Geriatric conditions and healthcare utilization among older adults living in subsidized housing.

BACKGROUND: Nearly 2.9 million older Americans with lower incomes live in subsidized housing. While regional and single-site studies show that this group has higher rates of healthcare utilization compared to older adults in the general community, little is known about healthcare utilization nationally nor associated risk factors. METHODS: We conducted a retrospective cohort study of Medicare beneficiaries aged ≥65 enrolled in the National Health and Aging Trends Study in 2011, linked to Medicare claims data, including individuals living in subsidized housing and the general community. Participants were followed annually through 2020. Outcomes were hospitalization, short-term skilled nursing facility (SNF) utilization, long-term care utilization, and death. Fine-Gray competing risks regression analysis was used to assess the association of subsidized housing residence with hospitalization and nursing facility utilization, and Cox proportional hazards regression analysis was used to assess the association with death. RESULTS: Among 6294 participants (3600 women, 2694 men; mean age, 75.5 years [SD, 7.0]), 295 lived in subsidized housing at baseline and 5999 in the general community. Compared to older adults in the general community, those in subsidized housing had a higher adjusted subdistribution hazard ratio [sHR] of hospitalization (sHR 1.21; 95% CI, 1.03-1.43), short-term SNF utilization (sHR 1.49; 95% CI, 1.15-1.92), and long-term care utilization (sHR 2.72; 95% CI, 1.67-4.43), but similar hazard of death (HR, 0.86; 95% CI, 0.69-1.08). Individuals with functional impairment had a higher adjusted subdistribution hazard of hospitalization and short-term SNF utilization and individuals with dementia and functional impairment had a higher hazard of long-term care utilization. CONCLUSIONS: Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing-based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia.

The dehydration mechanism of Na and K birnessites: a comprehensive multitechnique study.

The structural, spectroscopic and electronic properties of Na and K birnessites were investigated from ambient conditions (birA) to complete dehydration, and the involved mechanisms were scrutinized. Density Functional Theory (DFT) simulations were employed to derive structural models for lamellar A0.33MnO2·xH2O (A = Na+ or K+, x = 0 or 0.66), subsequently compared with the experimental results obtained for Na0.30MnO2·0.75H2O and K0.22MnO2·0.77H2O materials. Thermal analysis (TGA-DSC), X-ray diffraction (XRD), Fourier Transform Infrared (FTIR) spectroscopy, and Near Ambient Pressure X-ray Photoemission Spectroscopy (NAP-XPS) measurements were conducted for both birnessites. Dehydration under vacuum, annealing, or controlled relative humidity were considered. Results indicated that complete birnessite dehydration was a two-stage process. In the first stage, water removal from the interlayer of fully hydrated birnessite (birA) down to a molar H2O/A ratio of ∼2 (birB) led to the progressive shrinkage of the interlayer distance (3% for Na birnessite, 1% for K birnessite). In the second stage, water-free (birC) domains with a shorter interlayer distance (20% for Na birnessite, 10% for K birnessite) appeared and coexisted with birB domains. Then, birB was essentially transformed into birC when complete dehydration was achieved. The vibrational properties of birA were consistent with strong intermolecular interactions among water molecules, whereas partially dehydrated birnessite (birB) showed a distinct feature, with 3 (for Na-bir) and 2 (for K-bir) vibrations that were reproduced by DFT calculations for organized water into the interlayer (x = 0.66). The study also demonstrated that the electronic structure of Na birnessite depends on the interlayer water content. The external Na+ electronic level (Na 2p) was slightly destabilized (+0.3 eV binding energy) under near ambient conditions (birA) compared to drier conditions (birB and birC).

Incidence of Traumatic Brain Injury in a Longitudinal Cohort of Older Adults.

