Avoiding ecosystem and social impacts of hydropower, wind, and solar in Southern Africa's low-carbon electricity system.

The scale at which low-carbon electricity will need to be deployed to meet economic growth, electrification, and climate goals in Africa is unprecedented, yet the potential land use and freshwater impacts from this massive build-out of energy infrastructure is poorly understood. In this study, we characterize low-impact onshore wind, solar photovoltaics, and hydropower potential in Southern Africa and identify the cost-optimal mix of electricity generation technologies under different sets of socio-environmental land use and freshwater constraints and carbon targets. We find substantial wind and solar potential after applying land use protections, but about 40% of planned or proposed hydropower projects face socio-environmental conflicts. Applying land and freshwater protections results in more wind, solar, and battery capacity and less hydropower capacity compared to scenarios without protections. While a carbon target favors hydropower, the amount of cost-competitively selected hydropower is at most 45% of planned or proposed hydropower capacity in any scenario-and is only 25% under socio-environmental protections. Achieving both carbon targets and socio-environmental protections results in system cost increases of 3-6%. In the absence of land and freshwater protections, environmental and social impacts from new hydropower development could be significant.

Novel insights into the whole-blood DNA methylome of asthma in ethnically diverse children and youth.

BACKGROUND: The epigenetic mechanisms of asthma remain largely understudied in African Americans and Hispanics/Latinos, two populations disproportionately affected by asthma. We aimed to identify markers, regions and processes with differential patterns of DNA methylation (DNAm) in whole blood by asthma status in ethnically diverse children and youth, and to assess their functional consequences. METHODS: DNAm levels were profiled with the Infinium MethylationEPIC or HumanMethylation450 BeadChip arrays among 1226 African Americans or Hispanics/Latinos and assessed for differential methylation per asthma status at the CpG and region (differentially methylated region (DMR)) level. Novel associations were validated in blood and/or nasal epithelium from ethnically diverse children and youth. The functional and biological implications of the markers identified were investigated by combining epigenomics with transcriptomics from study participants. RESULTS: 128 CpGs and 196 DMRs were differentially methylated after multiple testing corrections, including 92.3% and 92.8% novel associations, respectively. 41 CpGs were replicated in other Hispanics/Latinos, prioritising cg17647904 (NCOR2) and cg16412914 (AXIN1) as asthma DNAm markers. Significant DNAm markers were enriched in previous associations for asthma, fractional exhaled nitric oxide, bacterial infections, immune regulation or eosinophilia. Functional annotation highlighted epigenetically regulated gene networks involved in corticosteroid response, host defence and immune regulation. Several implicated genes are targets for approved or experimental drugs, including TNNC1 and NDUFA12. Many differentially methylated loci previously associated with asthma were validated in our study. CONCLUSIONS: We report novel whole-blood DNAm markers for asthma underlying key processes of the disease pathophysiology and confirm the transferability of previous asthma DNAm associations to ethnically diverse populations.

Epigenome-Wide Association Studies of the Fractional Exhaled Nitric Oxide and Bronchodilator Drug Response in Moderate-to-Severe Pediatric Asthma.

Asthma is the most prevalent pediatric chronic disease. Bronchodilator drug response (BDR) and fractional exhaled nitric oxide (FeNO) are clinical biomarkers of asthma. Although DNA methylation (DNAm) contributes to asthma pathogenesis, the influence of DNAm on BDR and FeNO is scarcely investigated. This study aims to identify DNAm markers in whole blood associated either with BDR or FeNO in pediatric asthma. We analyzed 121 samples from children with moderate-to-severe asthma. The association of genome-wide DNAm with BDR and FeNO has been assessed using regression models, adjusting for age, sex, ancestry, and tissue heterogeneity. Cross-tissue validation was assessed in 50 nasal samples. Differentially methylated regions (DMRs) and enrichment in traits and biological pathways were assessed. A false discovery rate (FDR) < 0.1 and a genome-wide significance threshold of p < 9 × 10-8 were used to control for false-positive results. The CpG cg12835256 (PLA2G12A) was genome-wide associated with FeNO in blood samples (coefficient= -0.015, p = 2.53 × 10-9) and nominally associated in nasal samples (coefficient = -0.015, p = 0.045). Additionally, three CpGs were suggestively associated with BDR (FDR < 0.1). We identified 12 and four DMRs associated with FeNO and BDR (FDR < 0.05), respectively. An enrichment in allergic and inflammatory processes, smoking, and aging was observed. We reported novel associations of DNAm markers associated with BDR and FeNO enriched in asthma-related processes.

