Brominated flame retardants and natural organobrominated compounds in a vulnerable delphinid species along the Brazilian coast.

Guiana dolphins, Sotalia guianensis, are vulnerable to extinction along their distribution on the Brazilian coast and assessing chemical pollution is of utmost importance for their conservation. For this study, 51 carcasses of Guiana dolphins were sampled across the Brazilian coast to investigate legacy and emerging brominated flame retardants (BFRs) as well as the naturally-produced MeO-BDEs. PBDEs and MeO-BDEs were detected in all samples analyzed, whereas emerging BFRs were detected in 16 % of the samples, all in Rio de Janeiro state. PBDE concentrations varied between 2.24 and 799 ng.g-1 lipid weight (lw), emerging BFRs between 0.12 and 1.51 ng.g-1 lw and MeO-BDEs between 3.82 and 10,247 ng.g-1 lw. Concentrations of legacy and emerging BFRs and natural compounds varied considerably according to the sampling site and reflected both the local anthropogenic impact of the region and the diversity/mass of biosynthesizers. The PBDE concentrations are lower than what was found for delphinids in the Northern Hemisphere around the same sampling period and most sampling sites presented mean concentrations lower than the limits for endocrine disruption known to date for marine mammals of 460 ng.g-1 lw, except for sampled from Santa Catarina state, in Southern Brazil. Conversely, MeO-BDE concentrations are higher than those of the Northern Hemisphere, particularly close to the Abrolhos Bans and Royal Charlotte formation, that are hotspots for biodiversity. Despite the elevated concentrations reported for this group, there is not much information regarding the effects of such elevated concentrations for these marine mammals. The distinct patterns observed along the Brazilian coast show that organobrominated compounds can be used to identify the ecological segregation of delphinids and that conservation actions should be planned considering the local threats.

Ecologically driven differences in individual diet specialization across three populations of Guiana dolphin.

Populations usually considered foraging generalists may include specialized individuals that feed on a restricted subset of the prey spectrum consumed by the population. By analyzing the time series of δ13C and δ15N values in sequential growth layer groups within tooth dentin, we measured population- and individual-level variation in resource use of three populations of Guiana dolphins (Sotalia guianensis)-Caravelas River, Babitonga Bay, and Norte Bay-along a latitudinal gradient in the southwestern Atlantic Ocean. We show that the Guiana dolphin at Caravelas River is a generalist population consisting of individual dietary specialists, likely due to the absence of other resident dolphin populations thus allowing individuals to target prey across a wide range of habitats. The Babitonga Bay population is also composed of individual specialists potentially due to the selective foraging behavior of some individuals on high-quality prey sources within and near the bay. In contrast, the Norte Bay population comprises individual generalists, which likely reflects its distinctive cohesive social organization, coexistence with two other dolphin species, and an opportunistic foraging strategy in response to resource fluctuations inherent to the southern limit of the species distribution. Although the Guiana dolphin is generally considered to be a dietary generalist at the population level, our findings reveal that the total niche width of populations and the degree of individual diet specialization are highly context dependent, suggesting dietary plasticity that may be related to a latitudinal gradient in resource availability and environmental conditions.

Short-Finned Pilot Whale Strandings Associated with Pilot Whale Morbillivirus, Brazil.

Cetacean morbillivirus (CeMV) causes illness and death in cetaceans worldwide; the CeMV strains circulating in the Southern Hemisphere are poorly known. We detected a pilot whale CeMV strain in 3 short-finned pilot whales (Globicephala macrorhynchus) stranded in Brazil during July-October 2020. Our results confirm this virus circulates in this species.

Characterization of Traumatic Injuries Due to Motor Vehicle Collisions in Neotropical Wild Mammals.