Importance: Traumatic brain injury (TBI) occurs at the highest rate in older adulthood and increases risk for cognitive impairment and dementia. Objectives: To update existing TBI surveillance data to capture nonhospital settings and to explore how social determinants of health (SDOH) are associated with TBI incidence among older adults. Design, Setting, and Participants: This nationally representative longitudinal cohort study assessed participants for 18 years, from August 2000 through December 2018, using data from the Health and Retirement Study (HRS) and linked Medicare claims dates. Analyses were completed August 9 through December 12, 2022. Participants were 65 years of age or older in the HRS with survey data linked to Medicare without a TBI prior to HRS enrollment. They were community dwelling at enrollment but were retained in HRS if they were later institutionalized. Exposures: Baseline demographic, cognitive, medical, and SDOH information from HRS. Main Outcomes and Measures: Incident TBI was defined using inpatient and outpatient International Classification of Diseases, Ninth or Tenth Revision, diagnosis codes received the same day or within 1 day as the emergency department (ED) visit code and the computed tomography (CT) or magnetic resonance imaging (MRI) code, after baseline HRS interview. A cohort with TBI codes but no ED visit or CT or MRI scan was derived to capture diagnoses in nonhospital settings. Descriptive statistics and bivariate associations of TBI with demographic and SDOH characteristics used sample weights. Fine-Gray regression models estimated associations between covariates and TBI, with death as a competing risk. Imputation considering outcome and complex survey design was performed by race and ethnicity, sex, education level, and Area Deprivation Index percentiles 1, 50, and 100. Other exposure variables were fixed at their weighted means. Results: Among 9239 eligible respondents, 5258 (57.7%) were female and 1210 (9.1%) were Black, 574 (4.7%) were Hispanic, and 7297 (84.4%) were White. Mean (SD) baseline age was 75.2 (8.0) years. During follow-up (18 years), 797 (8.9%) of respondents received an incident TBI diagnosis with an ED visit and a CT code within 1 day, 964 (10.2%) received an incident TBI diagnosis and an ED code, and 1148 (12.9%) received a TBI code with or without an ED visit and CT scan code. Compared with respondents without incident TBI, respondents with TBI were more likely to be female (absolute difference, 7.0 [95% CI, 3.3-10.8]; P < .001) and White (absolute difference, 5.1 [95% CI, 2.8-7.4]; P < .001), have normal cognition (vs cognitive impairment or dementia; absolute difference, 6.1 [95% CI, 2.8-9.3]; P = .001), higher education (absolute difference, 3.8 [95% CI, 0.9-6.7]; P < .001), and wealth (absolute difference, 6.5 [95% CI, 2.3-10.7]; P = .01), and be without baseline lung disease (absolute difference, 5.1 [95% CI, 3.0-7.2]; P < .001) or functional impairment (absolute difference, 3.3 [95% CI, 0.4-6.1]; P = .03). In adjusted multivariate models, lower education (subdistribution hazard ratio [SHR], 0.73 [95% CI, 0.57-0.94]; P = .01), Black race (SHR, 0.61 [95% CI, 0.46-0.80]; P < .001), area deprivation index national rank (SHR 1.00 [95% CI 0.99-1.00]; P = .009), and male sex (SHR, 0.73 [95% CI, 0.56-0.94]; P = .02) were associated with membership in the group without TBI. Sensitivity analyses using a broader definition of TBI yielded similar results. Conclusions and Relevance: In this longitudinal cohort study of older adults, almost 13% experienced incident TBI during the 18-year study period. For older adults who seek care for TBI, race and ethnicity, sex, and SDOH factors may be associated with incidence of TBI, seeking medical attention for TBI in older adulthood, or both.

Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV.

Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.

Biomarkers and sepsis severity as predictors of mechanical ventilation and mortality in COVID-19.

Introduction: Patients with septic shock face an elevated risk of mortality compared to those with sepsis. Several biomarkers, including lactate dehydrogenase, albumin, and lactate/albumin (L/A), have been associated with increased mortality in COVID-19 patients. This study aims to assess the relationship between sepsis, septic shock, and mortality, as well as the need for mechanical ventilation in COVID-19 patients. Demographic, sepsis severity factors, and biomarkers are examined. Methods: A retrospective case series from June 2020 to March 2021 included 490 patients diagnosed with sepsis or septic shock secondary to SARS-CoV-2 pneumonia. Time-to-event analyses were conducted for mechanical ventilation and mortality. Statistical significance was set at p ≤ .0038. Serum lactate, albumin, lactate/albumin ratio, C-reactive protein, platelet levels, and three sepsis severity scales, (CCI, SOFA, APACHE IV) were assessed. Results: Sepsis was identified in 352 patients (71.8%), while 138 had septic shock. Patients with septic shock were more likely to require invasive ventilator support. Factors associated with a higher risk of intubation included higher APACHE IV scores, elevated serum albumin levels, and increased L/A ratio. L/A ratio and serum lactate levels demonstrated the best diagnostic accuracy for mechanical ventilation (AUC, 0.964 and 0.946, respectively), mortality (AUC, 0.926 and 0.887, respectively). Discussion: Increased C-reactive protein, combined with increased serum lactate and a high lactate/albumin ratio, may assist clinicians in identifying COVID-19 patients at risk of mechanical ventilation and mortality upon admission. Optimal cut-off values for lactate (1.45-1.65 mmol/L) and L/A ratio (0.413) can aid in prioritizing medical care for at risk COVID-19 patients.

