On the persistence of near-surface temperature dynamics in a warming world.

We consider issues related to the effect of climate change on the persistence of (trend-corrected) temperatures using global gridded data for both land and oceans. We first discuss how the presence of trends and additive noise affects inference about persistence. Ignoring a trend induces an upward bias, while not accounting for noise induces a downward bias. We show that the increase in persistence in the commonly used Warm Spell Duration Index is simply an artifact of increasing temperatures. To purge the impact of both trends and noise, we adopt a simple state-space model. Of separate interest, we document a much larger noise component for land than for oceans. The estimates of the persistence are much larger for oceans than for land. Inspection of the estimates across various subsamples and the application of tests for structural changes suggest the same pattern of persistence for both land and oceans across time, with few minor exceptions. Hence, our results show that surface temperature persistence has remained constant during the observed period.

Anthropogenic influence on extremes and risk hotspots.

Study of the frequency and magnitude of climate extremes as the world warms is of utmost importance, especially separating the influence of natural and anthropogenic forcing factors. Record-breaking temperature and precipitation events have been studied using event-attribution techniques. Here, we provide spatial and temporal observation-based analyses of the role of natural and anthropogenic factors, using state-of-the-art time series methods. We show that the risk from extreme temperature and rainfall events has severely increased for most regions worldwide. In some areas the probabilities of occurrence of extreme temperatures and precipitation have increased at least fivefold and twofold, respectively. Anthropogenic forcing has been the main driver of such increases and its effects amplify those of natural forcing. We also identify risk hotspots defined as regions for which increased risk of extreme events and high exposure in terms of either high Gross Domestic Product (GDP) or large population are both present. For the year 2018, increased anthropogenic forcings are mostly responsible for increased risk to extreme temperature/precipitation affecting 94%/72% of global population and 97%/76% of global GDP relative to the baseline period 1961-1990.

Toward New Epidemiological Landscapes of Trypanosoma cruzi (Kinetoplastida, Trypanosomatidae) Transmission under Future Human-Modified Land Cover and Climatic Change in Mexico.

Chagas disease, caused by the protozoa Trypanosoma cruzi, is an important yet neglected disease that represents a severe public health problem in the Americas. Although the alteration of natural habitats and climate change can favor the establishment of new transmission cycles for T. cruzi, the compound effect of human-modified landscapes and current climate change on the transmission dynamics of T. cruzi has until now received little attention. A better understanding of the relationship between these factors and T. cruzi presence is an important step towards finding ways to mitigate the future impact of this disease on human communities. Here, we assess how wild and domestic cycles of T. cruzi transmission are related to human-modified landscapes and climate conditions (LUCC-CC). Using a Bayesian datamining framework, we measured the correlations among the presence of T. cruzi transmission cycles (sylvatic, rural, and urban) and historical land use, land cover, and climate for the period 1985 to 2012. We then estimated the potential range changes of T. cruzi transmission cycles under future land-use and -cover change and climate change scenarios for 2050 and 2070 time-horizons, with respect to "green" (RCP 2.6), "business-as-usual" (RCP 4.5), and "worst-case" (RCP 8.5) scenarios, and four general circulation models. Our results show how sylvatic and domestic transmission cycles could have historically interacted through the potential exchange of wild triatomines (insect vectors of T. cruzi) and mammals carrying T. cruzi, due to the proximity of human settlements (urban and rural) to natural habitats. However, T. cruzi transmission cycles in recent times (i.e., 2011) have undergone a domiciliation process where several triatomines have colonized and adapted to human dwellings and domestic species (e.g., dogs and cats) that can be the main blood sources for these triatomines. Accordingly, Chagas disease could become an emerging health problem in urban areas. Projecting potential future range shifts of T. cruzi transmission cycles under LUCC-CC scenarios we found for RCP 2.6 no expansion of favourable conditions for the presence of T. cruzi transmission cycles. However, for RCP 4.5 and 8.5, a significant range expansion of T. cruzi could be expected. We conclude that if sustainable goals are reached by appropriate changes in socio-economic and development policies we can expect no increase in suitable habitats for T. cruzi transmission cycles.

