Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring

AIMS

Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers.

METHODS

We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region.

RESULTS

From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed.

CONCLUSIONS

Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.

Operational domain for the new 3MW/1000s ECRH System on WEST

The ECRH system formerly used in Tore Supra is being upgraded to start on WEST in 2023, at a power level of 1MW and frequency of 105 GHz. Its ultimate 3MW/1000s capability is expected to enlarge the WEST operational domain by increasing margins with respect to H-mode access, and by providing additional flexibility in terms of achievable scenarios using impurity and/or MHD control. This flexibility is made possible using an antenna based on three steerable mirrors for controlled power injection. In order to determine an appropriate range of EC wave injection angles for WEST scenarios, the fast and reliable ray-tracing code REMA has been interfaced with the WEST IMAS database. This allows the EC power damping rate to be quickly assessed, as well as deposition profiles to be predicted in realistic plasma conditions. Based on a typical WEST discharge at central magnetic field B0~3.6 T, central line-averaged electron density nl~4 × 1019 m−3 and central electron temperature Te0~3keV, ray-tracing calculations have been performed. Comprehensive poloidal and toroidal angle scans, as well as variations of Bt, nl and Te0 with respect to the reference parameters have allowed an adequate range of injection angles to be determined for efficient use of ECRH and/or ECCD in typical WEST scenarios, and compared with the mechanical limits set by the antenna mechanical characteristics. In order to further characterize the effect of this new power source in WEST scenarios, EC wave deposition and current profiles from ray-tracing calculations have been included in integrated simulation codes. It has been shown that this additional power source could allow central electron heating to be achieved, potentially alleviating the issue of radiative collapse caused by impurities observed in some situations.

Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial

BACKGROUND

Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection.

OBJECTIVE

To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone.

DESIGN

Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978).

SETTING

Multinational, multicenter trial.

PARTICIPANTS

Adults hospitalized with COVID-19.

INTERVENTION

Intravenous ensovibep, 600 mg, or placebo.

MEASUREMENTS

Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90.

RESULTS

An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep).

LIMITATION

The trial was prematurely stopped because of futility, limiting power for the primary outcome.

CONCLUSION

Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Sarcoma felino posvacunal (FISS), reporte de caso en Colombia

El sarcoma felino posvacunal o sarcoma de sitio de inyección (FISS) en una neoplasia poco descrita en felinos en Colombia, se presenta posterior al uso de vacunas inactivas con adyuvante. El objetivo fue describir la presencia de un sarcoma felino posterior a la vacunación con leucemia felina virus inactivo, primer caso documentado en Colombia. Un felino, macho, mestizo, de 7 años de edad, esterilizado, vacunado con leucemia felina inactiva desde hace 3 años, desarrolla un nódulo de 5 cm de diámetro en la región dorsal, firme y no doloroso. En dermis profunda y músculo estriado, se evidencia proliferación neoplásica de células fusiformes, de crecimiento principalmente expansivo y en menor medida invasivo, que se organiza y forma haces cortos y fascículos largos que se entrecruzan, con focos densos y laxos y en focos se dispone en un patrón de espina de pescado. Las células presentan morfología fusiforme, ligeramente ovoide, irregular, algunas redondeadas, con citoplasma eosinófilo tenue e intenso en otros focos más densos. Se evidencia pleomorfismo celular y anisocitosis moderadas. Los núcleos presentan morfología redonda, ovoide e irregular. Se evidencia la presencia de uno o más nucléolos en algunas de sus células, cromatina principalmente granular fina, pleomorfismo nuclear y anisocariosis moderada. Se contabilizaron 4 mitosis en 10 campos con el objetivo de alto poder en 2,37 mm2, no se observa aparente invasión linfovascular, se evidencia compromiso de bordes laterales. Adicionalmente, discretos focos de necrosis multifocal < 50%, infiltrado inflamatorio mixto polimorfonuclear, neutrófilos moderados multifocales e infiltrado mononuclear linfocítico multifocal.