Impact of an educational intervention about healthy lifestyles in teenagers.

BACKGROUND: During the last years, lifestyle has worsened along the entire European population, causing an alarming boom-up regarding overweight and obese people. Pediatric population is also influenced in this sense, which may predispose to suffer from several diseases in adulthood. Educational interventions at early ages could be an effective strategy to face this situation. AIM: To describe the impact of an educational intervention about healthy lifestyle in adolescents. METHODS: A quasi-experimental study analyzing the knowledge of high school students, before and after a brief educational intervention based on a self-elaborated questionnaire including questions from the validated questionnaire CAPA (from Spanish, Conocimientos en Alimentación de Personas Adolescentes). RESULTS: The results of this study show a significant increase in knowledge about healthy lifestyles in the study population after the educational intervention (14.3±3.8 vs. 16.5±4.5; p<0.001). In addition, this improvement presents an asymmetric distribution according to gender (13.2±3.6 vs. 14.9±4.6; p=0.002 in men; 15.6±3 vs. 18.1±3.6; p<0.001 in women) and the type of educational center (14.17±3.6 vs. 16.48±4.17; p<0.001 in public schools and 14.86±4.15 vs. 16.54±5.32; p=0.047 in private schools). Parents' educational level was associated with improvement in knowledge about healthy lifestyles (13.44±2.9 vs. 15.67±5.37; p=0.132 at low level, 14.22±3.42 vs. 16.9±4.68; p<0.001 at medium level and 15.75±3.3 vs. 17.39±4.5; p=0.022 at high level). CONCLUSION: Educational intervention taught by primary health care professionals is a useful and efficient tool for the acquisition of nutritional and healthy lifestyle knowledge in adolescents.

Long-term cognitive outcome after elective hip or knee total joint arthroplasty: A population-based observational study.

BACKGROUND: One year after elective hip or knee total joint arthroplasty (TJA), >30% of older adults meet criteria for postoperative neurocognitive disorder. However, this is not contextualized with long-term cognitive outcomes in comparable surgical and nonsurgical controls. We analyzed population-based data to compare long-term cognitive outcomes in older adults after TJA, other surgeries, and with and without arthritis pain. METHODS: This was a retrospective observational analysis of United States older adults in the Health and Retirement Study (HRS) who underwent elective TJA, or elective surgery without expected functional benefits (e.g., cholecystectomy; inguinal herniorrhaphy), between 1998 and 2018 at aged 65 or older. TJA recipients were also age- and sex-matched to nonsurgical controls who reported moderate-severe arthritic pain or denied pain, so that comparison groups included surgical and nonsurgical (pain-suffering and pain-free) controls. We modeled biennially-assessed memory performance, a measure of direct and proxy cognitive assessments, before and after surgery, normalized to the rate of memory decline ("cognitive aging") in controls to express effect size estimates as excess, or fewer, months of memory decline. We used linear mixed effects models adjusted for preoperative health and demographic factors, including frailty, flexibly capturing time before/after surgery (knots at -4, 0, 8 years; discontinuity at surgery). RESULTS: There were 1947 TJA recipients (average age 74; 63% women; 1358 knee, 589 hip) and 1631 surgical controls (average age 76; 38% women). Memory decline 3 years after TJA was similar to surgical controls (5.2 [95% confidence interval, CI -1.2 to 11.5] months less memory decline in the TJA group, p = 0.11) and nonsurgical controls. At 5 years, TJA recipients experienced 5.0 [95% CI -0.9 to 10.9] months less memory decline than arthritic pain nonsurgical controls. CONCLUSION: There is no systematic accelerated memory decline at 3 years after TJA compared with surgical or nonsurgical controls.

Anthocyanin-Loaded Polymers as Promising Nature-Based, Responsive, and Bioactive Materials.