Substantial Out-of-Pocket Health Expenditure on Prenatal Check-Ups: Estimates from a Sample of Pregnant Women in Cartagena, Colombia.

OBJECTIVE: We aimed to estimate out-of-pocket (OOP) health expenditures and the indirect costs related to prenatal check-ups in pregnant women seen in a maternity hospital in the Colombian Caribbean region. METHODS: We described the economic costs of pregnant women, with no age limits, who attended prenatal check-ups in a maternity hospital. To estimate OOP and indirect costs owing to prenatal check-ups in pregnant women, a survey was constructed, where the woman was asked about some sociodemographic variables, to characterize those attending the prenatal check-ups. Absolute and relative frequencies, averages and confidence intervals were used to characterize the population and estimate OOP and indirect costs in pregnant women. The latter were estimated from the percentile method. A bootstrapping was performed to reduce the bias within the analysis. RESULTS: In total, 56 pregnant women were surveyed, with an average age of 25.9 years (±6.2). All women surveyed had OOP associated to the prenatal check-up in at least one cost-item, and the OOP ranged between $0.3 and $108.7. Transportation was the item with the highest frequency of expenses, followed by food, other expenses, and drugs. The mean of OOP expenditures was $24.3 (CI 95% $18.1-31.4) for women who attended their prenatal check-up. DISCUSSION: Considering the estimated OOP health expenditures caused by prenatal check-ups by household income, women living with <1 minimum wage spend 7% of their income in a prenatal check-up. In women with 1-2 and >2-3 minimum wages, these proportions were 5%, 3%, respectively. Unfortunately, this makes prenatal care a significant source of economic burden, impacting poor households in Cartagena.

Pressure Sensor Placement for Leak Localization in Water Distribution Networks Using Information Theory.

This paper presents a method for optimal pressure sensor placement in water distribution networks using information theory. The criterion for selecting the network nodes where to place the pressure sensors was that they provide the most useful information for locating leaks in the network. Considering that the node pressures measured by the sensors can be correlated (mutual information), a subset of sensor nodes in the network was chosen. The relevance of information was maximized, and information redundancy was minimized simultaneously. The selection of the nodes where to place the sensors was performed on datasets of pressure changes caused by multiple leak scenarios, which were synthetically generated by simulation using the EPANET software application. In order to select the optimal subset of nodes, the candidate nodes were ranked using a heuristic algorithm with quadratic computational cost, which made it time-efficient compared to other sensor placement algorithms. The sensor placement algorithm was implemented in MATLAB and tested on the Hanoi network. It was verified by exhaustive analysis that the selected nodes were the best combination to place the sensors and detect leaks.

Impacts of land management and climate change in a developing and socioenvironmental challenging transboundary region.

Land-use/cover change is the major cause of terrestrial ecosystem degradation. However, its impacts will be exacerbated due to climate change and population growth, driving agricultural expansion because of higher demand of food and lower agricultural yields in some tropical areas. International strategies aimed to mitigate impacts of climate change and land use-cover change are challenging in developing regions. This study aims to evaluate alternatives to minimize the impacts of these threats under socioeconomic trajectories, in one of the biologically richest regions in Guatemala and Mexico. This study is located at the Usumacinta watershed, a transboundary region that shares a common history, with similar biophysical properties and economic constraints which have led to large land use/cover changes. To understand the impacts on deforestation and carbon emissions of different land-management practices, we developed three scenarios (1): business as usual (BAU), (2) a reducing emissions scenario aimed to reduce deforestation and degradation (REDD+), and (3) zero-deforestation from 2030 onwards based on the international commitments. Our results suggest that by 2050, natural land cover might reduce 22.3 and 12.2% of its extent under the BAU and REDD + scenarios, respectively in comparison with 2012. However, the zero-deforestation scenario shows that by 2050, it would be possible to avoid losing 22.4% of the forested watershed (1.7 million ha) and recover 5.9% (0.4 million hectares) of it. In terms of carbon sequestration, REDD + projects can reduce the carbon losses in natural vegetation, but a zero-deforestation policy can double the carbon sequestration produced by REDD + projects only. This study shows that to reduce the pressures on ecosystems, particularly in regions highly marginalized with significant migration, it is necessary to implement transboundary land-management policies that also integrate poverty alleviation strategies.