Assessment of endangered freshwater pearl mussel populations in the Northern Iberian Plateau in relation to non–native species: xenodiversity as a threat

In the last two decades, small populations of freshwater pearl mussels, Margaritifera margaritifera, have been recorded in Mediterranean rivers of the Iberian Northern Plateau. A survey was carried out in Castilla and León in 2018 to assess the development of populations of this species in all the rivers of known distribution and to update the threat classification. Thirty sections in the rivers Negro, Tera, Alberche and Águeda were positive for its presence, and another 50 stretches of seven rivers were negative. The species is currently distributed over about 22.5 km. Águeda and Tera populations have decreased dramatically in the last 14 years and are on the threshold of extinction. The Negro river supports the largest population, although the species has now disappeared in at least 61 % of the stretches that were inhabited in 2004. All populations showed very low densities and an ageing population structure, with no recruitment for decades. The presence of non-native invasive alien species (NIS) was higher than in a previous regional survey, with the signal crayfish representing the greatest threat. We observed changes in benthic microhabitats and direct predation of adults and glochidia conglutinates. In the Alberche River, in strict syntopy with M. margaritifera and two other mussel species, 10 NIS were detected. The current hydrological and ecological conditions in the Duero watershed support the settlement of exotic species to the disadvantage of native mollusks, which are more demanding in terms of microhabitats.

Physical activity and sedentary behavior in medical students at a Peruvian public university

Introduction

Studies show a high prevalence of physical inactivity and sedentary behavior among university students. However, the relationship between physical activity and sedentary behavior in medical students is unknown.

Objectives

To determine the prevalence of physical activity, sedentary behavior, and related factors among medical students at a public university.

Methods

We conducted an analytical cross-sectional study that included students from the first to the sixth year of medical school. We used the International Physical Activity Questionnaire (IPAQ). We analyzed study variables using Poisson regression, estimating crude and adjusted prevalence ratios.

Results

The final sample consisted of 513 students, of which 35% of women and 30.1% of all pre-clinical students had a low level of physical activity. Male sex and 20 to 24 age group were associated with a lower prevalence of low level of physical activity. Sedentary behavior was 60.9% among students under 20 years old and 55.5% among pre-clinical students. A lower prevalence of sedentary behavior was found in students over 25 years old, clinical students, and those with high levels of physical activity.

Conclusion

Most medical students presented a moderate level of physical activity. We found a higher presence of low-level physical activity among females and pre-clinical students. We found that sedentary behavior was higher than reported in similar populations. The relationship between physical activity and lower sedentary behavior was significant only for students with a high-level physical activity.

Earthquakes and entropy: Characterization of occurrence of earthquakes in southern Spain and Alboran Sea

We propose the use of entropy, H, as an indicator of the equilibrium state of a seismically active region (seismic system). The relationship between an increase in H and the occurrence of a great earthquake in a study area can be predicted by acknowledging the irreversible transition of a system. From this point of view, the seismic system evolves from an unstable initial state (due to external stresses) to another, where the stresses have dropped after the earthquake occurred. It is an irreversible transition that entails an increase in entropy. Five seismic episodes were analyzed in the south of the Iberian Peninsula, the Alboran Sea (Mediterranean Sea), and the North of Morocco: two of them of moderate-high magnitude (Al Hoceima, 2004 and 2016) and three of them of moderate-low magnitude (Adra, 1993-1994; Moron, 2007; and Torreperogil, 2012-2013). The results are remarkably in line with the theoretical forecasts; in other words: an earthquake, understood as an irreversible transition, must suppose an increase in entropy.