Motor vehicle collisions (MVCs) are a severe threat to wildlife biodiversity worldwide and most vertebrate species are at risk. However, there is a considerable knowledge gap on the traumatic features and potential patterns of MVCs in wildlife. We investigated traumatic injuries (TIs) caused by MVCs (MVCs-TIs) in 430 neotropical wild mammals representing 44 species from Brazil. Injuries were classified topographically into four categories: abdomen/pelvis (AP), chest (TX), head/neck (HN) and extremities (EX). We also determined the prevalence of pathological changes in MVC fatalities. AP (n = 381; 89%) was the most affected body segment, followed by TX (n = 372; 87%), HN (n = 363; 84%) and EX (n = 288; 67%). The most prevalent gross pathological findings were single or multiple bone fractures (n = 397; 92%), visceral organ rupture (n = 371; 86%), haemothorax (n = 220; 51%) and pulmonary haemorrhage (n = 212; 49%). Microscopically, pulmonary oedema (n = 324; 82%) and haemorrhage (n = 272; 69%) were the most prevalent lesions. No distinct TI patterns were evident across the various taxonomic groups, although trends were found in some taxa, such as armadillos. These results may help clinicians performing emergency care on MVC wildlife patients and may be of value in pathological and forensic investigations where a MVC has been deemed a likely contributory factor to death.

Promoting interprofessional student outcomes through the narrative of an opioid use disorder survivor.

The inappropriate use of opioids is a national concern. Experts suggest a multifaceted, collaborative practice approach to reduce mortality rates in complex healthcare issues is effective. Before practice, students require education to address the development of interprofessional (IP) skills. The purpose of this mixed-methods cohort study was to identify changes in student self-perceived value of IP socialization skills and to explore student perceptions of IP engagement in the context of the opioid crisis, before and after a combined IP panel and focus group discussion using a healthcare professional's journey from addiction into recovery. Thirty-three pre-licensure healthcare students in Schools of Counseling, Nursing, Occupational Therapy, Pharmacy, and Physical Therapy assessed their IP experience using the Interprofessional Socialization and Valuing Scale (ISVS). The IP event included interactive discussions with a panel of healthcare providers, a pharmacist in recovery from opioid use disorder, and a local prescription drug awareness and prevention advocate. Significant differences occurred between pre and post ISVS scores in the perceived value of IP collaborative work. Results from the qualitative analysis revealed a need for student-driven self-reflection before the discussions evolved to address the perspectives of future practitioner, the patient, and the healthcare system. Creating a real-time, face-to-face interaction with a panel of healthcare practitioners, an opioid survivor in concert with a local prescription drug prevention advocate may be an effective means toward improving teaching IP value and progressing student outcomes toward IP skill attainment.

Echolocation variability of franciscana dolphins (Pontoporia blainvillei) between estuarine and open-sea habitats, with insights into foraging patterns.

Environmental and ecological factors can trigger changes in the acoustic repertoire of cetaceans. This study documents the first use of a well-established passive acoustic monitoring device (C-POD) to analyze echolocation sounds and behavior of franciscana dolphins in different habitats: estuary [Babitonga Bay (BB)] and open sea [Itapirubá Beach (IB)]. A total of 10 924 click trains were recorded in BB and 6 093 in IB. An inter-click interval < 10 ms (so called "feeding buzzes") was used as a proxy for foraging activity. The main difference in the acoustic parameters between the two habitats was related to the frequency spectrum, with higher maximum and lower modal and minimum click frequencies in BB, and a train frequency range of 17 kHz, against 10 kHz in IB. Also, the click emission rate (clicks/s) was almost 20% higher in BB. Both studied habitats showed a high proportion of feeding buzzes (BB = 68%; IB = 58%), but with a higher probability of occurrence in BB (p < 0.001) and at night (p < 0.001) in both habitats. The C-PODs showed great potential to monitor occurrence, bioacoustics parameters, and echolocation behavior of franciscana dolphins. Longer-term temporal and spatial monitoring are necessary for elucidating several issues raised in this study.

Low-frequency sampling rates are effective to record bottlenose dolphins.

Acoustic monitoring in cetacean studies is an effective but expensive approach. This is partly because of the high sampling rate required by acoustic devices when recording high-frequency echolocation clicks. However, the proportion of echolocation clicks recorded at different frequencies is unknown for many species, including bottlenose dolphins. Here, we investigated the echolocation clicks of two subspecies of bottlenose dolphins in the western South Atlantic Ocean. The possibility of recording echolocation clicks at 24 and 48 kHz was assessed by two approaches. First, we considered the clicks in the frequency range up to 96 kHz. We found a loss of 0.95-13.90% of echolocation clicks in the frequency range below 24 kHz, and 0.01-0.42% below 48 kHz, to each subspecies. Then, we evaluated these recordings downsampled at 48 and 96 kHz and confirmed that echolocation clicks are recorded at these lower frequencies, with some loss. Therefore, despite reaching high frequencies, the clicks can also be recorded at lower frequencies because echolocation clicks from bottlenose dolphins are broadband. We concluded that ecological studies based on the presence-absence data are still effective for bottlenose dolphins when acoustic devices with a limited sampling rate are used.