TGFB1 mRNA expression and frequency of the + 869T>C and + 915G>C genetic variants: impact on risk for systemic sclerosis.

Systemic Sclerosis (SSc) is a chronic autoimmune disease characterized by immune disorder, microvascular damage, and fibrosis. TGFB1 gene encodes for the transforming growth factor isoform 1 (TGF-ß1), one of the most important pro-fibrotic cytokines. Therefore, variants in TGFB1 and changes in its expression could be associated with the pathogenesis of SSc. We aimed to evaluate the association of TGFB1 variants (+ 869T>C [rs1982073] and + 915G > C [rs1800471]) with the TGFB1 mRNA expression and SSc risk in the Southern Mexican population. We included 56 SSc patients and 112 control subjects (CS). The genetic variants were determined by the PCR-RFLP method. The TGFB1 mRNA expression was determined by qPCR. For the + 869T>C variant, the C allele was associated with SSc risk (OR = 1.733; CI = 1.087-2.762; p = 0.020). The C allele for the + 915G>C variant was also associated with SSc risk (OR = 11.168; CI = 1.289-96.754; p = 0.023). The relative expression of TGFB1 mRNA was 1.77-fold lower in SSc patients than in CS. Carriers of polymorphic alleles (TC or CC genotypes) for the + 869T>C variant showed 3.7-fold lower mRNA expression than the TT genotype in patients and 4.81-fold lower in CS. For the + 915G>C variant, patients with GA genotype had 1.78-fold lower mRNA expression than GG genotype carriers. In conclusion, the present study showed that + 869T>C and + 915G>C variants could be SSc risk factors for patients from Southern Mexico, and these genetic variants could induce lower mRNA expression of TGFB1.

Diagnóstico y tratamiento multidisciplinario de melanoma temprano y localmente avanzado. Consenso de expertos. Asociación Colombiana de Hematología y Oncología (ACHO) / Diagnosis and multidisciplinary treatment of early-stage and locally advanced melanoma: Expert consensus, Colombian Association of Hemato-Oncology (ACHO)

Resumen Introducción: El melanoma ocasiona el 75% de las muertes por cáncer de piel. Según GLOBOCAN, en 2018 se presentaron 287.723 casos nuevos de melanoma, con una mortalidad de 60.712 casos, que equivale al 20% del total de los casos incidentes. Las alternativas para el tratamiento del melanoma se fundamentan en la estatificación de la enfermedad, y en las características moleculares de la enfermedad. Objetivo: Consensuar, por común acuerdo de expertos, sugerencias para el diagnóstico y manejo de melanoma temprano basadas en la evidencia y ajustadas al contexto colombiano. Métodos: Se llevó a cabo un consenso de expertos multidisciplinario, constituido por 19 oncólogos clínicos, 2 cirujanos de mama y tejidos blandos, 2 dermatólogos, 2 patólogos y 2 radioterapeutas, miembros activos de la Asociación Colombiana de Hemato Oncología (ACHO). Este consenso se realizó en 4 etapas: 1. Estructuración de 29 preguntas, que se calificaron de 1 a 9. 2. Reenvío de las preguntas no consensuadas. 3. Análisis y discusión de las respuestas. 4. Las respuestas no consensuadas se llevaron a un consenso nominal. Resultados: Se discutieron 29 preguntas relacionadas con el diagnóstico y tratamiento de melanoma temprano, se construyeron sugerencias basadas en evidencia utilizada por los expertos y en guías de manejo de oncología reconocidas internacionalmente, adaptadas al contexto y realidad colombianos. Conclusiones: Se presentan sugerencias multidisciplinarias para el diagnóstico y tratamiento de melanoma temprano, las cuales debe considerarse para orientar la toma de decisiones y homogenizar la práctica clínica de acuerdo al contexto colombiano y a las características propias del sistema de salud del país. Este es un documento académico y no regulatorio.