Disentangling the trend in the warming of urban areas into global and local factors.

Large cities account for a significant share of national population and wealth, and exert high pressure on local and regional resources, exacerbating socioenvironmental risks. The replacement of natural landscapes with higher heat capacity materials because of urbanization and anthropogenic waste heat are some of the factors contributing to local climate change caused by the urban heat island (UHI) effect. Because of synergistic effects, local climate change can exacerbate the impacts of global warming in cities. Disentangling the contributions to warming in cities from global and local drivers can help to understand their relative importance and guide local adaptation policies. The canopy UHI intensity is commonly approximated by the difference between temperatures within cities and the surrounding areas. We present a complementary approach that applies the concept of common trends to extract the global contributions to observed warming in cities and to obtain a residual warming trend caused by local and regional factors. Once the effects of global drivers are removed, common features appear in cities' temperatures in the eastern part of the United States. Most cities experienced higher warming than that attributable to global climate change, and some shared a period of rapid warming during urban sprawl in the mid-20th century in the United States.

Economic impacts and risks of climate change under failure and success of the Paris Agreement.

The Nationally Determined Contributions (NDCs) represent the world's first effort toward the Paris Agreement goal of keeping global temperature increase well below 2 °C and pursuing 1.5 °C. Little is known about how much the proposed mitigation efforts can reduce the risks and economic damages from unabated climate change and about the consequences if key emitters drop the Paris Agreement. Here, we use CLIMRISK, an integrated assessment model designed to support climate policy at the global, national, and subnational scales where mitigation and adaptation policy decisions are made. We characterize the consequences of unabated climate change and the benefits of current climate policy proposals by means of probabilistic estimates of the economic damages of climate change and uni- and multivariate dynamic climate risk indices at a detailed spatial resolution. The results presented reveal that the economic costs and risks are highly unequally distributed between and within countries and larger than previously estimated when warming in urban areas and temporal persistence of impacts are accounted for. Costs and risks can be significantly limited by strict implementation of NDCs, but increase noticeably under noncompliance by large emitters, like the United States.

Iron status in late pregnancy is inversely associated with birth weight in Colombia.

OBJECTIVE: Gestational anaemia (GA) is common in developing countries. This study assessed the relationship of late GA and negative perinatal outcomes in participants recruited in a reference maternity unit of the Caribbean region of Colombia. DESIGN: Prospective analytical birth cohort study. Maternal Hb and serum ferritin (SF) levels were measured. GA was defined as Hb levels <6·82 mmol/l (<11 g/dl), SF depletion as SF levels <12 µg/l. Birth outcomes such as low birth weight (LBW), preterm birth (PB) and small for gestational age (SGA) were examined. SETTING: Mothers in the first stage of labour, living in urban or rural areas of Bolívar, were enrolled in an obstetrical centre located in Cartagena, Colombia. Blood and stool samples were taken prior delivery. Maternal blood count, SF levels and infant anthropometric data were recorded for analysis. PARTICIPANTS: 1218 pregnant women aged 18-42 years and their newborns. RESULTS: Prevalence of GA and SF depletion was 41·6 % and 41·1 %, respectively. GA was positively associated with poverty-related sociodemographic conditions. Prenatal care attendance lowered the risk of PB, LBW and SGA. Birth weight was inversely associated with Hb levels, observing a -36·8 g decrease in newborn weight per 0·62 mmol/l (or 1 g/dl) of maternal Hb. SF depletion, but not anaemia, was associated with PB. SGA outcome showed a significant association with anaemia, but not a significant relationship with SF depletion. CONCLUSIONS: Birth weight and other-related perinatal outcomes are negatively associated with Hb and SF depletion. Prenatal care attendance reduced the risk of negative birth outcomes.