Microsatellite markers for the endangered franciscana dolphin (Pontoporia blainvillei).

The franciscana (Pontoporia blainvillei) is the most threatened small cetacean in the South Atlantic. In this study we report the development of 13 microsatellite markers for franciscanas through next-generation sequencing, and the characterization of those loci in 38 samples from the species' northernmost population (Espírito Santo, Brazil). Besides providing diversity indices for the new, specific loci, we also report on the transferability of heterologous loci which had not been screened in franciscanas before, and review all loci used in previous studies. Expected heterozygosity in the new loci ranged between 0.107 and 0.595, and all but one were in Hardy Weinberg Equilibrium. These are the first microsatellite loci isolated from franciscanas, and they are an important addition to heterologous markers that were available previously.

Prevalence and Sociodemographic Predictors of Intimate Partner Violence Against Women in El Salvador.

Violence against women is currently one of the major problems in El Salvador. However, the country lacks existing data to address this issue. The recent coming into effect of the Ley Especial Integral para una Vida Libre de Violencia para las Mujeres (LEIV) [Comprehensive Law for a Life Free of Violence Against Women] urgently calls for the dimensions of the problem to be understood. The aim of this study is to determine the prevalence of physical, sexual, emotional, and controlling violence, which Salvadoran women aged 15 to 64 years suffer at the hands of their current partners or ex-partners, and the association of such violence with sociodemographic factors. The target population of the study is composed of Salvadoran women aged 15 to 64, from which a representative sample of 1,274 women was obtained. The results reveal that 54.4% of Salvadoran women reported having suffered some type of physical, sexual, or psychological violence during their lives. Psychological control (41.2%) was the most frequent form of violence, followed by emotional violence (39%), physical violence (22.5%), and sexual violence (13.3%). Women's number of children, marital status, and age were the main factors associated with violence. This study provides information needed to develop victim care measures and training programs for professionals. The study also provides evidence of the impact of public policies and prevention programs already in place.

Total tin (TSn) biomagnification: Evaluating organotin trophic flow and dispersion using hepatic TSn concentrations and stable isotope (C, N) data of nektonic organisms from Brazil.

A previous investigation of our research team has demonstrated the suitability of using hepatic total tin (ΣSn) concentrations for evaluating dolphin exposure to organotins (OTs). The present study develops the previous technique into three different approaches that comprise data: (1) on hepatic ΣSn concentrations of 121 Guiana dolphins (Sotalia guianensis) from five different coastal areas (CAs): (2) on ΣSn, δ13C and δ15N for 40 dolphins from Rio de Janeiro state (RJ), including ten different delphinid species; as well as (3) on hepatic ΣSn concentrations and δ15N values on 31 individuals from five different fish species from Sepetiba Bay (SB, Rio de Janeiro-RJ, Brazil). Hepatic ΣSn concentrations of Guiana dolphins from Guanabara Bay (GB, RJ) were significantly higher than those found in other four CAs from S and SE Brazilian regions. Significant positive correlations were found between ΣSn concentrations and δ13C data in delphinid species, demonstrating a coast-ocean gradient in dolphin exposure to OTs in RJ state. Significant and positive correlations were observed between ΣSn concentrations and both δ15N and Trophic Position (TP) values of fish, as well as high values were found for Trophic Magnification Factor (TMF = 3.03) and Trophic Magnification Slope (TMS = 0.14), demonstrating OT biomagnification in SB ichthyofauna.

Pyrethroid insecticides along the Southwestern Atlantic coast: Guiana dolphin (Sotalia guianensis) as a bioindicator.

