An empirical and modelling approach to the evaluation of cruise ships' influence on air quality: The case of La Paz, Mexico.

Maritime activity has diverse environmental consequences impacts in port areas, especially for air quality, and the post-COVID-19 cruise tourism market's potential to recover and grow is causing new environmental concerns in expanding port cities. This research proposes an empirical and modelling approach for the evaluation of cruise ships' influence on air quality concerning NO2 and SO2 in the city of La Paz (Mexico) using indirect measurements. EPA emission factors and the AERMOD modelling system coupled to WRF were used to model dispersions, while street-level mobile monitoring data of air quality from two days of 2018 were used and processed using a radial base function interpolator. The local differential Moran's Index was estimated at the intersection level using both datasets and a co-location clustering analysis was performed to address spatial constancy and to identify the pollution levels. The modelled results showed that cruise ships' impact on air quality had maximum values of 13.66 µg/m3 for NO2 and 15.71 µg/m3 for SO2, while background concentrations of 8.80 for NOx and 0.05 for SOx (µg/m3) were found by analysing the LISA index values for intersections not influenced by port pollution. This paper brings insights to the use of hybrid methodologies as an approach to studying the influence of multiple-source pollutants on air quality in contexts totally devoid of environmental data.

Evaluation of the communication of nursing students in the simulated teleconsultation: A cross-sectional study.

INTRODUCTION: The COVID-19 pandemic presented universities with the challenge of virtualizing the teaching-learning process. Simulated teleconsultation has been used in undergraduate training, which allows nursing students to interact with simulated patients remotely. Studies have identified that distance imposes communication barriers on all elements-sender, receiver and message-and in both forms of transmission: verbal and nonverbal. OBJECTIVE: To describe the communication of nursing students in teleconsultation with simulated patients in the context of primary health care. METHODS: This was a descriptive, cross-sectional study of 92 fifth-year nursing students. The communication variable was measured with the Connect Identify Understand Agree Help scale. In the data analysis, the mean and standard deviation of the scores on the 29 items of the scale were determined, as were the mean values for the total scale and for the 3 domains of the scale. RESULTS: The items that presented an average of less than 1 were primarily those related to the Agree and Help to Act domain. The total mean was 1.15, and the means for the domains Connect, Identify and Understand Problems and Agree and Help to Act were 1.53, 0.90 and 1.28, respectively. A weakness in the exploration of the psychosocial context of the simulated patients was observed. CONCLUSIONS: The results of this study, which evaluated communication in the context of distance care, corroborate the evidence regarding communication in real or simulated face-to-face situations. Studies that compare communication in various teaching-learning contexts, whether real or virtual, face-to-face or at a distance, are recommended.

Multidimensional Urban Exposure Analysis of Industrial Chemical Risk Scenarios in Mexican Metropolitan Areas.

Risk scenarios are caused by the convergence of a hazard with a potentially affected system in a specific place and time. One urban planning goal is to prevent environmental hazards, such as those generated by chemical accidents, from reaching human settlements, as they can cause public health issues. However, in many developing countries, due to their strategic positioning in global value chains, the quick and easy access to labor pools, and competitive production costs, urban sprawls have engulfed industrial areas, exposing residential conurbations to environmental hazards. This case study analyzes the spatial configuration of accidental chemical risk scenarios in three major Mexican metropolitan areas: Mexico City, Guadalajara, and Monterrey. Spatial analyses use an areal locations of hazardous atmosphere (ALOHA) dispersion model to represent the spatial effects of high-risk industrial activities in conurbations and the potentially affected populations vulnerable to chemical hazards. Complementary geostatistical correlation analyses use population data, marginalization indexes, and industrial clustering sectors to identify trends that can lead to comprehensive environmental justice approaches. In addition, the marginalization degree of inhabitants evaluates social inequalities concerning chemical risk scenarios.

Genetic analysis of activity, brain and behavioral associations in extended families with heavy genetic loading for bipolar disorder.