Anthocyanins are a specific group of molecules found in nature that have recently received increasing attention due to their interesting biological and colorimetric properties that have been successfully applied in several fields such as food preservation and biomedicine. Consequently, reviews devoted to a general overview of these flavonoids have proliferated in recent years. Meanwhile, the incorporation of anthocyanins into polymeric systems has become an interesting strategy to widen the applicability of these molecules and develop new smart and functional polymers in the above cited areas. However, anthocyanin-based polymers have been scarcely reviewed in the literature. Accordingly, this review aims to be a systematic summary of the most recent approaches for the incorporation of anthocyanins into macro-, micro-, or nanostructured polymers. Moreover, this work describes the fundamentals of the applicability of smart anthocyanin-based polymers and offers an updated review of their most interesting applications as sensors, biological regulators, and active materials.

Differences in molecular sensitization profiles between a Spanish and Latin American mite allergic patients.

BACKGROUND AND OBJECTIVE: To analyze the sensitization pattern to Dermatophagoides pteronyssinus and to associate the diagnostic findings and clinical severity in 218 allergic patients from two different continents. METHODS: Mite allergic patients were recruited by the Allergology departments from Latin America (n=88: Colombia, Costa Rica and Guatemala) and Spain (N=130). All patients had allergic rhinitis with or without asthma and positive skin prick test results to D. pteronyssinus. Specific IgE levels to D. pteronyssinus, D. farinae, Der p 1, Der p 2, and Der p 23 were quantified by ImmunoCAP system (ThermoFisher Scientific). Allergenic profile was also determined by western blot. Comparative Statistical analysis was performed by GraphPad software. RESULTS: Patients recognized most frequently Der p 2 (79%) followed by Der p 1 (73%), and Der p 23 (69%) allergens. The percentage of asthmatic patients increases with the number of sensitizations however none statistically significant differences were found. Interestingly, asthmatic patients presented the highest median levels of total IgE and specific IgE levels of D. pteronyssinus and molecular allergens, mainly Der p 2. Analysing the two different populations, Spanish patients were predominantly sensitized to Der p 2 (88.46%) and Der p 1 (83.84%), whereas Latin American population were more sensitized to Der p 23. CONCLUSION: Our data support the relevance of Der p 2 in mite allergy as the major allergen, with the high number of patients sensitized to it and its importance in the development of asthma. Sensitization to Der p 23 was more important in Latin America.

A fractional-order Wilson-Cowan formulation of cortical disinhibition.

This work presents a fractional-order Wilson-Cowan model derivation under Caputo's formalism, considering an order of 0 < α ≤ 1 . To that end, we propose memory-dependent response functions and average neuronal excitation functions that permit us to naturally arrive at a fractional-order model that incorporates past dynamics into the description of synaptically coupled neuronal populations' activity. We then shift our focus on a particular example, aiming to analyze the fractional-order dynamics of the disinhibited cortex. This system mimics cortical activity observed during neurological disorders such as epileptic seizures, where an imbalance between excitation and inhibition is present, which allows brain dynamics to transition to a hyperexcited activity state. In the context of the first-order mathematical model, we recover traditional results showing a transition from a low-level activity state to a potentially pathological high-level activity state as an external factor modifies cortical inhibition. On the other hand, under the fractional-order formulation, we establish novel results showing that the system resists such transition as the order is decreased, permitting the possibility of staying in the low-activity state even with increased disinhibition. Furthermore, considering the memory index interpretation of the fractional-order model motivation here developed, our results establish that by increasing the memory index, the system becomes more resistant to transitioning towards the high-level activity state. That is, one possible effect of the memory index is to stabilize neuronal activity. Noticeably, this neuronal stabilizing effect is similar to homeostatic plasticity mechanisms. To summarize our results, we present a two-parameter structural portrait describing the system's dynamics dependent on a proposed disinhibition parameter and the order. We also explore numerical model simulations to validate our results.

Minimally Anterior Medial Maxillary Approach (MAMMA): a novel technique for a wide access to the maxillary sinus.