Abstract Introduction: Melanoma causes 75% of deaths from skin cancer. In 2018, according to GLOBOCAN, 287,723 new melanoma cases were registered, with a mortality of 60,712 cases, which is equivalent to 20% of all incident cases. Alternatives for the treatment of melanoma are based on disease staging and the molecular characteristics of the disease. Objective: To establish a consensus by common agreement of experts and construct suggestions for the diagnosis and management of early-stage melanoma based on evidence and adjusted to the Colombian context. Methods: A multidisciplinary expert consensus was established, wth the participation of 19 clinical oncologists, 2 soft tissue surgeons, 2 dermatologists, 2 pathologists, and 2 radiotherapists, active members of the Colombian Association of Hemato-Oncology (ACHO). This consensus was carried out in four stages: 1) Structuring of 29 questions, which were scored from 1 to 9; 2) Resubmission of non-consensual questions; 3) Analysis and discussion of responses; and 4) Validation of non-consensual responses by nominal consensus. Results: Twenty-nine questions related to the diagnosis and treatment of early-stage melanoma were discussed in order to construct suggestions based on evidence proven by experts, as well as on internationally recognized oncology management guidelines adapted to the Colombian context and reality. Conclusions: Multidisciplinary suggestions are offered for the diagnosis and treatment of early-stage melanoma, which should be considered in order to guide decision-making and homogenize clinical practice according to the Colombian context and the characteristics of the Colombian health care system. This is an academic and non-regulatory document.

Contributions of Crystalline and Noncrystalline Cellulose Can Occur in the Same Spectral Regions: Evidence Based on Raman and IR and Its Implication for Crystallinity Measurements.

Aggregated states of celluloses remain poorly understood, and therefore, the topic requires careful investigation. In this study, Raman, IR, and X-ray diffraction (XRDs) were used to study cotton microcrystalline cellulose (MCC) and MCC that has been ball-milled to various degrees. Raman and IR spectroscopy methods indicated that when these ball-milled samples were wet with water, most underwent conformational changes at the molecular level. Although formation of cellulose II was observed in longer duration ball-milled samples, the changes primarily gave rise to increased contributions in spectral and diffraction regions typically associated with the contributions of crystalline cellulose I. Moreover, when the wet samples were air-dried at 25 °C, the newly formed cellulose I-like structures partly reverted to the previous form present in the initial dry state. These findings explained for the previously reported XRD and NMR observations, where the addition of water resulted in increased crystallinities of cellulose samples. The implications of these findings to cellulose crystallinity measurements and other situations are discussed.

Pilot-Scale Production of Cellulosic Nanowhiskers With Similar Morphology to Cellulose Nanocrystals.

This study describes a class of cellulosic nanomaterials, cellulosic nanowhiskers (CNWs), and demonstrates scaled-up production with acid recovery using less expensive equipment made of common stainless steel rather than glass-lined steel. CNWs produced using concentrated maleic acid (MA) hydrolysis followed by mechanical fibrillation have morphology similar to MA-produced cellulose nanocrystals (CNCs) and sulfuric-acid-produced CNCs (S-CNCs) but differ in crystallinity. Applications of CNWs as a substitute for CNCs for which morphology and surface charge, rather than crystallinity, are the pertinent characteristics are presented. The tested CNW suspensions have a wider viscosity range of 0.001 to 1000 Pa.s over a variety of shear rates of 0.01 to 1000 1/s compared to S-CNCs of 0.001 to 0.1 Pa.s and are better suited for applications such as rheology modification and 3D printing. This study proposes CNWs as a less expensive and sustainable replacement for CNCs in applications that do not require crystalline properties.

New cellulose crystallinity estimation method that differentiates between organized and crystalline phases.

A new method is proposed for estimation of cellulose crystallinity (CrI) based on 93 cm-1 Raman band in spectra of cellulose I materials. In this method (93-Raman), CrI was determined based on regression that was developed using the ratios of peak-heights of the 93 and 1096 cm-1 Raman bands (I93/I1096). For calibration purposes, a set of eight samples, all derived from cotton microcrystalline cellulose Whatman CC31 were selected. When the peak intensity ratios (I93/I1096) were plotted against the calculated CrIs of the calibration set samples, the plot showed an excellent linear correlation (R2 = 0.9888). The 93-Raman method was used to estimate crystallinities of a number of cellulose materials including poplar wood samples that were hydrothermally treated at various temperatures. The wood 93-Raman CrI data showed that the method is able to differentiate between organized and crystalline phases of cellulose, a capability lacking in many other CrI estimation methods.

Optimizing the treatment of metastatic castration-resistant prostate cancer: a Latin America perspective.

