensivos, al igual que dosis elevadas de antiveneno.

SUMMARY Objective: To describe the sociodemographic, clinical and paraclinical characteristics of the patients treated at the Neiva University Hospital between 2014 and 2018, and identify risk factors that are associated with mortality. Materials and Methods: Observational, analytic retrospective, study. Absolute and relative frequencies were calculated. Normality analysis was performed with the Shapiro-Wilk Test. The relationship of different sociodemographic and clinical variables and the risk of mortality were evaluated using logistic regression. Results: 305 events were registered, predominantly mild (117 cases), being 2018 the year with the highest number of reports (35.45%). Most were young people, with a mean age of 17 years, mainly between 0-11 years (61%). More than 90% resided in the Huila department and more than half (67%) belonged to the subsidized regime. Most bites occurred during the day, with the extremities being the most frequently reported location (82%). A statistically significant association was found between a severe condition and an increased need for an ICU. Conclusions: Scorpionism is an undervalued public health problem in Colombia. The pediatric population is at increased risk of developing severe complications and symptoms in scorpiotoxicosis. A severe condition at any age increases the probability of ICU admission, more frequent requirement for inotropic and liquids supply, and the use of antihypertensive drugs and high doses of anti-venom.

El ejercicio médico en el siglo XXI. Retos y rescate del método clínico / Medical practice in the twenty-first century. Challenges and rescue of the clinical method

Resumen El método clínico, desde su creación en la Grecia antigua, no ha tenido mayores cambios en sus componentes y aplicación. Sin embargo, desde hace un tiempo se ha venido vulnerando debido al gran impacto que ha tenido la tecnología en las ciencias de la salud, y los nuevos paradigmas impuestos a la práctica clínica y la educación médica. El presente artículo describe los datos históricos más relevantes del método clínico, sus componentes científicos y su aplicación en la medicina, se resalta su importancia en todos los aspectos médicos, y se plasma una reflexión acerca de las causas de esta crisis y cómo involucra al profesional de medicina general en Colombia. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1997).

Abstract Since its inception in ancient Greece, the clinical method has experienced no major changes in its components and application. However, for some time now, it has been infringed upon by the high impact of technology on the healthcare sciences, and the new paradigms imposed on clinical practice and medical education. This article describes the most relevant historical data on the clinical method, its scientific components and its application in medicine, highlighting its importance in all medical aspects; and provides some thoughts on the reasons for this crisis and how it involves general medical practitioners in Colombia. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1997).

Perceiving utilitarian gradients: Heart rate variability and self-regulatory effort in the moral dilemma task.

It is not yet clear which response behavior requires self-regulatory effort in the moral dilemma task. Previous research has proposed that utilitarian responses require cognitive control, but subsequent studies have found inconsistencies with the empirical predictions of that hypothesis. In this paper, we treat participants' sensitivity to utilitarian gradients as a measure of performance. We confronted participants (N = 82) with a set of five dilemmas evoking a gradient of mean utilitarian responses in a 4-point scale and collected data on heart rate variability and utilitarian responses. We found positive correlations between tonic and phasic HRV and sensitivity to the utilitarian gradient in the high tonic group, but not in the low tonic group. Moreover, the low tonic group misplaced a scenario with a selfish incentive at the high end of the gradient. Results suggest that performance is represented by sensitivity correlated with HRV and accompanied with a reasonable placement of individual scenarios within the gradient.

Willpower needs tactical skill.

Ainslie advances our understanding of self-control by theoretically unifying multiple forms of willpower. But one crucial question remains unanswered: How do agents pick the right forms of willpower in each situation? I argue that willpower requires tactical skill, which detects willpower-demanding contexts, selects context-appropriate tactics, and monitors their implementation. Research on tactical skill will significantly advance our understanding of willpower.