Spatial Limits of the TCM revisited: Island Effects

The purpose of this paper is to address a problem that may arise with the assumption of a continuous spatial market in the TCM model. We find that this assumption can be challenged by geographical limitations that an area of study might have. Particularly for islands (or isolated island-like areas) that have a valuable non-market resource or good, the spatial market characteristic of the TCM model might be limited or truncated. The geographical truncation limits the observed maximum travel cost of the demand curve falsely implying a lower WTP than otherwise. The study uses a dichotomous choice CVM to confirm that the resulting demand schedules from the TCM underestimates WTP for day trips to the Caribbean National Forest in Puerto Rico. This results in a considerably smaller TCM WTP for the value of recreation sites at $17 to$29 versus $109 per day trip from the dichotomous choice CVM.Marketing,

Primary Immune Deficiency: Patients’ Preferences for Replacement Immunoglobulin Therapy

Purpose Immunoglobulin (Ig) replacement therapy is an important life-saving treatment modality for patients with primary antibody immune deficiency disorders (PAD). IVIG and SCIg are suitable alternatives to treat patients with PAD but vary in key ways. Existing evidence on patient preferences for Ig treatments given the complexities associated with IVIG and SCIg treatment is limited and fails to account for variations in preferences across patients. For this reason, we sought to evaluate PAD patient preferences for features of IVIG and SCIg across different patient characteristics. Materials and Methods 119 PAD patients completed a discrete-choice experiment (DCE) survey. The DCE asked respondents to make choices between carefully constructed treatment alternatives described in terms of generic treatment features. Choices from the DCE were analyzed to determine the relative influence of attribute changes on treatment preferences. We used subgroup analysis to evaluate systematic variations in preferences by patients’ age, gender, time since diagnosis, and treatment experience. Results Patients were primarily concerned about the duration of treatment side effects, but preferences were heterogeneous. This was particularly true around administration features. Time since diagnosis was associated with an increase in patients’ concerns with the number of needles required per infusion. Also, patients appear to prefer the kind of therapy they are currently using which could be the result of properly aligned patient preferences or evidence of patient adaptive behavior. Conclusions Heterogeneity in preferences for Ig replacement treatments suggests that a formal shared decision making process could have an important role in improving patient care

Physicians’ Preferences for Bone Metastases Drug Therapy in the United States

AbstractObjectiveSeveral characteristics of bone-targeted agents are considered when making treatment decisions. This study evaluated physicians’ therapy preferences for preventing skeletal-related events (SREs) in patients with bone metastases secondary to solid tumors.MethodsA Web-enabled, discrete-choice experiment online survey was conducted among physicians who treated patients with bone metastases and solid tumors in the United States. Respondents chose between pairs of hypothetical medications defined by combinations of six attributes at varying levels for two hypothetical patients. Preference weights for attribute levels were estimated using a random-parameters logit model.ResultsIn total, 200 physicians completed the survey. Their mean age was 52 years, 57% were in practice for more than 15 years, 37% were oncologists, and 65% treated 10 or fewer patients with bone metastases weekly. Out-of-pocket cost to patients was the most important attribute overall. Among clinical outcomes, time to first SRE and risk of renal impairment were the most important attributes. Statistically significant preferences were observed for all attribute levels for time to first SRE, risk of renal impairment, and mode of administration. Predicted choice probability analysis showed that physicians preferred a hypothetical medication with attributes similar to those of denosumab over one with attributes similar to those of zoledronic acid.ConclusionsPhysicians indicated that clinical attributes are important when considering bone-targeting therapy for bone metastases, but consistent with the current health care landscape, patient out-of-pocket cost was the most important. With health care costs being increasingly shifted to patients, physicians require accurate information about co-pays and assistance programs to avoid patients receiving less costly, yet potentially inferior, treatment

Tuberculine reaction measured by infrared thermography

Setting: The infection with Mycobacterium tuberculosis gives a delayed immune response, measured by the tuberculine skin test. We present a new technique for evaluation based on automatic detection and measurement of skin temperature due to infrared emission.; Design: 34 subjects (46.8+/-16.9 years) (12/22, M/F) with suspected tuberculosis disease were examined with an IR thermal camera, 48h after tuberculin skin injection.; Results: In 20 subjects, IR analysis was positive for tuberculine test. Mean temperature of injection area was higher, around 1 degrees C, for the positive group (36.2+/-1.1 degrees C positive group; 35.1+/-1.6 degrees C negative group, p < 0.02 T test for unpaired groups).; Conclusion: IR image analysis achieves similar estimation of tuberculin reaction as the visual evaluation, based on higher temperature due to increased heat radiation from the skin lesion.Peer ReviewedPostprint (author's final draft

Heterogeneous vancomycin-intermediate susceptibility in a community-associated methicillin-resistant Staphylococcus aureus epidemic clone, in a case of Infective Endocarditis in Argentina