The presence of pyrethroid compounds in hepatic tissue of Guiana dolphins (Sotalia guianensis) is reported for the first time. Twelve pyrethroids were determined in 50 animals from eight locations of the Brazilian coast. The highest average concentration of total pyrethroids (∑PYR) was 1166 ng.g-1 lw, with values ranging from 148 to 5918 ng.g-1 lw, in Ilha Grande Bay, Rio de Janeiro State, while the Espírito Santo State had the highest median, 568 ng.g-1 lw. Permethrin was the predominant compound in most areas, contributing for 42% to 81% of the ∑PYR, whereas cypermethrin was the most abundant compound in Guanabara and Sepetiba bays (79% and 81%, respectively), both located in Rio de Janeiro State. Biological factors were not correlated with pyrethroids concentration. Tetramethrin and es/fenvalerate compounds were negatively correlated to the age, suggesting degradation/metabolization capacity in these animals that increases throughout life. Despite being metabolized and excreted, the wide use of these pollutants is reflected in relevant concentrations found in Guiana dolphins. This is the first study evaluating pyrethroids in a representative number of hepatic samples and covering >2600 km of coast. The overall lack of information on pyrethroids in cetaceans highlights the importance of understanding the profile and distribution of these pollutants in dolphins which exclusively inhabit the Southwestern Atlantic coast.

Safety and efficacy of radial access in trauma in 65 trauma endovascular cases.

OBJECTIVE: Endovascular techniques in trauma surgery are becoming increasingly important in patient management, with procedures such as pelvic and splenic angioembolization becoming the standard of care for certain injuries. Traditionally, such interventions are performed via femoral access, although the morbidity of this approach is not insignificant (3%-10%). Transradial access (TRA) is an attractive alternative, pioneered by cardiologists, with low rates of access site complications in patients undergoing coronary intervention. Recently, this technology has extended to other interventions. The aim of this study was to present the initial experience of a radial program in a busy trauma center, with specific regard to safety and complications. METHODS: The medical records of trauma patients undergoing endovascular procedures via TRA between March 2018 and December 2018 were queried for procedural and postoperative data. Demography and injury characteristics were presented for the overall cohort, followed by a comparison of procedural data and complications between laterality. Continuous variables were compared using a two-tailed t-test and categorical variables were compared using a χ2 test. RESULTS: Over a 9-month period, 65 patients underwent 81 interventions via TRA, most commonly solid organ or pelvic angiography/embolization. Radial artery access was achieved in all patients, with procedural success achieved in all but two patients (n = 63 [96.9%]) who had hypoplastic radial artery anatomy, who underwent ulnar access. The overall technique-related complication rate was 1.5% with no difference observed between laterality (n = 1; P = .523). One patient with an admission Glasgow Coma Score of 3 and coagulopathy developed radial artery thrombosis after pelvic angiography via right TRA. Mortality was seen in seven patients (10.8%) owing to hemorrhagic shock (n = 3 [42.8%]) or multiorgan failure (n = 4 [57.1%]). There were no cases of postprocedural access site bleeding, hematoma, pseudoaneurysm, vascular injury, intraoperative arrhythmia or cerebrovascular accident, arteriovenous fistula formation, or infection. CONCLUSIONS: TRA is a feasible and low-risk alternative for endovascular intervention in the trauma patient. It yields good technical success with low morbidity. Although larger studies are needed to establish the full efficacy of TRA at the multi-institutional level, this single-institution study demonstrates the legitimacy of an alternative means for endovascular intervention in the trauma patient.

Molecular, serological, pathological, immunohistochemical and microbiological investigation of Brucella spp. in marine mammals of Brazil reveals new cetacean hosts.