Strategies to Produce Grapefruit-Like Citrus Varieties With a Low Furanocoumarin Content and Distinctive Flavonoid Profiles

Pummelos and hybrids, such as grapefruits, have high furanocoumarin and low flavonoid contents. Furanocoumarins interact negatively with certain drugs, while flavonoids are antioxidant compounds with health benefits. To obtain new grapefruit-like varieties with low furanocoumarin and high flavonoid contents, diploid and triploid hybrid populations from crosses between diploid and tetraploid "Clemenules" clementine and diploid "Pink" pummelo were recovered and analyzed. With regard to furanocoumarins, triploids produce less bergapten, bergamottin and 6,7-DHB than diploids. Regarding flavonoids, triploids yielded more eriocitrin, narirutin, hesperidin and neohesperidin than diploids, whereas no differences were observed in neoeriocitrin and naringin. These results indicate that, the strategy to recover triploid hybrids by 4x × 2x crosses is more appropriate than the recovery of diploid hybrids by 2x × 2x crosses for obtaining grapefruit-like varieties of citrus with lower furanocoumarin and higher flavonoid contents.

Defining priority areas for blue whale conservation and investigating overlap with vessel traffic in Chilean Patagonia, using a fast-fitting movement model

Defining priority areas and risk evaluation is of utmost relevance for endangered species` conservation. For the blue whale (Balaenoptera musculus), we aim to assess environmental habitat selection drivers, priority areas for conservation and overlap with vessel traffic off northern Chilean Patagonia (NCP). For this, we implemented a single-step continuous-time correlated-random-walk model which accommodates observational error and movement parameters variation in relation to oceanographic variables. Spatially explicit predictions of whales' behavioral responses were combined with density predictions from previous species distribution models (SDM) and vessel tracking data to estimate the relative probability of vessels encountering whales and identifying areas where interaction is likely to occur. These estimations were conducted independently for the aquaculture, transport, artisanal fishery, and industrial fishery fleets operating in NCP. Blue whale movement patterns strongly agreed with SDM results, reinforcing our knowledge regarding oceanographic habitat selection drivers. By combining movement and density modeling approaches we provide a stronger support for purported priority areas for blue whale conservation and how they overlap with the main vessel traffic corridor in the NCP. The aquaculture fleet was one order of magnitude larger than any other fleet, indicating it could play a decisive role in modulating potential negative vessel-whale interactions within NCP.

On the structural formula of smectites: a review and new data on the influence of exchangeable cations

The understanding of the structural formula of smectite minerals is basic to predicting their physicochemical properties, which depend on the location of the cation substitutions within their 2:1 layer. This implies knowing the correct distribution and structural positions of the cations, which allows assigning the source of the layer charge of the tetrahedral or octahedral sheet, determining the total number of octahedral cations and, consequently, knowing the type of smectite. However, sometimes the structural formula obtained is not accurate. A key reason for the complexity of obtaining the correct structural formula is the presence of different exchangeable cations, especially Mg. Most smectites, to some extent, contain Mg²⁺ that can be on both octahedral and interlayer positions. This indeterminacy can lead to errors when constructing the structural formula. To estimate the correct position of the Mg²⁺ ions, that is their distribution over the octahedral and interlayer positions, it is necessary to substitute the interlayer Mg²⁺ and work with samples saturated with a known cation (homoionic samples). Seven smectites of the dioctahedral and trioctahedral types were homoionized with Ca²⁺, substituting the natural exchangeable cations. Several differences were found between the formulae obtained for the natural and Ca²⁺ homoionic samples. Both layer and interlayer charges increased, and the calculated numbers of octahedral cations in the homoionic samples were closer to four and six in the dioctahedral and trioctahedral smectites, respectively, with respect to the values calculated in the non-homoionic samples. This change was not limited to the octahedral sheet and interlayer, because the tetrahedral content also changed. For both dioctahedral and trioctahedral samples, the structural formulae improved considerably after homoionization of the samples, although higher accuracy was obtained the more magnesic and trioctahedral the smectites were. Additionally, the changes in the structural formulae sometimes resulted in changing the classification of the smectite.