BACKGROUND: Disturbed sleep and activity are prominent features of bipolar disorder type I (BP-I). However, the relationship of sleep and activity characteristics to brain structure and behavior in euthymic BP-I patients and their non-BP-I relatives is unknown. Additionally, underlying genetic relationships between these traits have not been investigated. METHODS: Relationships between sleep and activity phenotypes, assessed using actigraphy, with structural neuroimaging (brain) and cognitive and temperament (behavior) phenotypes were investigated in 558 euthymic individuals from multi-generational pedigrees including at least one member with BP-I. Genetic correlations between actigraphy-brain and actigraphy-behavior associations were assessed, and bivariate linkage analysis was conducted for trait pairs with evidence of shared genetic influences. RESULTS: More physical activity and longer awake time were significantly associated with increased brain volumes and cortical thickness, better performance on neurocognitive measures of long-term memory and executive function, and less extreme scores on measures of temperament (impulsivity, cyclothymia). These associations did not differ between BP-I patients and their non-BP-I relatives. For nine activity-brain or activity-behavior pairs there was evidence for shared genetic influence (genetic correlations); of these pairs, a suggestive bivariate quantitative trait locus on chromosome 7 for wake duration and verbal working memory was identified. CONCLUSIONS: Our findings indicate that increased physical activity and more adequate sleep are associated with increased brain size, better cognitive function and more stable temperament in BP-I patients and their non-BP-I relatives. Additionally, we found evidence for pleiotropy of several actigraphy-behavior and actigraphy-brain phenotypes, suggesting a shared genetic basis for these traits.

Assessment of maturity of reverse logistics as a strategy to sustainable solid waste management.

Small- and medium-sized enterprises primarily focus on their operations and rarely pay attention to issues related to sustainable solid waste management that originate from their production processes. A suitable strategy to support sustainable solid waste management is reverse logistics. Through the use of maturity models, it is possible to determine the grade to which small- and medium-sized enterprises are prepared to perform this strategy. This study proposes an adapted maturity model to measure maturity levels of reverse logistics aspects at small- and medium-sized enterprises in regions from Colombia in order to contribute to sustainable solid waste management. The maturity model was applied to seven small- and medium-sized enterprises in the plastics sector in the central and southern regions of Colombia by adapting a maturity model that was previously correlated to suggested drivers and barriers in this sector. Results show that maturity levels range from naïve to immature owing to the incipient development of reverse logistics in Colombia. Therefore, it is necessary to establish a holistic vision of the organisation to improve the reverse logistics decision-making process to achieve sustainable solid waste management.

Contribution of common and rare variants to bipolar disorder susceptibility in extended pedigrees from population isolates.

Current evidence from case/control studies indicates that genetic risk for psychiatric disorders derives primarily from numerous common variants, each with a small phenotypic impact. The literature describing apparent segregation of bipolar disorder (BP) in numerous multigenerational pedigrees suggests that, in such families, large-effect inherited variants might play a greater role. To identify roles of rare and common variants on BP, we conducted genetic analyses in 26 Colombia and Costa Rica pedigrees ascertained for bipolar disorder 1 (BP1), the most severe and heritable form of BP. In these pedigrees, we performed microarray SNP genotyping of 838 individuals and high-coverage whole-genome sequencing of 449 individuals. We compared polygenic risk scores (PRS), estimated using the latest BP1 genome-wide association study (GWAS) summary statistics, between BP1 individuals and related controls. We also evaluated whether BP1 individuals had a higher burden of rare deleterious single-nucleotide variants (SNVs) and rare copy number variants (CNVs) in a set of genes related to BP1. We found that compared with unaffected relatives, BP1 individuals had higher PRS estimated from BP1 GWAS statistics (P = 0.001 ~ 0.007) and displayed modest increase in burdens of rare deleterious SNVs (P = 0.047) and rare CNVs (P = 0.002 ~ 0.033) in genes related to BP1. We did not observe rare variants segregating in the pedigrees. These results suggest that small-to-moderate effect rare and common variants are more likely to contribute to BP1 risk in these extended pedigrees than a few large-effect rare variants.

Frontal fibrosing alopecia: A new autoimmune entity?

Frontal fibrosing alopecia (FFA) is a rare type of cicatricial alopecic band, with bilateral and symmetric progressive regression of the frontotemporal hairline. The specific mechanisms of development of FFA remain unknown. Due to several clues, including the presence of lymphocytic infiltrates and the association of FFA with other autoimmune disorders, we hypothesised that FFA may be a new autoimmune condition, and future research must be focused on this possible origin.

Estudio dinámico del reciclaje de envases pet en el Valle del Cauca / Dynamic study of pet containers recycling in Valle del Cauca / Estudo dinâmico da reciclagem de embalagens pet no Valle del Cauca

