Total Arch Replacement is Safe as Hemiarch Repair in Acute Type A Aortic Dissection in a Middle-Income Country Setting.

Objectiver: The aim of this study was to determine the clinical outcomes of patients with acute type A aortic dissection comparing proximal aortic repair vs. total arch replacement.

Methods: This was a retrospective cohort study.

Caregiver-reported emotional-behavioral symptoms in Spanish youth during the COVID-19 pandemic: a longitudinal study.

Background: COVID-19 pandemic stressors affected youth's mental health. This longitudinal study aims to explore these effects while considering predictive factors such as age and sex.

Methods: An initial sample of 1502 caregivers answered a longitudinal survey evaluating their youths' (4-17 years of age) emotional/behavioral symptoms using the Pediatric Symptom Checklist (PSC) screening tool.

Amphiregulin in infectious diseases: Role, mechanism, and potential therapeutic targets.

Amphiregulin (AREG) serves as a ligand for the epidermal growth factor receptor (EGFR) and is involved in vital biological functions, including inflammatory responses, tissue regeneration, and immune system function. Upon interaction with the EGFR, AREG initiates a series of signaling cascades necessary for several physiological activities, such as metabolism, cell cycle regulation, and cellular proliferation. Recent findings have provided evidence for the substantial role of AREG in maintaining the equilibrium of homeostasis in damaged tissues and preserving epithelial cell structure in the context of viral infections affecting the lungs.

Households with constrained off-street parking drive fewer miles.

Parking supply is one of the most neglected elements of the built environment in travel behavior research, despite evidence linking parking with vehicle use. As transportation impacts of new development are increasingly measured by vehicle miles traveled (VMT), explicitly connecting parking characteristics with vehicle travel is necessary to better inform transportation and land use policy. In this paper, we begin to address this research gap and explore the relationship between constrained parking and household VMT.

Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients.

Information on the immunopathobiology of coronavirus disease 2019 (COVID-19) is rapidly increasing; however, there remains a need to identify immune features predictive of fatal outcome. This large-scale study characterized immune responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection using multidimensional flow cytometry, with the aim of identifying high-risk immune biomarkers. Holistic and unbiased analyses of 17 immune cell-types were conducted on 1,075 peripheral blood samples obtained from 868 COVID-19 patients and on samples from 24 patients presenting with non-SARS-CoV-2 infections and 36 healthy donors.

Web-based formative assessment through clinical cases: role in pathophysiology teaching.

Background: Active learning strategies such as formative assessment through clinical cases may help to get a deeper learning. We have studied the effect of this kind of online formative assessment in pathophysiology teaching.

Methods: Seven brief clinical cases were used to give formative assessment in the first semester of a pathophysiology course.

A protein folding robot driven by a self-taught agent.

This paper presents a computer simulation of a virtual robot that behaves as a peptide chain of the Hemagglutinin-Esterase protein (HEs) from human coronavirus. The robot can learn efficient protein folding policies by itself and then use them to solve HEs folding episodes. The proposed robotic unfolded structure inhabits a dynamic environment and is driven by a self-taught neural agent.

Turing instability conditions in confined systems with an effective position-dependent diffusion coefficient.

We study a reaction-diffusion system within a long channel in the regime in which the projected Fick-Jacobs-Zwanzig operator for confined diffusion can be used. We found that under this approximation, Turing instability conditions can be modified due to the channel geometry. The dispersion relation, range of unstable modes where pattern formation occurs, and spatial structure of the patterns itself change as functions of the geometric parameters of the channel.

Including ultrasound scans in antenatal care in low-resource settings: Considering the complementarity of obstetric ultrasound screening and maternity waiting homes in strengthening referral systems in low-resource, rural settings.

Recent World Health Organization (WHO) antenatal care recommendations include an ultrasound scan as a part of routine antenatal care. The First Look Study, referenced in the WHO recommendation, subsequently shows that the routine use of ultrasound during antenatal care in rural, low-income settings did not improve maternal, fetal or neonatal mortality, nor did it increase women's use of antenatal care or the rate of hospital births. This article reviews the First Look Study, reconsidering the assumptions upon which it was built in light of these results, a supplemental descriptive study of interviews with patients and sonographers that participated in the First Look study intervention, and a review of the literature.

Factors influencing referrals for ultrasound-diagnosed complications during prenatal care in five low and middle income countries.

Background: Ultrasound during antenatal care (ANC) is proposed as a strategy for increasing hospital deliveries for complicated pregnancies and improving maternal, fetal, and neonatal outcomes. The First Look study was a cluster-randomized trial conducted in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan and Zambia to evaluate the impact of ANC-ultrasound on these outcomes. An additional survey was conducted to identify factors influencing women with complicated pregnancies to attend referrals for additional care.

