Frost risks in the Mantaro river basin

As part of the study on the Mantaro river basin's (central Andes of Perú) current vulnerability to climate change, the temporal and spatial characteristics of frosts were analysed. These characteristics included intensity, frequency, duration, frost-free periods, area distribution and historical trends. Maps of frost risk were determined for the entire river basin, by means of mathematical algorithms and GIS (Geographic Information Systems) tools, using minimum temperature – 1960 to 2002 period, geomorphology, slope, land-use, types of soils, vegetation and life zones, emphasizing the rainy season (September to April), when the impacts of frost on agriculture are most severe. We recognized four categories of frost risks: low, moderate, high and critical. The critical risks (with a very high probability of occurrence) were related to high altitudes on the basin (altitudes higher than 3800 m a.s.l.), while the low (or null) probability of occurring risks were found in the lower zones (less than 2500 m a.s.l.). Because of the very intense agricultural activity and the high sensitivity of the main crops (Maize, potato, artichoke) in the Mantaro valley (altitudes between 3100 and 3300 m a.s.l.), moderate to high frost risks can be expected, with a low to moderate probability of occurrence. Another significant result was a positive trend of 8 days per decade in the number of frost days during the rainy season

A multi-institutional and interdisciplinary approach to the assessment of vulnerability and adaptation to climate change in the Peruvian Central Andes: problems and prospects

A local integrated assessment of the vulnerability and adaptation to climate change in the Mantaro River Basin, located in Peruvian Central Andes, was developed between years 2003 to 2005. In this paper we present some lessons learned during the development of this study, emphasizing the multi-institutional and interdisciplinary efforts, briefly showing the methodological aspects, and pointing out the main problems found

Genetic Testing to Inform Epilepsy Treatment Management From an International Study of Clinical Practice

IMPORTANCE: It is currently unknown how often and in which ways a genetic diagnosis given to a patient with epilepsy is associated with clinical management and outcomes. OBJECTIVE: To evaluate how genetic diagnoses in patients with epilepsy are associated with clinical management and outcomes. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study of patients referred for multigene panel testing between March 18, 2016, and August 3, 2020, with outcomes reported between May and November 2020. The study setting included a commercial genetic testing laboratory and multicenter clinical practices. Patients with epilepsy, regardless of sociodemographic features, who received a pathogenic/likely pathogenic (P/LP) variant were included in the study. Case report forms were completed by all health care professionals. EXPOSURES: Genetic test results. MAIN OUTCOMES AND MEASURES: Clinical management changes after a genetic diagnosis (ie, 1 P/LP variant in autosomal dominant and X-linked diseases; 2 P/LP variants in autosomal recessive diseases) and subsequent patient outcomes as reported by health care professionals on case report forms. RESULTS: Among 418 patients, median (IQR) age at the time of testing was 4 (1-10) years, with an age range of 0 to 52 years, and 53.8% (n = 225) were female individuals. The mean (SD) time from a genetic test order to case report form completion was 595 (368) days (range, 27-1673 days). A genetic diagnosis was associated with changes in clinical management for 208 patients (49.8%) and usually (81.7% of the time) within 3 months of receiving the result. The most common clinical management changes were the addition of a new medication (78 [21.7%]), the initiation of medication (51 [14.2%]), the referral of a patient to a specialist (48 [13.4%]), vigilance for subclinical or extraneurological disease features (46 [12.8%]), and the cessation of a medication (42 [11.7%]). Among 167 patients with follow-up clinical information available (mean [SD] time, 584 [365] days), 125 (74.9%) reported positive outcomes, 108 (64.7%) reported reduction or elimination of seizures, 37 (22.2%) had decreases in the severity of other clinical signs, and 11 (6.6%) had reduced medication adverse effects. A few patients reported worsening of outcomes, including a decline in their condition (20 [12.0%]), increased seizure frequency (6 [3.6%]), and adverse medication effects (3 [1.8%]). No clinical management changes were reported for 178 patients (42.6%). CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study suggest that genetic testing of individuals with epilepsy may be materially associated with clinical decision-making and improved patient outcomes

Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review

Abstract Background People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons. Methods A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons. Results Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists. Conclusion Users’ satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users’ point of view are ease of adjustment, size and weight, and ease of use

Effects of ATLAS 2030 gait exoskeleton on strength and range of motion in children with spinal muscular atrophy II: a case series

Abstract Background Children with spinal muscular atrophy (SMA) present muscle weakness and atrophy that results in a number of complications affecting their mobility, hindering their independence and the development of activities of daily living. Walking has well-recognized physiological and functional benefits. The ATLAS 2030 exoskeleton is a paediatric device that allows gait rehabilitation in children with either neurological or neuromuscular pathologies with gait disorders. The purpose is to assess the effects in range of motion (ROM) and maximal isometric strength in hips, knees and ankles of children with SMA type II after the use of ATLAS 2030 exoskeleton. Methods Three children (mean age 5.7 ± 0.6) received nine sessions bi-weekly of 60 min with ATLAS 2030. ROM was assessed by goniometry and strength by hand-held dynamometer. All modes of use of the exoskeleton were tested: stand up and sit down, forward and backward walking, and gait in automatic and active-assisted modes. In addition, different activities were performed during the gait session. A descriptive analysis of all variables was carried out. Results The average time of use was 53.5 ± 12.0 min in all sessions, and all participants were able to carry out all the proposed activities as well as to complete the study. Regarding isometric strength, all the measurements increased compared to the initial state, obtaining the greatest improvements for the hip flexors (60.2%) and extensors muscles (48.0%). The ROM increased 12.6% in hip and 34.1% in the ankle after the study, while knee ROM remained stable after the study. Conclusion Improvements were showed in ROM and maximal isometric strength in hips, knees and ankles after using ATLAS 2030 paediatric gait exoskeleton in all three children. This research could serve as a preliminary support for future clinical integration of ATLAS 2030 as a part of a long-term rehabilitation of children with SMA. Trial registration: The approval was obtained (reference 47/370329.9/19) by Comunidad de Madrid Regional Research Ethics Committee with Medical Products and the clinical trial has been registered on Clinical Trials.gov: NCT04837157

Obstetrical providers’ preferred mode of delivery and attitude towards non-medically indicated caesarean sections: a cross-sectional study

Objective: To describe obstetrical providers’ delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. Design: Cross-sectional study. Setting: Two public and two private hospitals in Argentina. Population: Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. Methods: Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. Main outcome measures: Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. Results: 168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19–18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58–12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. Conclusions: Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. Tweetable abstract: Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.Fil: Rivo, J. C.. Duke University Medical Center; Estados UnidosFil: Amyx, Melissa Michele. University of Tulane; Estados Unidos. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Pingray, María Verónica. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Casale, R. A.. Hospital Nacional Profesor Dr. Alejandro Posadas; ArgentinaFil: Fiorillo, Angel Eduardo. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Krupitzki, Hugo Bernardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Malamud, J. D.. Sanatorio de la Mujer; ArgentinaFil: Mendilaharzu, M.. Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes; ArgentinaFil: Medina, M. L.. Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes; ArgentinaFil: del Pino, A. B.. Sanatorio de la Mujer; ArgentinaFil: Ribola, L.. Hospital Nacional Professor Dr. Alejandro Posadas; ArgentinaFil: Schvartzman, Javier Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Tartalo, G. M.. Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes; ArgentinaFil: Trasmonte, Monica. Hospital Nacional Profesor Dr. Alejandro Posadas; ArgentinaFil: Varela, S.. Hospital Nacional Profesor Dr. Alejandro Posadas; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Belizán, J. M.. Instituto de Efectividad Clínica y Sanitaria; Argentin