Author Correction: Novel insights on the geomagnetic field in West Africa from a new intensity reference curve (0–2000 AD)

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Recovery of motor function after traumatic spinal cord injury by using plasma-synthesized polypyrrole/iodine application in combination with a mixed rehabilitation scheme

Traumatic spinal cord injury (TSCI) can cause paralysis and permanent disability. Rehabilitation (RB) is currently the only accepted treatment, although its beneficial effect is limited. The development of biomaterials has provided therapeutic possibilities for TSCI, where our research group previously showed that the plasma-synthesized polypyrrole/iodine (PPy/I), a biopolymer with different physicochemical characteristics than those of the PPy synthesized by conventional methods, promotes recovery of motor function after TSCI. The present study evaluated if the plasma-synthesized PPy/I applied in combination with RB could increase its beneficial effects and the mechanisms involved. Adult rats with TSCI were divided into no treatment (control); biopolymer (PPy/I); mixed RB by swimming and enriched environment (SW/EE); and combined treatment (PPy/I + SW/EE) groups. Eight weeks after TSCI, the general health of the animals that received any of the treatments was better than the control animals. Functional recovery evaluated by two scales was better and was achieved in less time with the PPy/I + SW/EE combination. All treatments significantly increased βIII-tubulin (nerve plasticity) expression, but only PPy/I increased GAP-43 (nerve regeneration) and MBP (myelination) expression when were analyzed by immunohistochemistry. The expression of GFAP (glial scar) decreased in treated groups when determined by histochemistry, while morphometric analysis showed that tissue was better preserved when PPy/I and PPy/I + SW/EE were administered. The application of PPy/I + SW/EE, promotes the preservation of nervous tissue, and the expression of molecules related to plasticity as βIII-tubulin, reduces the glial scar, improves general health and allows the recovery of motor function after TSCI. The implant of the biomaterial polypyrrole/iodine (PPy/I) synthesized by plasma (an unconventional synthesis method), in combination with a mixed rehabilitation scheme with swimming and enriched environment applied after a traumatic spinal cord injury, promotes expression of GAP-43 and βIII-tubulin (molecules related to plasticity and nerve regeneration) and reduces the expression of GFAP (molecule related to the formation of the glial scar). Both effects together allow the formation of nerve fibers, the reconnection of the spinal cord in the area of injury and the recovery of lost motor function. The figure shows the colocalization (yellow) of βIII-tubilin (red) and GAP-43 (green) in fibers crossing the epicenter of the injury (arrowheads) that reconnect the rostral and caudal ends of the injured spinal cord and allowed recovery of motor function.

Branched-Chain Amino Acids Depletion during Hemodialysis Is Associated with Fatigue

BACKGROUND

Fatigue is one of the most debilitating symptoms reported by maintenance hemodialysis (MHD) patients. Hemodialysis causes marked depletion in plasma essential amino acids. We studied the cross-sectional relationship of pre- and post-hemodialysis branched-chain amino acids (BCAAs) concentrations with fatigue in MHD patients.

METHODS

MHD patients self-reported fatigue during a dialysis session using the Brief Fatigue Inventory. Pre- and post-dialysis plasma levels of BCAAs (valine, leucine, and isoleucine) were measured using HPLC-mass spectrometry.

RESULTS

The mean age of study participants (n = 114) was 54.8 ± 12.8 years. Plasma levels of BCAAs decreased significantly post-dialysis compared to pre-dialysis (303.8 ± 9.4 vs. 392.1 ± 9.4 μM/L, p < 0.0001). Fatigue score increased as a function of age (p = 0.015). There was no association between pre-dialysis plasma levels of BCAAs and fatigue. A significant negative correlation was found between post-dialysis plasma levels of BCAAs and fatigue (p < 0.05).

CONCLUSIONS

These preliminary findings suggest that disruption in BCAAs homeostasis may play a role in precipitating fatigue.

Violencia de pareja en adolescentes estudiantes de colegios estatales de Lima Norte