Prostate cancer is a significant burden and cause of mortality in Latin America. This article reviews the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) and provides consensus recommendations to assist Latin American prostate cancer specialists with clinical decision making. A multidisciplinary expert panel from Latin America reviewed the available data and their individual experience to develop clinical consensus opinions for the use of life-prolonging agents in mCRPC, with consideration given to factors influencing patient selection and treatment monitoring. There is a lack of level 1 evidence for the best treatment sequence or combinations in mCRPC. In this context, consensus recommendations were provided for the use of taxane-based chemotherapies, androgen receptor axis-targeted agents and targeted alpha therapy, for patients in Latin America. Prostate-specific antigen (PSA) changes alone, during treatment, should be treated with caution; PSA may not be a suitable biomarker for radium-223. Bone scans and computed tomography are the standard imaging modalities in Latin America. Imaging should be prompted during treatment where symptomatic decline and/or significant worsening of laboratory evaluations are reported, or where a course of therapy has been completed and another antineoplastic agent is under consideration. Recommendations and guidance for treatment options in Latin America are provided in the context of country-level variable access to approved agents and technologies for treatment monitoring. Patients should be treated with the purpose of prolonging overall survival and preserving quality of life through increasing the opportunity to administer all available life-prolonging therapies when appropriate.

Atención Selectiva y sostenida de trabajadores en dos jornadas del día / Selective and sustained attention of workers of two different shifts in the day

Resumen Aun cuando se ha reconocido la importancia del proceso psicológico de la atención por contribuir a la capacidad productiva y la consecución de resultados eficientes y eficaces durante el desarrollo de diversas tareas cotidianas, no ha sido suficientemente estudiado en trabajadores de empresas u organizaciones. Esta investigación buscó identificar cómo es la atención selectiva y sostenida de los trabajadores en dos jornadas diferentes del día (mañana y tarde); adicionalmente, se exploró si variables como la edad, escolaridad y género afectan el desempeño. Se aplicó el programa computarizado Vienna Test System subprueba cognitron forma S1 a 184 trabajadores de una universidad. Los datos fueron analizados mediante un modelo de regresión y prueba t para muestras independientes. Los hallazgos mostraron que la atención selectiva es mayor en horas de la mañana, mientras que la atención sostenida se mantiene a lo largo del día. En cuanto a las otras variables analizadas, se evidenció que la edad fue la única predictora del rendimiento, por cuanto a menor edad mejores desempeños. Estos resultados aportan para la planeación de actividades en el ámbito laboral y complementa los estudios en el área de los procesos psicológicos básicos.

Abstract Although the importance of the psychological process of attention and how it to contributes productive capacity and achieving efficient and effective results during the development of daily tasks has been recognized, it has not been sufficiently studied in workers of companies or organizations. This research sought to identify what selective and sustained attention is like in the workers to two different shifts in the day (morning and afternoon); Additional variables such as age, schooling and gender were investigated to see if they affected performance. We applied the computer program Vienna Test System sub-test cognition form S1 to 184 university workers. Data was analyzed using a regression model and t-test for independent samples. The findings showed that selective attention is greater in the morning, while sustained attention is maintained throughout the day. As for the other variables analyzed, it was evidenced that age was the only predictor of performance, as workers of a younger age performed better. These results contribute to the planning of activities in the workplace and complements the studies in the area of the basic psychological processes.

A re-adjustable sling for female recurrent stress incontinence and sphincteric deficiency: Outcomes and complications in 125 patients using the Remeex sling system.

AIMS: To evaluate the outcomes, complications, and quality of life of patients after a Remeex re-adjustable sling for recurrent stress urinary incontinence (SUI) and intrinsic sphincteric deficiency (ISD) indications. METHODS: One hundred twenty-five patients with SUI were prospectively evaluated following a re-adjustable sling in a single tertiary academic Center. Patients were classified by Q-tip, urodynamic and clinical criteria into ISD (70) and recurrent SUI (55). All patients underwent a re-adjustable sling placement. Outcome measures included pad-test, urodynamics, and the King's Health Questionnaire. RESULTS: After a mean follow-up of 38 months (26-72), 109 patients (87%) are cured of SUI based on pad-test, clinical, and urodynamic criteria. Sixteen patients (13%) remain incontinent. Nine of those (7%) are satisfied to the point that they decline re-adjustment of the sling, and seven (6%) are on the waiting list for re-adjustment. Nineteen patients show urge incontinence (9 with previous urodynamic mixed incontinence, 10 (8%) with de novo detrusor overactivity). Twenty-one patients benefited from a re-adjustment of the sling during the follow-up. The tension was increased in 17 cases (continent at discharge) due to recurrence of SUI, and reduced in 4 due to obstruction. The Varitensor was removed in 1 case due to infection. No other complications were seen. CONCLUSIONS: The Remeex re-adjustable sling system provides a good cure rate for recurrent SUI and ISD with a low complication rate. The ability to increase or decrease sling tension allowed us to achieve cure in patients who were not initially dry, and to relieve obstruction in every case attempted.