PURPOSE: To describe a novel endoscopic technique to approach the maxillary sinus (MS), the Modified Anterior Medial Maxillary Approach (MAMMA), preserving the inferior turbinate (IT) and the nasolacrimal duct (NLD). To perform radiological measurements and describe a case series to study the feasibility and limits of MAMMA. METHODS: Computed tomography (CT) scans (n = 150 nasal cavities) were used to calculate areas of the MAMMA to define surgical limits and extensions. Measurement of distances to critical anatomy landmarks and total area for the MAMMA were calculated. An instructional case illustrating the surgical technique and outcome was also included. RESULTS: Radiological analysis showed a mean distance from the Piriform Aperture (PA) to the anterior limit of the NLD of 1.03 ± 0.18 cm (range 0.59-1.48) and a mean distance from de PA to the posterior limit of the NLD of 1.57 ± 0.22 cm (range 1.02-2.11). The mean distance from the nasal floor to the Hasner's valve was 1.61 ± 0.27 cm (range 1.06-2.52) and the distance from the nasal floor to the insertion of the IT was 2.20 ± 0.36 cm (range 1.70-3.69). Finally, the mean total area for the MAMMA was 4.04 ± 0.52 cm2 (range 3.17-5.53). No complications or recurrence of the pathology were observed in operated patients. CONCLUSION: The MAMMA provides a wide surgical field of the MS walls comparable to more aggressive techniques, with preservation of the sinonasal and lacrimal function. MAMMA is an effective alternative to treat different MS pathologies including benign recurrent maxillary sinus tumors.

Digital Marketing and Fast-Food Intake in the UAE: The Role of Firm-Generated Content among Adult Consumers.

In the contemporary digital marketing context, this study aimed to investigate the influence of firm-generated content and social media advertising on fast-food consumption patterns among the adult population. Utilizing a questionnaire distributed to customers of a restaurant in Fujairah, United Arab Emirates, convenience sampling was employed. The findings underscored a significant positive relationship between firm-generated content and social media engagement, as well as between the latter and online shopping behavior. However, it was determined that word of mouth did not significantly moderate the relationship between attitudes towards social media advertisements and fast-food consumption patterns. From a theoretical perspective, these results enrich the understanding of how digital dynamics shape consumer behavior in specific contexts. Practically speaking, they prompt a critical reflection on the ethics of marketing in promoting products potentially detrimental to health, urging both companies and policymakers to reconsider their strategies and regulations, respectively.

Around the EQUATOR with Clin-STAR: Prediction modeling opportunities and challenges in aging research.

The 2015 Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Statement was published to improve reporting transparency for prediction modeling studies. The objective of this review is to highlight methodologic challenges that aging-focused researchers will encounter when designing and reporting studies involving prediction models for older adults and provide guidance for addressing these challenges. In following the 22-item TRIPOD checklist, researchers must consider the representativeness of cohorts used (e.g., whether older adults with frailty, cognitive impairment, and social isolation were included), strategies for incorporating common geriatric predictors (e.g., age, comorbidities, functional status, and frailty), methods for handling missing data and competing risk of death, and assessment of model performance heterogeneity across important subgroups (e.g., age, sex, race, and ethnicity). We provide guidance to help aging-focused researchers develop, validate, and report models that can inform and improve patient care, which we label "TRIPOD-65."

[Validation of a questionnaire to assess patient safety culture in healthcare managers: Psychometric properties and usability]. / Validación de un cuestionario para evaluar la cultura de seguridad del paciente en directivos de la salud: propiedades psicométricas y usabilidad.

AIM: To validate a reduced and applicable to distinct location version of the only validated questionnaire of patient safety culture in managers in Spanish language. METHOD: Questionnaire validation study. Community of Madrid 2022. Reduction/adaptation of the original questionnaire: Giménez-Aibar-Gutiérrez, 2013 Questionnaire was reduced from 85 items to 25; those local or not applicable were removed. Pre-test: Semi-structured survey on comprehension and response scale. There was no need to modify the questionnaire. VALIDATION: It was tested in 39 primary care managers without care activity. Internal consistency (α Cronbach), content validity (experts) and construct validity (factor analysis) were analysed. Usability analysis: Survey on time spent and non-response rate. RESULTS: α Cronbach=0.894. Content validity: Experts deemed questionnaire was complete. Factor analysis: five factors explain 68% of variance. The factors corresponded to the dimensions of the theoretical construct. Factors, internal consistency of each and correlation with global score were: commitment with patient safety: α Cronbach=0.793, r=0.778; P<.001; procedures/reporting: α Cronbach=0.83, r=0.806; P<.001; attitudes with patient safety: α Cronbach=0.766, r=0.596; P<.001; clinicians involving: α Cronbach=0.773, r=0.798; P<.001; patient safety communication: α Cronbach=0.615, r=0.518; P=.001; usability survey: 95% thought spent time was adequate. Non-response rate was 0%, except one item. CONCLUSION: In this work, a reduced and adapted version of questionnaire of Giménez-Aibar-Gutiérrez was validated at distinct location (Madrid region). Psychometric properties and usability, which were found, suggest that the reduced questionnaire is a reliable, valid and usable instrument to assess patient safety culture in managers of any place.