Resumen Introducción: El acelerado crecimiento de la población, los diversos patrones de consumo y la reducción en los ciclos de vida de los productos, han generado un incremento en el consumo y por tanto en la generación de residuos sólidos, los cuales si no se tratan de manera adecuada tienen efectos adversos al ambiente como muerte de animales por ingesta, inundaciones debido a la inadecuada disposición en canales de aguas lluvias y disminución de la vida útil de los rellenos sanitarios de materiales aprovechables. Uno de los residuos generados es el polietileno teraftalato (PET) que pese a ser un material 100% reciclable, está terminando en los rellenos sanitarios, disminuyendo la vida útil de los mismos y consumiendo recursos como el petróleo para la generación de materiales nuevos. Objetivos: Evaluar los efectos al ambiente del reciclaje del PET en el Valle del Cauca, a través de un modelo de dinámica de sistemas. Materiales y métodos: Se estudiaron variables como el consumo de agua y energía, generación de CO2 y la vida útil del relleno sanitario Colomba El Guabal que le sirve a municipios del Valle del Cauca, variando la tasa de reciclaje del PET. Resultados: El efecto de incrementar la tasa de reciclaje disminuye el consumo de agua y energía, la emisión de CO2 e incrementa la vida útil del relleno sanitario. Conclusiones: Es importante hacer seguimiento a las políticas de gestión de residuos en las principales variables ambientales y fortalecer los procesos de toma de decisiones, como aquellos relacionados con las opciones de diseño de productos y reutilización de materia prima, orientados a generar un impacto positivo en el ambiente.

Abstract Introduction: Fast population growth has generated an increase in the consumption and therefore it has influenced the rise of the solid waste generation, which causes adverse effects on the environment if treated inadequated. Polyethylene terephthalate (PET) is a kind of solid waste generated that is 100% recyclable, however it is ending in landfills reducing the lifespan of them and consuming resources like petroleum in order to generate new products. Objective: Evaluating the effect on the environment of PET recycling by means of a system dinamics model. Material and method: The variables considered were water and energy consumption, CO2 emissions and landfill lifespan varying the PET recycling rate. RESULTS: the increase of the recycling rate cause a decrease in water and energy consumption as well as de CO2 emissions and produce a rise in the landfill lifespan. Conclusions: It is still important to follow the acomplishment of the solid waste management policies so as to enhace the decision making process related to generate a positive impact on the environment.

Resumo Introdução: O acelerado crescimento a população, os diversos patrões de consumo e a redução nos ciclos de vida dos produtos, tem gerado um incremento no consumo e por tanto na geração de resíduos sólidos, em caso de não serem tratadas adequadamente tem efeitos adversos sobre o ambiente como a morte de animais pela ingestão, inundações devido à inadequada disposição em canais de águas de chuva e a diminuição da vida útil dos aterros sanitários de materiais aproveitáveis. Um dos resíduos gerados é o teraftalato de polietileno (PET) apesar de ser um material 100% reciclável, está acabando nos aterros sanitários, diminuindo a vida útil dos mesmos e consumindo recursos como o óleo para a geração de novos materiais. Objetivo: Avaliar os efeitos ao ambiente de reciclagem do PET no Valle del Cauca, através de um modelo de dinâmica de sistemas. Materiais e métodos: Estudaram-se variáveis como o consumo de água e energia, geração de CO2 e a vida útil do aterro sanitário Colomba El Guabal que serve aos municípios do Valle del Cauca, variando a taxa de reciclagem do PET. Resultados: O efeito de incrementar a taxa de reciclagem diminuindo o consumo de água e energia, a emissão de CO2 e o aumento da vida útil do aterro sanitário. Conclusões: É importante fazer seguimentos políticos de gestão de resíduos nas principais variáveis ambientais e melhorar os processos de tomada de decisões, como aqueles relacionados com as opções de desenho de produtos e reutilização de matéria prima, orientados a gerarum impacto positivo no ambiente.

Novel mutation in ABBC9 gene associated with congenital hypertrichosis and acromegaloid facial features, without cardiac or skeletal anomalies: a new phenotype.

INTRODUCTION: Mutations in ABCC9 are associated with Cantú syndrome (CS), a very rare genetic disorder characterized by congenital hypertrichosis, acromegaloid facial appearance (AFA), cardiomegaly, and skeletal anomalies. CASE REPORT: We report an 8-year-old female patient with congenital generalized hypertrichosis and coarse facial appearance but without cardiovascular or skeletal compromise. Whole exome sequencing revealed a novel de novo heterozygous mutation in ABCC9. In addition, the genotype and phenotype of the patient were compared with those of the patients reported in the literature and with other related conditions that include AFA, hypertrichosis and AFA, and CS. CONCLUSION: This is the first report of a South-American patient with mutation in ABCC9. We propose that her phenotype is a part of a spectrum of features associated with congenital hypertrichosis and mutations in ABCC9, which differs from CS and related disorders. Whole exome sequencing enabled the identification of the causality of this disease characterized by high clinical and genetic heterogeneity.