Spatial variations in the warming trend and the transition to more severe weather in midlatitudes.

Due to various feedback processes called Arctic amplification, the high-latitudes' response to increases in radiative forcing is much larger than elsewhere in the world, with a warming more than twice the global average. Since the 1990's, this rapid warming of the Arctic was accompanied by no-warming or cooling over midlatitudes in the Northern Hemisphere in winter (the hiatus). The decrease in the thermal contrast between Arctic and midlatitudes has been connected to extreme weather events in midlatitudes via, e.g., shifts in the jet stream towards the equator and increases in the probability of high-latitude atmospheric blocking. Here we present an observational attribution study showing the spatial structure of the response to changes in radiative forcing. The results also connect the hiatus with diminished contrast between temperatures over regions in the Arctic and midlatitudes. Recent changes in these regional warming trends are linked to international actions such as the Montreal Protocol, and illustrate how changes in radiative forcing can trigger unexpected responses from the climate system. The lesson for climate policy is that human intervention with the climate is already large enough that even if stabilization was attained, impacts from an adjusting climate are to be expected.

Nurse and Nursing Students´ Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care.

It is widely accepted that nursing staff play a key role in palliative care (PC). The use of Nasogastric tubes (NG tubes) for Enteral Nutrition (EN) administration is still controversial in patients who receive PC. The aim of this study was to describe nurses' and nursing students´ opinions and perceptions about EN using NG tubes in adult patients in palliative care. To achieve this goal, a cross-sectional descriptive study was carried out. A self-administered, semi-structured questionnaire intended for nurses and nursing students was used. Data was descriptively and inferentially analyzed using a chi-square test to determine the differential frequency of responses. In addition, a multivariate logistic regression model was also conducted. A total of 511 participants completed the questionnaire. Among them, nursing staff represented 74.9% (n = 383) whereas nursing students were 25.1% (n = 128). When life expectancy was above six months, 90.0% (n = 460) reported that EN using NG should be implemented. In contrast, when life expectancy is less than a month, 57.5% (n = 294) discouraged it. Significant differences within groups were found when life expectancy was <1 month (p = 0.044). It was also found that 491 participants (96.1%) reported that patient´s autonomy must be carefully respected for deciding whether continuing EN by NG tube or not. Finally, it was concluded for both nurses and nursing students that life expectancy should be the mean reason for implementing and withdrawing EN by NG tube. Major differences were found regarding when it should be ceased, suggesting perceptions may change as nurses graduate and move into their professional roles.

Synergistic impacts of global warming and thermohaline circulation collapse on amphibians.

Impacts on ecosystems and biodiversity are a prominent area of research in climate change. However, little is known about the effects of abrupt climate change and climate catastrophes on them. The probability of occurrence of such events is largely unknown but the associated risks could be large enough to influence global climate policy. Amphibians are indicators of ecosystems' health and particularly sensitive to novel climate conditions. Using state-of-the-art climate model simulations, we present a global assessment of the effects of unabated global warming and a collapse of the Atlantic meridional overturning circulation (AMOC) on the distribution of 2509 amphibian species across six biogeographical realms and extinction risk categories. Global warming impacts are severe and strongly enhanced by additional and substantial AMOC weakening, showing tipping point behavior for many amphibian species. Further declines in climatically suitable areas are projected across multiple clades, and biogeographical regions. Species loss in regional assemblages is extensive across regions, with Neotropical, Nearctic and Palearctic regions being most affected. Results underline the need to expand existing knowledge about the consequences of climate catastrophes on human and natural systems to properly assess the risks of unabated warming and the benefits of active mitigation strategies.