Objetivos: Determinar la frecuencia de violencia de pareja en los adolescentes estudiantes de los colegios estatales de un distrito de Lima Norte. Materiales y métodos: Estudio descriptivo transversal realizado en cinco colegio estatales del distrito de Puente Piedra. El instrumento utilizado fue el cuestionario de conflictos en las relaciones de pareja en adolescentes (CADRI). Resultados: De 208 adolescentes (Media=15,48; DE=0,99; Rango: 14 a 18), el 59,6% (n=124) correspondió al sexo masculino y el resto femenino, en su mayoría cursaban el tercero y cuarto año. Casi todos los adolescentes han cometido o sufrido algún tipo de violencia, la violencia verbal emocional fue el más frecuente en ambos grupos. La violencia cometida, en su dimensión violencia relacional se presentó en mayor proporción en los adolescentes varones [p=0,045; OR=2,52 (IC95%: 1,01-6,33)]. La violencia cometida en la dimensión amenaza, también se presentó en mayor proporción en los varones [p=0,002; OR=8,15 (IC95%: 1,71-38,87)]. La violencia sufrida, en la dimensión verbal emocional, amenaza y violencia física se presentó en mayor proporción en los adolescentes varones. Mostrando diferencias significativas en la violencia verbal emocional [p=0,04; OR=2,45 (1,99-3,02)], amenaza [p=0,001; OR=14,55 (IC95%:1,78-118,58)] y en la violencia física [p=0,009; OR=4,46 (IC95%: 1,34-14,86)]. Conclusiones: La violencia cometida y sufrida en parejas de adolescentes es frecuente y ocurre principalmente en los varones, destacando el componente verbal emocional y la amenaza. Se recomienda fortalecer el trabajo tanto del sector educación y salud para contribuir con la reducción de la violencia.

Novel insights on the geomagnetic field in West Africa from a new intensity reference curve (0-2000 AD)

The geomagnetic field variations on the continent of Africa are still largely undeciphered for the past two millennia. In spite of archaeological artefacts being reliable recorders of the ancient geomagnetic field strength, only few data have been reported for this continent so far. Here we use the Thellier-Coe and calibrated pseudo-Thellier methods to recover archaeointensity data from Burkina Faso and Ivory Coast (West Africa) from well-dated archaeological artefacts. By combining our 18 new data with previously published data from West Africa, we construct a reference curve for West Africa for the past 2000 years. To obtain a reliable curve of the archaeointensity variation, we evaluate a penalized smoothing spline fit and a stochastic modelling method, both combined with a bootstrap approach. Both intensity curves agree well, supporting the confidence in our proposed intensity variation during this time span, and small differences arise from the different methodologies of treating data and uncertainties. Two prominent peaks at around 740 AD and 1050 AD appear to be common in ours and several reference curves from other locations, indicating a general westward movement from China to Hawaii of a rather stable feature of the geomagnetic field. However, independent smaller peaks that do not correlate in different locations may hint to localized expressions of the geomagnetic field as a result of temporarily varying non-dipole sources.

Epitactic growth of celestite on anhydrite: substrate induced twinning and morphological evolution of aggregates

Celestite crystals grow epitaxially on anhydrite surfaces that interact with aqueous solutions bearing Sr. Progressive polygonization and splitting during celestite growth drives to the development of striking crystal morphologies and textures.

Impact of ethylene degreening treatment on sensory properties and consumer response to citrus fruits

Degreening treatment is normally applied to early-season citrus varieties grown in the Mediterranean area in order to enhance the external colour when fruits have already reached internal maturity. Despite profound knowledge about the effect of ethylene on the physico-chemical quality of citrus fruit, less is known about its effect on consumers' expectations in the supermarket or consumer quality perceptions when they eat such fruit. In this study, three mandarin cultivars ('Owari', 'Clemenules' and 'Oronules') with two initial colours at harvest, and one orange cultivar, 'Navelina', were submitted to the degreening treatment under commercial conditions. The effect of treatment on both external and internal qualities perceived by consumers was evaluated. The main physico-chemical parameters were also determined. The degreening treatment slightly affected firmness, total soluble solids or acidity level in 'Owari' and 'Navelina'. However, sensory triangle tests, in which 100-122 consumers compared the internal quality of degreened fruit and control fruit, did not show significant differences between treatments for any of the studied cultivars. A survey based on images of citrus fruit was responded by 340 consumers; it showed that the degreening treatment strongly affected consumers' maturity expectations, which resulted in improved fruit liking expectations and increased the number of consumers willing to buy. The extent of this effect depended on the initial colour of the fruit submitted to degreening. In order to improve liking expectations, fruit should arrive on the market with an external colour index (CI = 1000a/Lb) between +10 and +20. We conclude that the ethylene degreening treatment, which did not have any effect on the internal quality that consumers perceive, is a potent postharvest tool to increase citrus fruit sales at the beginning of the season.