Efecto de las intervenciones fisioterapéuticas en personas con fractura distal de radio / Effect of physiotherapy in people with distal radius fractures: A systematic review

Resumen Introducción. La fractura distal de radio (FDR) es muy frecuente y afecta a todos los grupos poblacionales. Objetivo. Realizar una revisión sistemática de la mejor evidencia disponible para determinar el efecto de las intervenciones fisioterapéuticas sobre el dolor, el rango de movimiento, la fuerza muscular y la funcionalidad en personas con fractura distal de radio. Materiales y métodos. Se realizó una búsqueda sistemática de ensayos clínicos controlados en las bases de datos ScienceDirect, PubMed, Medline y Embase. Resultados. Se encontraron 14 estudios que cumplieron los criterios de selección. Conclusión. La evidencia sugiere que intervenciones terapéuticas supervisadas que incluyan modalidades físicas y del ejercicio con una duración entre 6 y 9 semanas, con un promedio de 18 sesiones y realizadas tres veces a la semana mejoran de forma significativa las variables estudiadas en pacientes con FDR. Es necesario que futuros estudios establezcan la relación dosis-respuesta de estas intervenciones.

Abstract Introduction: Distal radius fracture (DRF) is very common and affects all age groups. Objective: To conduct a systematic review of the best available evidence to determine the effect of physiotherapeutic interventions on pain, range of motion, muscle strength and function in people with distal radius fracture. Materials and methods: A systematic search of controlled clinical trials was carried out in the ScienceDirect, PubMed, Medline, lilacs and EMBASE databases. Results: 14 studies met the selection criteria. Conclusion: Evidence suggests that supervised therapeutic interventions that include physical and exercise modalities lasting between 6 and 9 weeks, with an average of18 sessions and three times a week, significantly improve the variables studied in patients with DRF. Future studies should establish the dose-response correlation of these interventions.

Genetic contributions to circadian activity rhythm and sleep pattern phenotypes in pedigrees segregating for severe bipolar disorder.

Abnormalities in sleep and circadian rhythms are central features of bipolar disorder (BP), often persisting between episodes. We report here, to our knowledge, the first systematic analysis of circadian rhythm activity in pedigrees segregating severe BP (BP-I). By analyzing actigraphy data obtained from members of 26 Costa Rican and Colombian pedigrees [136 euthymic (i.e., interepisode) BP-I individuals and 422 non-BP-I relatives], we delineated 73 phenotypes, of which 49 demonstrated significant heritability and 13 showed significant trait-like association with BP-I. All BP-I-associated traits related to activity level, with BP-I individuals consistently demonstrating lower activity levels than their non-BP-I relatives. We analyzed all 49 heritable phenotypes using genetic linkage analysis, with special emphasis on phenotypes judged to have the strongest impact on the biology underlying BP. We identified a locus for interdaily stability of activity, at a threshold exceeding genome-wide significance, on chromosome 12pter, a region that also showed pleiotropic linkage to two additional activity phenotypes.

GESTIÓN DE RESIDUOS SÓLIDOS EN CADENAS DE SUMINISTRO DE CICLO CERRADO DESDE LA PERSPECTIVA DE LA INVESTIGACIÓN DE OPERACIONES / SOLID WASTE MANAGEMENT IN CLOSED-LOOP SUPPLY CHAINS FROM THE PERSPECTIVE OF OPERATIONS RESEARCH

La integración de los flujos reversos y directos en la cadena de suministro, trae beneficios al reducir costos y evitar el daño ambiental porque se recupera valor de los residuos sólidos; esta integración se conoce como la cadena de suministro de ciclo cerrado. La mayoría de experiencias que relacionan cadena de suministro de ciclo cerrado y decisiones de gestión de residuos sólidos, provienen de países desarrollados con estrictas regulaciones ambientales y usan técnicas de invetigación de operaciones. El objetivo se este artículo es identificar la factibilidad de aplicar técnicas de investigación de operaciones a las decisiones de gestión de residuos sólidos en las cadena de suministro de ciclo cerrado en países en desarrollo como Colombia. Se identificaron variables importantes de los articulos revisados tales como los diferentes tipos de residuos, las regiones y el uso de técnicas de optmización, simulación y multicriterio. La metodología de vigilancia tecnológica se uso para correlacionar estas variables. Los resultados mostraron que la técnica de multicriterio es usada con más frecuencia porque permite la consideración de varios aspectos en una misma decisión; por lo tanto, el uso de esta técnica sería conveniente para enfrentar efectivamente las principales decisiones en las incipientes cadenas de suministro de ciclo cerrado en países en desarrollo.