Brucella-exposure and infection is increasingly recognized in marine mammals worldwide. To better understand the epidemiology and health impacts of Brucella spp. in marine mammals of Brazil, molecular (conventional PCR and/or real-time PCR), serological (Rose Bengal Test [RBT], Competitive [c]ELISA, Serum Agglutination Test [SAT]), pathological, immunohistochemical (IHC) and/or microbiological investigations were conducted in samples of 129 stranded or by-caught marine mammals (orders Cetartiodactyla [n = 124], Carnivora [n = 4] and Sirenia [n = 1]). Previous serological tests performed on available sera of 27 of the 129 animals (26 cetaceans and one manatee), indicated 10 seropositive cetaceans. Conventional PCR and/or real-time PCR performed in cases with available organs (n = 119) and/or blood or swabs (n = 10) revealed 4/129 (3.1%) Brucella-infected cetaceans (one of them with positive serology; the remaining three with no available sera). Pathological, IHC and/or microbiological analyses conducted in PCR/real-time PCR and/or seropositive cases (n = 13) revealed Brucella-type lesions, including meningitis/meningoencephalitis, pneumonia, necrotizing hepatitis, pericarditis and osteoarthritis in some of those animals, and positive IHC was found in all of them (excepting two live-stranded animals without available organs). Brucella spp. culture attempts were unsuccessful. Our results demonstrated exposure, asymptomatic, acute and chronic Brucella sp. infection in several cetacean species in the Brazilian coast, highlighting the role of this pathogen in stranding and/or death, particularly in Clymene dolphin (Stenella clymene) and short-finned pilot whale (Globicephala macrorhynchus) off Ceará State. Novel hosts susceptible to Brucella included the franciscana (Pontoporia blainvillei), the Guiana dolphin (Sotalia guianensis) and the spinner dolphin (Stenella longirostris). Additionally, three coinfection cases involving Brucella spp. and cetacean morbillivirus, Edwarsiella tarda and Proteus mirabilis were detected. To the best of our knowledge, this is the first long-term and large-scale survey of Brucella spp. in marine mammals of South America, widening the spectrum of susceptible hosts and geographical distribution range of this agent with zoonotic potential.

Pulmonary and systemic fungal infections in an Atlantic spotted dolphin and a Bryde's whale, Brazil.

We report the gross and microscopic findings and molecular identification of 2 cases of hyphate fungal infection in cetaceans from Brazil. The first case involved an adult male Atlantic spotted dolphin Stenella frontalis with localized pulmonary disease characterized by pyogranulomatous and necrotizing bronchopneumonia with intralesional hyphae. The second case involved an adult male Bryde's whale Balaenoptera edeni with orchitis, periorchitis, mesenteric lymphadenitis and pyogranulomatous bronchopneumonia with intralesional hyphae. PCR analysis from the dolphin's lung yielded Aspergillus fumigatus, and the fungus from the whale's mesenteric lymph node showed the greatest identity to Nanniziopsis obscura and Stagonosporopsis cucurbitacearum These cases represent the first reports of pulmonary aspergillosis by A. fumigatus in an Atlantic spotted dolphin and systemic mycosis by a possibly novel Onygenales in marine mammals.

Infecciones oportunistas como causa de muerte en pacientes con enfermedad autoinmune. Un estudio de autopsias / Opportunistic infections as a cause of death in patients with autoimmune disease. A study of autopsies

Introducción y objetivo: Los pacientes con enfermedades autoinmunes puede desarrollar infecciones oportunistas potencialmente mortales y de difícil diagnóstico. En este trabajo se presentan los resultados de autopsias realizadas en pacientes que recibieron tratamiento inmunosupresor y fallecen a causa de dichos procesos infecciosos. Métodos: Se analizaron 1441 protocolos de autopsias realizadas en el Departamento de Patología de la Universidad Industrial de Santander (UIS) a individuos fallecidos en Bucaramanga, entre enero de 2010 y diciembre de 2014.

A new Synthesium species (Digenea: Brachycladiidae) from the bottlenose dolphin Tursiops truncatus (Cetacea: Delphinidae) in Southwestern Atlantic waters.

A new species of Synthesium from the bottlenose dolphin Tursiops truncatus in South Brazilian waters is described. Morphological and molecular identification was performed, and phylogenetic analyses were carried out using the ribosomal small subunit and internal transcribed spacer 1 and the mitochondrial NDH dehydrogenase subunit 3 and cytochrome c oxidase subunit 1 genes. The main characteristics of the new species are the subterminal round-shaped oral sucker, the anterior distribution of vitellaria reaching the level of the ovary and the oval-shaped testes. The results obtained with the molecular markers supported the inclusion of the specimens into the genus Synthesium. The nucleotide divergence detected for the mitochondrial genes among the new species and others of the same genus supported the erection of a new species. This is the ninth species assigned to the genus and the third Synthesium species recorded in the South Atlantic Ocean.