BACKGROUND: Community-Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) has traditionally been related to skin and soft tissue infections in healthy young patients. However, it has now emerged as responsible for severe infections worldwide, for which vancomycin is one of the mainstays of treatment. Infective endocarditis (IE) due to CA-MRSA with heterogeneous vancomycin-intermediate susceptibility-(h-VISA) has been recently reported, associated to an epidemic USA 300 CA-MRSA clone. CASE PRESENTATION: We describe the occurrence of h-VISA phenotype in a case of IE caused by a strain belonging to an epidemic CA-MRSA clone, distinct from USA300, for the first time in Argentina. The isolate h-VISA (SaB2) was recovered from a patient with persistent bacteraemia after a 7-day therapy with vancomycin, which evolved to fatal case of IE complicated with brain abscesses. The initial isolate-(SaB1) was fully vancomycin susceptible (VSSA). Although MRSA SaB2 was vancomycin susceptible (≤ 2 μg/ml) by MIC (agar and broth dilution, E-test and VITEK 2), a slight increase of MIC values between SaB1 and SaB2 isolates was detected by the four MIC methods, particularly for teicoplanin. Moreover, Sab2 was classified as h-VISA by three different screening methods [MHA5T-screening agar, Macromethod-E-test-(MET) and by GRD E-test] and confirmed by population analysis profile-(PAP). In addition, a significant increase in cell-wall thickness was revealed for SaB2 by electron microscopy. Molecular typing showed that both strains, SaB1 and SaB2, belonged to ST5 lineage, carried SCCmecIV, lacked Panton-Valentine leukocidin-(PVL) genes and had indistinguishable PFGE patterns (subtype I2), thereby confirming their isogenic nature. In addition, they were clonally related to the epidemic CA-MRSA clone (pulsotype I) detected in our country. CONCLUSIONS: This report demonstrates the ability of this epidemic CA-MRSA clone, disseminated in some regions of Argentina, to produce severe and rapidly fatal infections such as IE, in addition to its ability to acquire low-level vancomycin resistance; for these reasons, it constitutes a new challenge for the Healthcare System of this country.This study was supported by the National Council for Scientific Research and Technology of Argentina (CONICET), Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT - PICT 01630 to JLB), Secretaría de Ciencia y Técnica-Universidad Nacional de Córdoba (SECyT-UNC) and Agencia Córdoba Ciencia.S

El cerro Dos Cuernos: Otro ejemplo de escudos basálticos en el oeste de Santa Cruz extraandina, Argentina