Glycosylated hemoglobin level in patients with and without surgical site infection after hysterectomy.

BACKGROUND: Surgical site infection (SSI) occurs in 11-12% of surgeries. The glycosylated hemoglobin (HbA1c) has been found to be significantly elevated in those who presented infection. OBJECTIVE: To compare the concentration of HbA1c between patients with and without SSI after hysterectomy. METHOD: In healthy, postoperative women with total abdominal (open) hysterectomy, the HbA1c serum concentration was measured (normal <5.7%) and the difference between those who presented SSI and other risk factors for SSI were compared with Mann Whitney U test was used. The HbA1c values were stratified as normal or abnormal and were contrasted with the presence or absence of SSI by means of X2. RESULTS: 27 women without SSI and 20 with SSI were studied. The preoperative glucose was and 88 (70-99) mg/dl and 86 (70-99) mg/dl for the groups with and without SSI respectively. The HbA1c was significantly higher in the group with ISQ 5.6% (5-8) vs. 6.5% (5.2-8.2). The sensitivity of HbA1c with cut point <5.7 was 80% and the specificity was 51.9%. CONCLUSION: HbA1c can serve as a prognostic criterion of ISQ.

ANTECEDENTES: La infección del sitio quirúrgico (ISQ) se presenta en el 11-12% de las cirugías. La hemoglobina glucosilada (HbA1c) se ha encontrado significativamente elevada en los pacientes que presentan infección. OBJETIVO: Comparar la concentración de HbA1c entre pacientes con y sin ISQ posterior a una histerectomía. MÉTODO: En mujeres sanas posoperadas de histerectomía total abdominal (abierta) se midió la concentración sérica de HbA1c (normal < 5.7%) y se comparó la diferencia entre las que presentaron ISQ y las que no. Se investigaron también otros factores de riesgo para ISQ. Se utilizó la prueba U de Mann Whitney. Los valores de HbA1c se estratificaron como normales o anormales, y se contrastaron con la presencia o no de ISQ por medio de la prueba ji al cuadrado. RESULTADOS: Se estudiaron 27 mujeres sin ISQ y 20 con ISQ. La glucosa preoperatoria fue de 88 (70-99) y 86 (70-99) mg/dl para los grupos con y sin ISQ, respectivamente. La HbA1c fue significativamente mayor en el grupo con ISQ (5.6%; 5-8) que en el grupo sin ISQ (6.5%; 5.2-8.2). La sensibilidad de la HbA1c con un punto de corte < 5.7 fue del 80% y la especificidad fue del 51.9%. CONCLUSIÓN: La HbA1c puede servir como criterio pronóstico de ISQ.

Causality from long-lived radiative forcings to the climate trend.

In our study, we present a purely statistical observations-based model-free analysis that provides evidence about Granger causality (GC) from long-lived radiative forcings (LLRFs) to the climate trend (CT). This relies on having locally ordered breaks in the slopes of the trend functions of LLRF and the CT, with the break for LLRF occurring before that of the CT and with the slope changes being of the same sign. The empirical evidence indicates that these conditions are satisfied empirically using standard global surface temperature series and an aggregate measure of LLRF (carbon dioxide, nitrous oxide, and chlorofluorocarbons). We also discuss why the presence of broken trends can lead one to conclude in favor of GC when using standard methods even if the noise function in LLRF is negligible.

Terminal Complement Activation in Preeclampsia.