Review of thirty-two years of toothed whale strandings in Santa Catarina, southern Brazil (Cetacea: Odontoceti)

Marine mammal strandings provide valuable insights into local biodiversity. Strandings can be caused by both natural and anthropogenic factors. In the state of Santa Catarina, Southern Brazil, organized marine mammal collections started in the 1980s through opportunistic and non-systematic collection efforts, representing a record of over 30 years of marine biodiversity. This study aimed to perform a preliminary review of 32 years of stranding records within this region. The secondary aim was to elucidate the stranding dynamics of the three most commonly recorded species. A total of 460 records were obtained, representing 17 species of odontocetes. The species registered most frequently were the franciscana, Pontoporia blainvillei (Gervais & d' Orbigny, 1844) (n = 173), bottlenose dolphin, Tursiops truncatus (Montagu, 1821) (n = 100), and Guiana dolphin Sotalia guianensis (Van Bénéden, 1864) (n = 97). Most of the stranding records were observed in the second half of the year during the austral winter and spring. The apparent causes of death could not be determined for most of the specimens due to carcass decomposition. For the specimens in which the apparent cause of death could be determined, 27% of the strandings were compatible with anthropogenic interactions. While the focus of this study was a preliminary assessment of stranding data obtained through opportunistic collection, it is evident that future systematic monitoring efforts and stable networks of collaborators will generate more reliable coastal biodiversity inventories and will allow the knowledge of population dynamics of marine mammal species. In particular, for threatened and vulnerable species, or species with poor natural history data, strandings are a fundamental tool for the understanding of marine biodiversity. Ideally, future more refined analyses of stranding data should be used to inform conservation and management policies and to elucidate the biology and ecology of marine and coastal...

Review of thirty-two years of toothed whale strandings in Santa Catarina, southern Brazil (Cetacea: Odontoceti)

Marine mammal strandings provide valuable insights into local biodiversity. Strandings can be caused by both natural and anthropogenic factors. In the state of Santa Catarina, Southern Brazil, organized marine mammal collections started in the 1980s through opportunistic and non-systematic collection efforts, representing a record of over 30 years of marine biodiversity. This study aimed to perform a preliminary review of 32 years of stranding records within this region. The secondary aim was to elucidate the stranding dynamics of the three most commonly recorded species. A total of 460 records were obtained, representing 17 species of odontocetes. The species registered most frequently were the franciscana, Pontoporia blainvillei (Gervais & d' Orbigny, 1844) (n = 173), bottlenose dolphin, Tursiops truncatus (Montagu, 1821) (n = 100), and Guiana dolphin Sotalia guianensis (Van Bénéden, 1864) (n = 97). Most of the stranding records were observed in the second half of the year during the austral winter and spring. The apparent causes of death could not be determined for most of the specimens due to carcass decomposition. For the specimens in which the apparent cause of death could be determined, 27% of the strandings were compatible with anthropogenic interactions. While the focus of this study was a preliminary assessment of stranding data obtained through opportunistic collection, it is evident that future systematic monitoring efforts and stable networks of collaborators will generate more reliable coastal biodiversity inventories and will allow the knowledge of population dynamics of marine mammal species. In particular, for threatened and vulnerable species, or species with poor natural history data, strandings are a fundamental tool for the understanding of marine biodiversity. Ideally, future more refined analyses of stranding data should be used to inform conservation and management policies and to elucidate the biology and ecology of marine and coastal...(AU)

Herramientas para prevenir la violencia de género: implicaciones de un registro diario de situaciones de desigualdad de género / Tools for gender violence prevention: implications of keeping records of everyday situations of gender inequality / Ferramentas para prevenir a violência de gênero: implicações de um registro diário de situações de desigualdade de gênero

Em El Salvador, a violência contra as mulheres e os feminicídios são os problemas mais graves que afetam o país. Embora nos últimos anos tenham sido promovidas algumas mudanças legislativas e diferentes políticas públicas, a sensibilização e a consciência sobre as desigualdades de gênero na sociedade em seu conjunto têm avançado mais lentamente do que as mudanças estruturais. Por isso, fazem-se urgentes o desenho de programas de formação e prevenção de violência de gênero e a sua validação bem como o uso de ferramentas úteis para a interiorização dessas mudanças. Neste trabalho, propõe-se uma ferramenta de registro de situações cotidianas de desigualdade de gênero que foi empregada num programa de prevenção de violência de gênero, cuja avaliação se fez por meio de um desenho quase-experimental (De Lemus, Navarro, Megías, Velásquez e Ryan, 2014), que buscava cumprir com o primeiro de seus objetivos: aumentar a consciência sobre as desigualdades de gênero na vida cotidiana. Discutem-se os resultados qualitativos obtidos a partir dessa metodologia baseada em outros estudos (Becker e Swim, 2011) e de acordo com os resultados obtidos na aplicação do programa a fim de reduzir as crenças sexistas e a discriminação de gênero.