The integration of reverse and direct flows within the supply chain is highly benefitial to reduce costs and avoid the enviromental damage because value from the solid waste is recovered; this integration is known as closed-loop supply chain. Most of the reported experiences regarding closed-loop supply chains and solid waste management decisions come from developed countries with strict environmental regulations and use of operations research techniques.This paper aims to identify the feasibility of applying operations research techniques to solid waste magement decisions within closed-loop supply chains in developing countries such as Colombia. Important variables such as the different kinds of solid waste, the regions and the use of optimization, simulation and multi-criteria techniques were identified by reviewing research articles. Technologic watch methodology was used to correlate these variables. The results showed that the multi-criteria technique is most frequently used because it allows including different aspects related to a single decision; therefore, the use of this technique would be appropiate to effectively approach the main decisions at the emerging closed-loop supply chains in developing countries.

[Bullous systemic lupus mimicking a Stevens-Johnson syndrome]. / Lupus ampolloso que simula síndrome de Stevens-Johnson.

Autoimmune bullous diseases represent a diagnostic challenge due to the wide spectrum of pathologies that share similar clinical features. This paper reports the case of a woman admitted with a supposed diagnosis of a Stevens-Johnson syndrome, in which the history, the profile of autoimmunity and interdisciplinary approach were of vital importance to clarify the clinical picture.

Las enfermedades ampollosas autoinmunitarias constituyen, en algunas ocasiones, un reto diagnóstico debido al amplio espectro de afecciones que comparten características clínicas similares. Se comunica el caso de una paciente que ingresó con un supuesto diagnóstico de reacción medicamentosa severa tipo síndrome de Stevens-Johnson, en la que sus antecedentes personales, perfil de autoinmunidad y aproximación interdisciplinaria fueron de vital ayuda para establecer el diagnóstico final.

[Neuroimaging findings in cerebroretinal microangiopathy with calcifications and cysts]. / Hallazgo por neuroimaginología de microangiopatía cerebral retiniana con calcificaciones y quistes.

Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.

Hallazgo por neuroimaginología de microangiopatía cerebral retiniana con calcificaciones y quistes / Neuroimaging findings in cerebroretinal microangiopathy with calcifications and cysts

La microangiopatía cerebral retiniana con calcificaciones y quistes es una enfermedad poco frecuente, caracterizada por alteraciones cerebrales, retinianas y óseas, así como por predisposición al sangrado gastrointestinal. Existen pocos reportes de casos de esta condición, especialmente en adultos, en quienes la incidencia es baja. Los hallazgos por medio de neuroimágenes son característicos, con calcificaciones bilaterales y múltiples formaciones quísticas. El propósito de este artículo fue hacer una revisión bibliográfica e ilustrar dos casos cuyo diagnóstico fue posible con la ayuda de neuroimágenes.

Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.

Complicaciones biliares en pacientes trasplantados: comparación de dos métodos diagnósticos con la CPRE / Biliary complications in transplant patients: A comparison of two ERCP

Antecedentes: Las complicaciones biliares después del trasplante ortotópico de hígado (TOH) son una seria causa de morbilidad y mortalidad. Técnicas invasivas de colangiografía como la colangiografía retrógrada endoscópica (CPRE) o percutánea cursan con complicaciones asociadas al procedimiento. La resonancia magnética (RM) es un método no invasivo, seguro y preciso. Objetivo: El propósito de este estudio es evaluar el papel de la RM y del US para detectar las complicaciones biliares después del TOH y comparar los hallazgos con la CPRE como patrón de oro. Métodos: En el Hospital Pablo Tobón Uribe, Medellín-Colombia, el registro de 27 pacientes con TOH entre marzo de 2006 y enero de 2009 que presentaron evidencias clínicas y bioquímicas de complicaciones biliares fueron evaluados con US, CPRE y RM. Resultados: La presencia de complicaciones biliares se confirmó en 26 pacientes (92,6%); las estenosis anastomóticas en 24 (88,9%). Estenosis isquémicas o difusas intrahepáticas en 2 pacientes (7,4%) y coledocolitiasis en uno (3,7%). A todos los pacientes se les hizo CPRE, en 25 US (92,5%) y en 13 RM (48,1%). Hubo una relación de concordancia significativa entre los hallazgos de la CPRE y la RM pero no con el US. LA sensibilidad y especificidad de la RM fue de 80% y 50%, para el US fue de 55,6% y 50% respectivamente, los valores predictivos positivos y negativos para la RM fueron de 92,3% y 25%, para el US fueron de 93,7% y 7,79% respectivamente. Conclusiones: La RM es una útil herramienta en la evaluación de las complicaciones de la vía biliar post-TOH. Recomendamos la RM como el método diagnóstico de elección, reservando la CPRE para los procedimientos terapéuticos