Comparative study of mechanical vs. manual circumcision in the pediatric population: An alternative to the conventional technique? / Estudio comparativo entre circuncisión mecánica y manual en población pediátrica: ¿una alternativa a la técnica convencional?

OBJECTIVE: Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) is regarded as the gold standard technique, easy-to-use mechanical suture (MECS) devices have been recently developed, with better postoperative results in the adult population. The objective of our study was to compare the operating time and incidence of postoperative complications between both techniques in our environment. MATERIALS AND METHODS: A retrospective study of patients undergoing circumcision in our institution from October 2021 to December 2022 was carried out. Operating time and complications observed in the first 14 postoperative days (edema, hematoma, dehiscence) were analyzed according to the technique used (MANS vs. MECS) and patient age (< 12 and ≥ 12 years old). RESULTS: 173 patients (147 MANS, 26 MECS) were included. Mean operating time was significantly lower in MECS patients, both in patients < 12 years old (16 min vs. 10 min, p= 0.002) and in patients ≥ 12 years old (23 min vs. 12 min, p< 0.001). Regarding complications, MECS patients ≥ 12 years old had a lower rate of suture dehiscence (23.5% vs. 0%, p< 0.001), with no significant differences in the younger group. CONCLUSIONS: MECS circumcision is a simple and effective technique involving shorter operating times than MANS circumcision, regardless of age. It has a lower rate of complications in older children (≥ 12 years), which means it stands as a valid alternative to the conventional technique.

OBJETIVOS: La circuncisión es una de las intervenciones quirúrgicas más realizadas en cirugía pediátrica. Aunque la técnica con sutura manual (SMAN) se considera el gold standard, recientemente se han desarrollado dispositivos de sutura mecánica (SMEC) de fácil manejo y con mejores resultados postoperatorios en la población adulta. El objetivo de nuestro estudio es comparar el tiempo quirúrgico y la incidencia de complicaciones postoperatorias entre ambas técnicas en nuestro ámbito. MATERIAL Y METODOS: Estudio retrospectivo de pacientes circuncidados en nuestro centro entre octubre 2021 y diciembre 2022. Se analizó el tiempo quirúrgico y las complicaciones observadas en los primeros 14 días postoperatorios (edema, hematoma, dehiscencia), en función de la técnica empleada (SMAN vs SMEC) y la edad de los pacientes (< 12 y ≥ 12 años). RESULTADOS: Se incluyeron 173 pacientes (147 SMAN, 26 SMEC). El tiempo quirúrgico medio fue significativamente menor en los pacientes con SMEC, tanto en < 12 años (16 min vs. 10 min, p= 0,002) como en ≥ 12 años (23 min vs 12 min, p< 0,001). En cuanto a las complicaciones, los pacientes con SMEC del grupo ≥ 12 años presentaron menor tasa de dehiscencia de sutura (23,5% vs 0%, p< 0,001), sin observarse diferencias significativas en el grupo de menor edad. CONCLUSIONES: La circuncisión con SMEC es una técnica sencilla y eficaz, que precisa un tiempo quirúrgico más reducido que la sutura manual, independientemente de la edad. Presenta menor tasa de complicaciones en los niños de mayor edad (≥ 12 años), por lo que se plantea como una alternativa válida a la técnica clásica.

Estudio comparativo entre circuncisión mecánica y manual en población pediátrica: ¿una alternativa a la técnica convencional? / Comparative study of mechanical vs. manual circumcision in the pediatric population: An alternative to the conventional technique?