Violence against women and feminicides are some of the most severe problems in El Salvador. During the last few years, some legislative changes as well as changes in matters of public policies have taken place; however, increasing sensitivity and awareness on gender inequality in society have not matched the structural changes. Given this context, the design and validation of violence prevention and promotion programs is mandatory, as well as the implementation of useful tools for the internalization of these changes. The main objective of this paper is to propose a tool for keeping records of everyday situations of gender inequality. This instrument has been already used in a gender-based violence prevention program (De Lemus, Navarro, Megías, Velásquez & Ryan, 2014, whose evaluation was done through a quasi-experimental design and sought to achieve one of its goals: to increase awareness on gender inequalities in everyday situations. Qualitative results of this methodology based on other studies (Becker and Swim, (2011) are discussed, with the aim of reducing the existing sexist beliefs and gender discrimination.

En El Salvador, la violencia contra las mujeres y los feminicidios son los problemas más graves que azotan el país. Aunque en los últimos años se han promovido algunos cambios legislativos y diferentes políticas públicas, la sensibilización y conciencia sobre las desigualdades de género en la sociedad en su conjunto han avanzado más lentamente que los cambios estructurales. Por esto, se hace urgente el diseño y la validación de programas de formación y prevención de violencia de género, así como el uso de herramientas útiles para la interiorización de estos cambios. En el presente trabajo se propone una herramienta de registro de situaciones cotidianas de desigualdad de género que fue empleada en un programa de prevención de violencia de género, cuya evaluación se hizo a través de un diseño cuasi-experimental (De Lemus, Navarro, Megías, Velásquez y Ryan, 2014), y que buscaba cumplir con el primero de sus objetivos: incrementar la conciencia sobre las desigualdades de género en la vida cotidiana. Se discuten los resultados cualitativos obtenidos a partir de dicha metodología basada en otros estudios (Becker y Swim, 2011) y al tenor de los resultados obtenidos en la aplicación del programa, con el fin de reducir las creencias sexistas y la discriminación de género.

Impact of Rest Myocardial Perfusion Imaging on Clinical Management of Non-High Risk Chest Pain in the VA Caribbean Healthcare System Emergency Department: 2006-2008.

OBJECTIVE: To evaluate the appropriate clinical use of an acute rest myocardial perfusion imaging (R-MPI) in the initial emergency department (ED) evaluation of a patient presenting with chest pain (CP). METHODS: This is a retrospective study of patients evaluated with CP at the ED with an acute R-MPI. The data collected included medical history, clinical presentation, electrocardiogram, laboratory data, MPI results, confirmatory studies, disposition diagnosis and cost analysis. RESULTS: Three-hundred-sixty-six (366) patients were evaluated. The population studied had a mean Thrombolysis in Myocardial Infarction (TIMI) score of 2 and predominance of patients in the Virginia Commonwealth University (VCU) CP Category-Scale between level 3 and 4 (34% and 49% respectively). The risk of acute coronary syndrome (ACS) was significantly higher in patients with abnormal compared to normal studies (50% versus 0.4%; P < .0005; RR, 129.5; 95% CI, 18 to 924). There were a total of 14 and 19 major adverse cardiovascular events (MACE) events during the follow-up of 30-days and 1-year respectively. There were no cardiovascular fatalities. The risk of MACE at 30-days was significantly higher in patients with abnormal compared to normal studies (12% versus 0.4%; P < .001; RR, 32; 95% CI, 4.2 to 240), as well as with 1-year of follow-up (14% versus 1.6%; P < .001; RR, 9.1; 95% CI, 3.1 to 27). CONCLUSION: Using acute R-MPI in the evaluation of non-high risk patients presenting with CP is a safe, reliable and cost-effective strategy to be used in the ED to predict ACS and future MACE.