Position-dependent mass Schrödinger equation for exponential-type potentials

In quantum chemical calculations, there are two facts of particular relevance: the position-dependent mass Schrödinger equation (PDMSE) and the exponential-type potentials used in the theoretical study of vibrational properties for diatomic molecules. Accordingly, in this work, the treatment of exactly solvable PDMSE for exponential-type potentials is presented. The proposal is based on the exactly solvable constant mass Schrödinger equation (CMSE) for a class of multiparameter exponential-type potentials, adapted to the position-dependent-mass (PDM) kinetic energy operator in the O von Roos formulation. As a useful application, we consider a PDM distribution of the form [Formula: see text], where the different parameters can be adjusted depending on the potential under study. The principal advantage of the method is that solution of different specific PDM exponential potential models are obtained as particular cases from the proposal by means of a simple choice of the involved exponential parameters. This means that is not necessary resort to specialized methods for solving second-order differential equations as usually done for each specific potential. Also, the usefulness of our results is shown with the calculation of s-waves scattering cross-section for the Hulthén potential although this kind of study can be extended to other specific potential models such as PDM deformed potentials.

Conductivity and Activation Energy in Polymers Synthesized by Plasmas of Thiophene

The electric conductivity, activation energy and morphology of polythiophene synthesized by radiofrequency resistive plasmas are studied in this work. The continuous collisions of particles in the plasma induce the polymerization of thiophene but also break some of the monomer molecules producing complex polymers with thiophene rings and aliphatic hydrocarbon segments. These multidirectional chemical reactions are more marked at longer reaction times in which the morphology of the polymers evolved from smooth surfaces, at low exposure time, to spherical particles with diameter in the 300-1000 nm interval. Between both morphologies, some bubbles are formed on the surface. The intrinsic conductivity of plasma polymers of thiophene synthesized in this way varied in the range of 10-10 to 10-8 S/m; however, the conductivity resulted very sensitive to the water content in the polymers, which produced variations of up to 5 magnitude orders. The activation energy of the intrinsic conductivity was between 0.56 and 1.41 eV, increasing with the reaction time.   Plasma, Polymerization, Polythiophene, Conductivity, Activation Energy

Dural puncture epidural analgesia for labor: a randomized comparison between 25-gauge and 27-gauge pencil point spinal needles

BACKGROUND

This double-blind, randomized trial compared dural puncture epidural analgesia (DPEA) for labor using 25-gauge and 27-gauge pencil point spinal needles. We hypothesized that both needle sizes would result in similar onset time (equivalence margin=2.5 min) and therefore designed the study as an equivalence trial.

METHODS

One hundred and forty patients undergoing labor were randomized to DPEA with 25-gauge (n=70) or 27-gauge (n=70) pencil point spinal needles. After the placement of the epidural catheter, a bolus of 20 mL of bupivacaine 0.125% and fentanyl 2 µg/mL was administered to all subjects. Thereafter, patients received boluses of 12 mL of bupivacaine 0.125% every 2 hours as needed.A blinded investigator recorded the onset time (defined as the temporal interval required to achieve a pain score ≤1 on a 0-10 scale), S2 block, sensory block height (30 min after the initial bolus of local anesthetic), presence of motor block (30 min after the initial bolus of local anesthetic), number of top-up doses required during labor and incidence of postural headache.

RESULTS

Out of the 140 recruited patients, 135 were retained for analysis. Compared with their 27-gauge counterparts, 25-gauge pencil point spinal needles provided a 1.6 min shorter DPEA onset (95% CI of the difference of the means: -3.2 to -0.1 min). However, there were no intergroup differences in terms of S2 block, sensory block height, motor block, number of top-up doses and incidence of postural headache.