Objetivos: La circuncisión es una de las intervenciones quirúrgicas más realizadas en cirugía pediátrica. Aunque la técnica con suturamanual (SMAN) se considera el gold standard, recientemente se handesarrollado dispositivos de sutura mecánica (SMEC) de fácil manejo ycon mejores resultados postoperatorios en la población adulta. El objetivo de nuestro estudio es comparar el tiempo quirúrgico y la incidencia decomplicaciones postoperatorias entre ambas técnicas en nuestro ámbito.Material y métodos: Estudio retrospectivo de pacientes circuncidados en nuestro centro entre octubre 2021 y diciembre 2022. Se analizóel tiempo quirúrgico y las complicaciones observadas en los primeros14 días postoperatorios (edema, hematoma, dehiscencia), en funciónde la técnica empleada (SMAN vs SMEC) y la edad de los pacientes(< 12 y ≥ 12 años). Resultados: Se incluyeron 173 pacientes (147 SMAN, 26 SMEC).El tiempo quirúrgico medio fue significativamente menor en los pacientes con SMEC, tanto en < 12 años (16 min vs. 10 min, p= 0,002) comoen ≥ 12 años (23 min vs 12 min, p< 0,001). En cuanto a las complicaciones, los pacientes con SMEC del grupo ≥ 12 años presentaron menortasa de dehiscencia de sutura (23,5% vs 0%, p< 0,001), sin observarsediferencias significativas en el grupo de menor edad. Conclusiones: La circuncisión con SMEC es una técnica sencillay eficaz, que precisa un tiempo quirúrgico más reducido que la suturamanual, independientemente de la edad. Presenta menor tasa de complicaciones en los niños de mayor edad (≥ 12 años), por lo que se planteacomo una alternativa válida a la técnica clásica.(AU)

Objective: Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) isregarded as the gold standard technique, easy-to-use mechanical suture(MECS) devices have been recently developed, with better postoperative results in the adult population. The objective of our study was tocompare the operating time and incidence of postoperative complicationsbetween both techniques in our environment.Materials and methods: A retrospective study of patients undergoing circumcision in our institution from October 2021 to December 2022was carried out. Operating time and complications observed in the first14 postoperative days (edema, hematoma, dehiscence) were analyzedaccording to the technique used (MANS vs. MECS) and patient age(< 12 and ≥12 years old).Results: 173 patients (147 MANS, 26 MECS) were included.Mean operating time was significantly lower in MECS patients, bothin patients < 12 years old (16 min vs. 10 min, p= 0.002) and in patients≥12 years old (23 min vs. 12 min, p< 0.001). Regarding complications,MECS patients ≥12 years old had a lower rate of suture dehiscence(23.5% vs. 0%, p< 0.001), with no significant differences in the youngergroup. Conclusions: MECS circumcision is a simple and effective technique involving shorter operating times than MANS circumcision, regardless of age. It has a lower rate of complications in older children (≥12years), which means it stands as a valid alternative to the conventionaltechnique.(AU)

Inference on a Multi-Patch Epidemic Model with Partial Mobility, Residency, and Demography: Case of the 2020 COVID-19 Outbreak in Hermosillo, Mexico.

Most studies modeling population mobility and the spread of infectious diseases, particularly those using meta-population multi-patch models, tend to focus on the theoretical properties and numerical simulation of such models. As such, there is relatively scant literature focused on numerical fit, inference, and uncertainty quantification of epidemic models with population mobility. In this research, we use three estimation techniques to solve an inverse problem and quantify its uncertainty for a human-mobility-based multi-patch epidemic model using mobile phone sensing data and confirmed COVID-19-positive cases in Hermosillo, Mexico. First, we utilize a Brownian bridge model using mobile phone GPS data to estimate the residence and mobility parameters of the epidemic model. In the second step, we estimate the optimal model epidemiological parameters by deterministically inverting the model using a Darwinian-inspired evolutionary algorithm (EA)-that is, a genetic algorithm (GA). The third part of the analysis involves performing inference and uncertainty quantification in the epidemic model using two Bayesian Monte Carlo sampling methods: t-walk and Hamiltonian Monte Carlo (HMC). The results demonstrate that the estimated model parameters and incidence adequately fit the observed daily COVID-19 incidence in Hermosillo. Moreover, the estimated parameters from the HMC method yield large credible intervals, improving their coverage for the observed and predicted daily incidences. Furthermore, we observe that the use of a multi-patch model with mobility yields improved predictions when compared to a single-patch model.

Random sequential adsorption of self-avoiding chains on two-dimensional lattices.