[Multicenter study of satisfaction with fast-dissolving ebastine, 20 mg/ day, in Mexican patients with allergic rhinitis]. / Estudio multicéntrico de satisfacción con ebastina de disolución rápida 20 mg/día en pacientes mexicanos con rinitis alérgica.

BACKGROUND: Allergic rhinitis is an inflammatory disease of the nasal mucosa, with common symptoms, which is essentially characterized by nasal itching, nasal congestion, sneezing, hyaline rhinorrhea and repetitive sneezing. The disease is very common, 15% of the population worldwide suffers it. Among many treatments that have been used to relieve the symptoms of this disease there is a selective inhibitor of H1 receptors, ebastine. OBJECTIVE: To evaluate patient satisfaction using the scale of Treatment Satisfaction Questionnaire for Medication (TSQM). MATERIAL AND METHODS: A multicentric, retrospective, observational study performed in 250 Mexican patients with the diagnosis of intermittent allergic rhinitis (IAR) or persistent allergic rhinitis (PER), confirmed by prick test, specific IgE, or both, treated with lyophilised ebastine in fast-dissolving (FDT) 20 mg at any time in the last two months, prescribed for at least two weeks by their doctor to relieve the symptoms of intermittent allergic rhinitis or persistent allergic rhinitis. We used a validated questionnaire assessment scales, TSQM. RESULTS: The presentation of ebastine fast-dissolving (FDT) is effective and has good tolerability, over 80% of patients reported comfort and satisfaction using it. CONCLUSIONS: Assessment of overall satisfaction, efficacy, tolerability and comfort showed that ebastine in fast-dissolving is an antihistamine with clear benefits to encourage compliance.

Blogs, herramienta para el trabajo en red en la Educación Médica Superior de postgrado en la Escuela Nacional de Salud Pública / Blogs, Tools for Working in Networks in the National Healthschool's Higher Medical Education Posgraduate Program

El artículo presenta el diseño de un espacio en red para el intercambio de información y conocimiento entre profesores, estudiantes y graduados de los diferentes procesos de educación médica superior en el postgrado aplicado en la Escuela Nacional de Salud Pública (ENSAP). En este espacio, diseñado como una experiencia práctica, se utilizó la herramienta Blogs como Sistema de Gestión de Contenidos. Su aplicación fortalecerá los vínculos culturales y de trabajo de la comunidad de práctica que participa en la Educación Médica Superior cubana. Brinda, además, la oportunidad de obtener información sobre las distintas figuras docentes de la Educación Médica Superior, realizar intercambios interactivos, revisar noticias y disponer de las revistas especializadas en la educación médica y otras de ciencias asociadas a la medicina. Cuenta con enlaces a la Intranet de la ENSAP, al Portal de Salud Cubano, al Aula Virtual de la Salud, a Revistas y a otros servicios que se encuentran en la Red Telemática de la Salud. Por otro lado, sirve de marco de referencia e intercambio del Primer Encuentro de Graduados de la Maestría de Educación Médica Superior. El trabajo realizado ha permitido elevar los niveles de eficiencia en la gestión de contenidos para el desarrollo del Departamento Docente de Educación Médica de la ENSAP. Actualmente contribuye a lograr una mayor eficacia en el perfeccionamiento docente y en los métodos y estilos que cohesionan el trabajo. Estas acciones tienen una importante repercusión en el ámbito social y más específicamente en la educación médica superior. Sirven de referente a futuros trabajos en red de las diferentes figuras docentes y de la gestión educativa de procesos(AU)

The article presents a network space for the exchange of information and knowledge among teachers, students and graduates of the different medical education processes at the National School of Public Health (ENSAP). In this space, designed as a practical experience, we used the Blog tool as Content Management System. Its implementation will strengthen the cultural and professional ties of the practicing community in Cuban Higher Medical Education. It also provides an opportunity to obtain information about different educational figures in Higher Medical Education.This space will facilitate interactive exchanges, and it will allow the search in magazines specialized in medical education and others sciences associated to it. It has links to the ENSAPs Intranet, the Cuban Health Portal, the Virtual Classroom of Health, Magazines and other services on the Health Telematics Network. On the other hand, provides a frame of reference and interchange for the First Encounter of the Master's Degree Graduates of Higher Medical Education. The work carried out has increased the efficiency levels in the management of contents for the development of the Educational Department of Medical Education of the ENSAP. Currently, it contributes to increase the effectiveness of the educational improvement and it impels the methods and styles that unite the work. These actions have a significant impact on the social sphere and more specifically in higher medical education. This space serves as a reference to future networks of different educational figures and to the management of educational processes(AU)