CONCLUSION

Dural puncture epidural analgesia with 25-gauge pencil point spinal needles provides a 1.6 min shorter onset time than DPEA with 27-gauge spinal needles. Although statistically significant, such a difference may not be clinically relevant. Further investigation is required to compare 25-gauge and 27-gauge spinal needles for DPEA in the setting of different local anesthetic infusion strategies.

TRIAL REGISTRATION NUMBER

NCT03389945.

Nivel de carga de trabajo en cuidadores del adulto mayor residentes en albergues de Lima Norte

Objetivo: Determinar la frecuencia del síndrome del cuidador en los trabajadores de albergues de Lima Norte. Materiales y métodos: Estudio descriptivo transversal. La muestra estuvo constituida por 143 trabajadores de ambos géneros, dedicados al cuidado de los adultos mayores. La recolección de datos se desarrolló entre noviembre y diciembre del 2017. El instrumento empleado fue la escala de Zarit. Resultados: La edad media de los participantes fue de 40 años (DE= 13,6; min. 18, máx.: 64), el 72,7%(n=104) de los cuidadores fueron mujeres, con predominio del grupo etario de 18 a 30 años con el 32,9% (n=47), el 60,2% (n=86) eran casados o convivientes. Respecto a las características laborales, el 58% (n=83) de los cuidadores trabajaba en el turno mañana, el 67,1% (n=96) no tenían ningún vínculo familiar con el paciente, el 42,7% (n=61) se dedicaba al cuidado del paciente entre 1 a 3 años y el 74,8% (n=107) era responsable de cuidado entre 1 a 5 adultos mayores. Respecto a la sobrecarga del cuidador, el 96,5% (n=138) resultó con sobrecarga intensa y el 3,5% (n=5) con sobrecarga leve. Conclusión: Todos los cuidadores del adulto mayor residentes en los albergues ubicados en Lima Norte presentaron sobrecarga, con una alta proporción de sobrecarga intensa, principalmente en el género femenino.

InTool Explorer: An Interactive Exploratory Analysis Tool for Versatile Visualizations of Neuroscientific Data

The bottleneck for progress in many research areas within neuroscience has shifted from the data acquisition to the data analysis stages. In the present article, we propose a method named InTool Explorer that we have developed to perform interactive exploratory data analysis, focusing on neuroanatomy as an example of its utility. This tool is freely-available software that has been designed to facilitate the study of complex neuroscience data. InTool Explorer requires no more than an internet connection and a web browser. The main contribution of this tool is to provide a user-designed canvas for data visualization and interaction, to perform specific exploratory tasks according to the user needs. Moreover, InTool Explorer permits visualization of the datasets in a very dynamic and versatile way using a linked-card approach. For this purpose, the tool allows the user to select among different predefined card types. Each card type offers an abstract data representation, a filtering tool or a set of statistical analysis methods. Additionally, InTool Explorer makes it possible linking raw images to the data. These images can be used by InTool Explorer to define new customized filtering cards. Another significant contribution of this tool is that it allows fast visualization of the data, error finding, and re-evaluation to establish new hypotheses or new lines of research. Thus, regarding its practical application in the laboratory, InTool Explorer provides a new opportunity to study and analyze neuroscience data prior to any statistical analysis being carried out.

Abstract P5-13-05: Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views

Accurate recruitment in performing clinical trials is crucial to avoid delays in the availability of potential beneficial treatments for patients. However, optimal strategies to improve it remain elusive and highly variable. The aim of this study was to identify the factors affecting recruitment from a multi-professional approach.

Methods: A convergent mixed method study was used, including key informant in-depth interviews (n=13), 5 focus groups (n=40) and a 209-item Likert-scale survey for the measurement of a whole array of variables of interest (i.e. job attitudes, job satisfaction, job stressors and social status). A purposive sample of professionals from thirty-three clinical trial sites in Spain were targeted. Qualitative data were analyzed alongside quantitative data to document patterns and modifiers of recruitment performance. Audio material was recorded, transcribed verbatim and analyzed using the framework method.