Random sequential adsorption of extended objects deposited on two-dimensional regular lattices is studied. The depositing objects are chains formed by occupying adsorption sites on the substrate through a self-avoiding walk of k lattice steps; these objects are also called "tortuous k-mers." We study how the jamming coverage, θ_{j,k}, depends on k for lattices with different connectivity (honeycomb, square, and triangular). The dependence can be fitted by the function θ_{j,k}=θ_{j,k→∞}+B/k+C/k^{2}, where B and C are found to be shared parameters by the three lattices and θ_{j,k→∞} (>0) is the jamming coverage for infinitely long k-mers for each of them. The jamming coverage is found to have a growing behavior with the connectivity of the lattice. In addition, θ_{j,k} is found to be higher for tortuous k-mers than for the previously reported for linear k-mers in each lattice. The results were obtained by means of numerical simulation through an efficient algorithm whose characteristics are discussed in detail. The computational method introduced here also allows us to investigate the full-time kinetics of the surface coverage θ_{k}(t) [θ_{j,k}≡θ_{k}(t→∞)]. Along this line, different time regimes are identified and characterized.

Inverse percolation by removing straight semirigid rods from bilayer square lattices.

Numerical simulations and finite-size scaling analysis have been carried out to study the problem of inverse percolation by removing semirigid rods from a L×L square lattice that contains two layers (and M=L×L×2 sites). The process starts with an initial configuration where all lattice sites are occupied by single monomers (each monomer occupies one lattice site) and, consequently, the opposite sides of the lattice are connected by nearest-neighbor occupied sites. Then the system is diluted by removing groups of k consecutive monomers according to a generalized random sequential adsorption mechanism. The study is conducted by following the behavior of two critical concentrations with size k: (1) jamming coverage θ_{j,k}, which represents the concentration of occupied sites at which the jamming state is reached, and (2) inverse percolation threshold θ_{c,k}, which corresponds to the maximum concentration of occupied sites for which connectivity disappears. The obtained results indicate that (1) the jamming coverage exhibits an increasing dependence on the size k-it rapidly increases for small values of k and asymptotically converges towards a definite value for infinitely large k sizes θ_{j,k→∞}≈0.2701-and (2) the inverse percolation threshold is a decreasing function of k in the range 1≤k≤17. For k≥18, all jammed configurations are percolating states (the lattice remains connected even when the highest allowed concentration of removed sites is reached) and, consequently, there is no nonpercolating phase. This finding contrasts with the results obtained in literature for a complementary problem, where straight rigid k-mers are randomly and irreversibly deposited on a square lattice forming two layers. In this case, percolating and nonpercolating phases extend to infinity in the space of the parameter k and the model presents percolation transition for the whole range of k. The results obtained in the present study were also compared with those reported for the case of inverse percolation by removal of rigid linear k-mers from a square monolayer. The differences observed between monolayer and bilayer problems were discussed in terms of vulnerability and network robustness. Finally, the accurate determination of the critical exponents ν, ß, and γ reveals that the percolation phase transition involved in the system has the same universality class as the standard percolation problem.

The burden of chronic obstructive pulmonary disease among hospitalised women in a developing country.

BACKGROUND: The course of chronic obstructive pulmonary disease (COPD) is different in men and women. There are limited data in Latin America regarding COPD exacerbations (ECOPD) in women. This study aims to determine the sociodemographic and clinical profile of ECOPD adjusted by gender.METHODS: Cross-sectional analytical study of all patients hospitalised due to an ECOPD in a tertiary university hospital in Colombia between 2015 and 2019. A group comparison analysis was performed between male and female groups.RESULTS: A total of 81 patients met the inclusion criteria (35.8% were women). The mean age was 71.49 years. Most of the patients were GOLD (Global Initiative for Obstructive Lung Disease) 3 and 4. A history of TB was present in 15% of our cohort. While the proportion of smokers was higher among men (OR 5.11; P = 0.013), exposure to wood smoke was significantly higher in women (OR 24; P < 0.001). Females were associated with a lower probability of having forced expiratory volume in 1 sec >0,87 L (OR 0.11; P = 0.013) and were associated with an increased probability of receiving inhaled corticosteroids during hospitalisation (OR 3.33; P = 0.023). No differences in terms of mortality or complications were found.CONCLUSION: Women with COPD are underrepresented in literature. This study was able to identify some factors related to female sex among patients hospitalised for severe ECOPD.