OBJECTIVE: To evaluate whether C5b-9 concentrations in blood and urine are increased in preeclampsia with severe features. METHODS: The Complement and Preeclampsia in the Americas study is a prospective, multicenter case-control study performed at six centers in Colombia from November 2015 to July 2016. The case group included women with preeclampsia with severe features, and the control group included women who were healthy or had chronic hypertension, gestational hypertension, or preeclampsia without severe features. We enrolled two women in the control group for every woman in the case group. Soluble C5b-9 concentrations were measured by enzyme-linked immunosorbent assays in blood and urine. The primary outcome was C5b-9 concentrations in women in the case group compared with all women in the control group, and the secondary outcome was C5b-9 levels in women in the case group compared with individual control subgroups. Differences were assessed by test of medians, and associations were further evaluated by receiver operating characteristic curve analysis and logistic regression with α=0.05. RESULTS: Three hundred fifty-two patients were enrolled. Plasma C5b-9 concentrations did not differ significantly between women in the case group and those in the control group, but urine C5b-9 concentrations were higher in women in the case group (median [interquartile range] 9.9 [1.6-43.7] vs 1.8 [0.54-4.1] ng/mL, P<.001). In subgroup analysis, plasma C5b-9 concentrations were increased in women in the case group compared with healthy women in the control group (median [interquartile range] 2,778 [1,633-4,230] vs 1,374 [1,064-2,332] ng/mL, P<.001), and urine C5b-9 concentrations were increased in women in the case group compared with all control subgroups (P<.001). Using receiver operating characteristic analysis, urine C5b-9 concentrations differentiated preeclampsia with severe features from hypertensive women in the control group (area under the receiver operating characteristic curve 0.74, 95% CI 0.68-0.80). Urine C5b-9 22 ng/mL or greater (range 0-158.4 ng/mL) was the optimal cut point for diagnosis of preeclampsia with severe features with adjusted odds ratio of 10.0 (95% CI 3.5-28.8, P<.001). CONCLUSION: Urinary excretion of terminal complement effector C5b-9 is higher in women with preeclampsia with severe features compared with women with other hypertensive disorders of pregnancy and women without hypertension.

Global economic impacts of climate variability and change during the 20th century.

Estimates of the global economic impacts of observed climate change during the 20th century obtained by applying five impact functions of different integrated assessment models (IAMs) are separated into their main natural and anthropogenic components. The estimates of the costs that can be attributed to natural variability factors and to the anthropogenic intervention with the climate system in general tend to show that: 1) during the first half of the century, the amplitude of the impacts associated with natural variability is considerably larger than that produced by anthropogenic factors and the effects of natural variability fluctuated between being negative and positive. These non-monotonic impacts are mostly determined by the low-frequency variability and the persistence of the climate system; 2) IAMs do not agree on the sign (nor on the magnitude) of the impacts of anthropogenic forcing but indicate that they steadily grew over the first part of the century, rapidly accelerated since the mid 1970's, and decelerated during the first decade of the 21st century. This deceleration is accentuated by the existence of interaction effects between natural variability and natural and anthropogenic forcing. The economic impacts of anthropogenic forcing range in the tenths of percentage of the world GDP by the end of the 20th century; 3) the impacts of natural forcing are about one order of magnitude lower than those associated with anthropogenic forcing and are dominated by the solar forcing; 4) the interaction effects between natural and anthropogenic factors can importantly modulate how impacts actually occur, at least for moderate increases in external forcing. Human activities became dominant drivers of the estimated economic impacts at the end of the 20th century, producing larger impacts than those of low-frequency natural variability. Some of the uses and limitations of IAMs are discussed.

Guía de práctica clínica para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio: sección 3. Infecciones en el embarazo: ruptura prematura de membranas (RPM) / Clinical practice guideline for the prevention, early detection and treatment of pregnancy, delivery and post-partum complications: section 3. Infections in pregnancy: premature rupture of membranes (PROM)

Realizar recomendaciones para la atención del embarazo con ruptura prematura de membranas como parte integral de la Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012, acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC "Preterm prelabour rupture of membranes" (Royal College of Obstetricians and Gynaecologists-2006) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de los embarazos con ruptura prematura de membranas. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno fetal exitoso en las gestaciones con esta complicación.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación...