Findings: Pattern observed in qualitative data was confirmed in quantitative analysis. A total of 32 key barriers to successful patient recruitment were identified and clustered in three categories. The most commonly reported barriers and facilitators regarding a multifactorial approach were: System/organization: Counting on experienced recruiters and having a strong team-workforce awareness (92,3%); automated recruitment software, scientific culture, recruiting philosophy, adequate workload demands (88%); high stimuli and interprofessional trust (84%). However, lack of time devoted to clinical research in favor of assistance demands, excessive workload and bureaucratic tasks were the most salient stressors to fulfill professional research and recruitment responsibilities (54%). Working team conditions: Insufficient workforce support as well as high employee turnover contributed to emotional exhaustion and depersonalization and to a lower personal accomplishment (15%). Interpersonal relations affected not only motivation and performance but professionalism satisfaction with outcomes. Professional recruiter characteristics: Professionals with a high level of expertise and academic specialization (&gt;5 years), greater active involvement in relevant clinical trials just as interprofessional prestige and recognition showed a greater satisfaction. Consequently, they were prompted to intensify their efforts to fulfill recruitment. The more effective clinical research settings were those better aligned with attributes for becoming high recruiters and with better multi-professional articulation. Suggestions to improve recruitment included providing professionals with devoted time for research, setting up collaborative research agreements, building a clinical research network, collaborative tumor registries, clinical trials data sharing resources, multidisciplinary functional units and committees, flexible staffing models and empowering oncologists/managers leadership.

Conclusions: This study provided useful understanding of how to maximize patient recruitment at clinical research sites. Strong team-workforce and adequate workload were the most important identified factors for achieving it. Results will be used to inform professionals and stakeholders of the next steps needed and to engage them to fulfill accurate recruitment.

Citation Format: Casas A, Gonzàlez X, Capelán M, Morales J, Fabián M, Ciruelos E, Gabriele G. Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-05.

[Chronic granulomatous disease: multiple infections as clinical presentation. Pediatric case report]

Chronic granulomatous disease is an uncommon primary immunodeficiency due to a defect of the killing activity of phagocytes, caused by mutations in any of the genes encoding subunits of the superoxide-generating phagocyte NADPH oxidase system. The incidence is 1 in 250 000 live births. It can occur from infancy to adulthood, usually in children under 2 years. Bacterial and fungal infections in association with granuloma lesions are the most common manifestations of the disease. Aspergillus species, Staphylococcus aureus, Serratia marcescens, Nocardia species are the most common microorganisms isolated. We describe here a case of a 1-year-old boy with chronic granulomatous disease and invasive pulmonary aspergillosis, Serratia marcescens osteomyelitis and Enterobacter cloacae cervical granuloma.

Case report: Apical variant hypertrophic cardiomyopathy simulating an acute inferior myocardial infarction

We present a female patient who arrived to the emergency department with chest pain without known medical history at the time of consultation. Considering her risk factors and electrocardiographic findings, it was decided to perform a coronary catheterization under the suspicion of acute myocardial infarction. The catheterization and another studies was negative for coronary artery disease. Additional studies were conclusive for apical variant hypertrophic cardiomyopathy or Yamaguchi syndrome.

The new magnetic diagnostics in the WEST tokamak

The WEST tokamak consists of a major upgrade of the superconducting medium size tokamak Tore Supra aiming at testing ITER divertor components. Such modification has required rebuilding a full set of magnetic diagnostics. The project was started in 2013 and completed in 2016. The diagnostic consists of a set of 469 sensors (421 pick-up coils, 36 flux loops, and 12 Rogowski coils) installed in the WEST vacuum vessel. New analog integrators have been developed in order to obtain the magnetic field and flux from the raw signal of the sensors. During the startup phase of WEST, plasma currents of the order of a few kilo amperes were measured despite much larger current of the order of hundreds of kilo amperes flowing in nearby conducting structures. The diagnostic is now fully operational and exhibits a noise level of about 0.5 mT on the magnetic field, and 2.0 mWb on flux loops allowing identifying the plasma boundary with an accuracy of a few millimeters on a 2 ms time cycle.