Mitral valve repair, how to make volume not matter; techniques, tendencies, and outcomes, a single center experience.

Background: Recent evidence has showed us that quality of mitral valve repair is strongly related to volume. However, this study shows how low-volume centers can achieve results in mitral valve repair surgery comparable to those reported by referral centers. It compares outcomes of mitral valve repair using resection versus noresection techniques, tendencies, and rates of repair.

Wide Dissection and Intercostal Vessel Division Allows for Repair of Hypoplastic Aortic Arch Through Thoracotomy.

Background: The approach to coarctation of the aorta with hypoplastic aortic arch is controversial. We evaluated the outcomes in patients with coarctation of the aorta with or without hypoplastic aortic arch operated through a posterior left lateral thoracotomy.

Methods: A retrospective cohort of patients with aortic coarctation, who underwent repair between January 2009 and October 2017, was analyzed.

Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial.

Objective: Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries.

Design: Cluster randomised trial.

Identification of clinically relevant phenotypes in patients with Ebstein anomaly.

Background: Ebstein anomaly (EA) is a heterogeneous congenital heart defect (CHD), frequently accompanied by diverse cardiac and extracardiac comorbidities, resulting in a wide range of clinical outcomes.

Hypothesis: Phenotypic characterization of EA patients has the potential to identify variables that influence prognosis and subgroups with distinct contributing factors.

Methods: A comprehensive cross-sectional phenotypic characterization of 147 EA patients from one of the main referral institutions for CHD in Colombia was carried out.

[Clinical practice guidelines: qualitative study of their implementation in the Chilean health system].

Objective: Characterize the implementation process, barriers, and facilitators of evidence-based recommendations in the context of developing clinical practice guidelines (CPGs) generated by the Ministry of Health of Chile, in order to make proposals to optimize the process.

Methods: Qualitative "action-oriented research" study. Nineteen semi-structured interviews were conducted and nine discussion groups were organized at various levels of the Chilean public health system.

Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia.

Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies.

[Quality assessment of clinical practice guidelines of the Chilean explicit guarantees in healthcare program].

Background: High quality practice guidelines are of utmost importance in clinical medicine.

Aim: To evaluate the methodological quality of Clinical Practice Guidelines (CPG) for 80 high burden health conditions included in the “Explicit Guarantees in Healthcare” (EGH) program available on July 2014, elaborated and published by the Ministry of Health of Chile.

Material And Methods: A cross-sectional observational study using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument to evaluate the methodological quality of the current CPGs for EGH.

Slow Lévy flights.

Among Markovian processes, the hallmark of Lévy flights is superdiffusion, or faster-than-Brownian dynamics. Here we show that Lévy laws, as well as Gaussian distributions, can also be the limit distributions of processes with long-range memory that exhibit very slow diffusion, logarithmic in time. These processes are path dependent and anomalous motion emerges from frequent relocations to already visited sites.

Screening obstetric ultrasound training for a 5-country cluster randomized controlled trial.

With decreased equipment cost, provision of ultrasound is now feasible in some low resource settings. Screening obstetric ultrasound may identify potential pregnancy complications and, with this knowledge, allow women to plan to deliver at the appropriate level of care. In this article, we describe a 10-day course with quality assurance activities to train ultrasound-naïve, nonphysician healthcare professionals at midlevel health facilities to perform screening obstetric ultrasound.

Fecal contamination of food, water, hands, and kitchen utensils at the household level in rural areas of Peru.

The study described in this article evaluated sources of contamination of children's food and drinking water in rural households in the highlands of Peru. Samples from children's meals, drinking water, kitchen utensils, and caregivers' and children's hands were analyzed for total coliforms and E. coli counts using Petrifilm EC.

Diffusion in narrow channels on curved manifolds.

In this work, we derive a general effective diffusion coefficient to describe the two-dimensional (2D) diffusion in a narrow and smoothly asymmetric channel of varying width, embedded on a curved surface, in the simple diffusion of non-interacting, point-like particles under no external field. To this end, we extend the generalization of the Kalinay-Percus' projection method [J. Chem.

[Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit].

Introduction And Objectives: Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF.

Diffusion in two-dimensional conical varying width channels: comparison of analytical and numerical results.

This study is devoted to the unbiased motion of a point-like brownian particle in two-dimensional tilted asymmetric channels of varying width formed by straight walls. An effective one-dimensional description in terms of the generalized Fick-Jacobs equation is used to derive formulas that yield the particle's effective diffusion coefficient as a function of the geometric parameters of the channel. To such end, we use the formulas obtained by Bradley [Phys.