Realizar recomendaciones para la atención del embarazo con ruptura prematura de membranas como parte integral de la Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012, acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC "Preterm prelabour rupture of membranes" (Royal College of Obstetricians and Gynaecologists-2006) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de los embarazos con ruptura prematura de membranas. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno fetal exitoso en las gestaciones con esta complicación.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación...

Prevalent HLA Class II Alleles in Mexico City Appear to Confer Resistance to the Development of Amebic Liver Abscess.

Amebiasis is an endemic disease and a public health problem throughout Mexico, although the incidence rates of amebic liver abscess (ALA) vary among the geographic regions of the country. Notably, incidence rates are high in the northwestern states (especially Sonora with a rate of 12.57/100,000 inhabitants) compared with the central region (Mexico City with a rate of 0.69/100,000 inhabitants). These data may be related to host genetic factors that are partially responsible for resistance or susceptibility. Therefore, we studied the association of the HLA-DRB1 and HLA-DQB1 alleles with resistance or susceptibility to ALA in two Mexican populations, one each from Mexico City and Sonora. Ninety ALA patients were clinically diagnosed by serology and sonography. Genomic DNA was extracted from peripheral blood mononuclear cells. To establish the genetic identity of both populations, 15 short tandem repeats (STRs) were analyzed with multiplexed PCR, and the allelic frequencies of HLA were studied by PCR-SSO using LUMINEX technology. The allele frequencies obtained were compared to an ethnically matched healthy control group (146 individuals). We observed that both affected populations differed genetically from the control group. We also found interesting trends in the population from Mexico City. HLA-DQB1*02 allele frequencies were higher in ALA patients compared to the control group (0.127 vs 0.047; p= 0.01; pc= NS; OR= 2.9, 95% CI= 1.09-8.3). The less frequent alleles in ALA patients were HLA-DRB1*08 (0.118 vs 0.238 in controls; p= 0.01; pc= NS; OR= 0.42, 95% CI= 0.19-0.87) and HLA-DQB1*04 (0.109 vs 0.214; p= 0.02; pc= NS; OR= 0.40, 95% CI= 0.20-0.94). The haplotype HLA-DRB1*08/-DQB1*04 also demonstrated a protective trend against the development of this disease (0.081 vs. 0.178; p=0.02; pc=NS; OR= 0.40, 95% CI= 0.16-0.93). These trends suggest that the prevalent alleles in the population of Mexico City may be associated with protection against the development of ALA.

Severe postpartum hemorrhage from uterine atony: a multicentric study.

OBJECTIVE: Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management. STUDY DESIGN: The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals. RESULTS: Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy. CONCLUSIONS: In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.

A time-series analysis of the 20th century climate simulations produced for the IPCC's Fourth Assessment Report.

In this paper evidence of anthropogenic influence over the warming of the 20th century is presented and the debate regarding the time-series properties of global temperatures is addressed in depth. The 20th century global temperature simulations produced for the Intergovernmental Panel on Climate Change's Fourth Assessment Report and a set of the radiative forcing series used to drive them are analyzed using modern econometric techniques. Results show that both temperatures and radiative forcing series share similar time-series properties and a common nonlinear secular movement. This long-term co-movement is characterized by the existence of time-ordered breaks in the slope of their trend functions. The evidence presented in this paper suggests that while natural forcing factors may help explain the warming of the first part of the century, anthropogenic forcing has been its main driver since the 1970's. In terms of Article 2 of the United Nations Framework Convention on Climate Change, significant anthropogenic interference with the climate system has already occurred and the current climate models are capable of accurately simulating the response of the climate system, even if it consists in a rapid or abrupt change, to changes in external forcing factors. This paper presents a new methodological approach for conducting time-series based attribution studies.