En Patagonia extraandina se formaron un gran número de mesetas durante diferentes ciclos basálticos (Panza y Franchi 2002). Las geoformas volcánicas típicas en Patagonia sur son conos de escoria, conos de salpicadura y maars (e.g. Panza y Franchi 2002, Corbella y Lara 2008). Sin embargo, recientemente se ha documentado que en la franja más occidental de las mesetas ocurren escudos basálticos de pequeñas dimensiones (scutulum) (González Guillot y Ponce 2017, 2021). Uno de esos escudos se ubica sobre la meseta Desocupada (49,44°S - 72,46°O), con pendientes suavemente cóncavas hacia arriba y un diámetro total (cono + abanico sensu Rossi 1996) de 6800 m. El cono presenta un diámetro de 2410 m y una altura de 104 m (González Guillot y Ponce 2021). En esta contribución se brindan las características de un escudo sobre la meseta de la Muerte, el cerro Dos Cuernos, y de otros posibles escudos en la región. El análisis morfométrico de edifi cios volcánicos que se presenta a continuación se realizó a partir de imágenes satelitales (Google Earth) y con modelos digitales de elevación (MDE) de la Shuttle Radar Topography Mission (SRTM), con píxel de 90 m de resolución, utilizando el programa Global Mapper 10 para su análisis y generación de mapas topográfi cos. Además, se recolectó información de campo en el cerro Dos Cuernos. El cerro Dos Cuernos (48,58°S - 71.68°O) es el punto más elevado sobre la meseta de la Muerte (Basalto Strobel, 9-6 Ma, Panza y Sacomani 2018). Se trata de un escudo basáltico de pendientes convexas hacia arriba (Fig. 1A). Presenta un cono de 204 m de alto y diámetro de 3042 m, y un abanico (asimétrico) de 5700 m en sentido NE-SO (Fig. 1B). Todo el edifi cio tiene una altura de ~230 m sobre el techo de la meseta. Las pendientes son 8° (cono) y 2,5° (abanico). El volcán está cubierto por un manto de clastos provenientes de la erosión de lavas compactas. No obstante, en sectores afl oran secciones de coladas con espesores de 0,8 a 4 m, y características de fl ujos pahoehoe. Prácticamente no hay escoria ni otros materiales piroclásticos en todo el edifi cio. Los dos cuernos se ubican en la cima (Fig. 1) y son estructuras de ~20 m de alto conformadas por un único paquete de lava muy pobremente vesiculada, y con disyunción horizontal con espaciamiento de 5-10 cm. Posiblemente representan remanentes de un lago de lava, ergo implican un importante desmantelamiento del aparato volcánico. Una muestra de lava próxima a la cima del volcán presenta color rojizo y textura porfírica, con fenocristales de plagioclasa (tamaño 2,5-0,3 mm) y clinopiroxeno (1,6-0,3 mm), y glomérulos de plagioclasa y piroxeno en relación subofítica. La pasta es menor a 80 μm, conformada por plagioclasa, minerales opacos junto a vidrio intersticial y un material rojizo de baja cristalinidad (¿limonitas?) que le confi ere el color a la roca. Por otro lado, una muestra en la base de uno de los cuernos posee un color gris claro, levemente rosado. Presenta textura seriada con cristales mayores de plagioclasa (hasta 4 mm) y clinopiroxeno (hasta 1,2 mm), en relación subofítica, junto a minerales opacos y escaso vidrio intersticial. Estas características difi eren del Basalto Strobel, caracterizado por fenocristales de olivina (Panza y Sacomani 2018). Los parámetros morfométricos del cono del cerro Dos Cuernos corresponden también al tipo scutulum (Fig. 1C). Otros posibles escudos han sido identifi cados en imágenes satelitales. Uno de ellos se ubica próximo al cerro Dos Cuernos, sobre la meseta del Strobel (48,60°S - 71,51°O). Consiste en un cono de 159 m de altura y 2451 m de diámetro, con pendientes de 6,4° (4 en Fig. 1C). Se aprecia escasa escoria rojiza alrededor de la cima en la imagen satelital. Sobre la meseta del Lago Buenos Aires ocurre otro edifi cio con geometría en escudo (46,95°S - 71,66°O), su cono posee una altura de 235 m y una base ovalada de 1895 m x 3144 m, con pendientes de 8,4° (3 en Fig. 1C). Otros dos edifi cios con características similares, pero más pequeños, fueron detectados más al sur; uno se ubica al norte de la meseta del Viento (49,31°S - 72,14°O), con un cono de 80 m de altura y diámetro basal de 1250 m (5 en Fig. 1C); el segundo se ubica en la meseta de las Vizcachas (50,66°S - 72,05°O), posee un cono de 83 m de altura y 1510 m de diámetro (6 en Fig. 1C). Ambos poseen pendientes de ~5°. Todos poseen características de pequeños escudos tipo scutulum. El escudo de la meseta Desocupada tiene evidencias de haberse formado inmediatamente después del retiro de glaciares pliocenos en el área, o concomitante con la deglaciación (González Guillot y Ponce 2017, 2021). Sus lavas poseen enclaves cognatos con textura cumular y están enriquecidas en elementos incompatibles, que indican mayor diferenciación que lavas previas y contemporáneas a la glaciación (González Guillot y Ponce 2021). Estos autores consideraron que el origen de los escudos se asocia a deglaciación, que conduce a relajación litosférica y facilita la canalización de magmas almacenados en la corteza. El estilo eruptivo efusivo estaría vinculado a una menor tasa de efusión (cf. Parfi tt 2004) de magmas que habrían perdido volátiles durante su residencia en la corteza. La posición de los escudos restringida al extremo occidental de Patagonia extraandina se explica por un mayor espesor de hielo por estar más cerca del área de aporte (el Campo de Hielo Patagónico). La deglaciación afecta la actividad volcánica en diversos ambientes geológicos, y en particular en Islandia se ha documentado un cambio en el estilo eruptivo y aparición de escudos volcánicos luego del Último Máximo Glacial (e.g. Gudmundsson 1986). Proponemos que ésta debe ser una hipótesis de trabajo en futuros estudios sobre el origen de escudos basálticos en Patagonia extraandina, más allá del escudo de la meseta Desocupada. Se agradece a Luis Imaz y personal de Ea. Río Capitán por su hospitalidad y facilidades para acceder a afl oramientos. Se contó con los subsidios PIP CONICET 0658 y PIDUNTDF-A- 07/2018.Fil: Gonzalez Guillot, Mauricio Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina. Universidad Nacional de Tierra del Fuego. Instituto de Ciencias Polares, Recursos Naturales y Ambiente; ArgentinaFil: Ponce, Juan Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina. Universidad Nacional de Tierra del Fuego. Instituto de Ciencias Polares, Recursos Naturales y Ambiente; ArgentinaFil: Lobo, Constanza. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; ArgentinaFil: Rodríguez, Marcos Ignacio. Universidad Nacional de Tierra del Fuego. Instituto de Ciencias Polares, Recursos Naturales y Ambiente; ArgentinaFil: Gómez Vereda, Ignacio. Universidad Nacional de Tierra del Fuego. Instituto de Ciencias Polares, Recursos Naturales y Ambiente; ArgentinaXXI Congreso Geológico ArgentinoPuerto MadrynArgentinaAsociación Geológica Argentin

Precision medicine in sepsis and septic shock: From omics to clinical tools

Endotype; Organ dysfunction; SepsisEndotipo; Disfunción de órganos; SepsisEndotip; Disfunció d'òrgans; SèpsiaSepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes. As it is associated with an increased risk of death, patients with this condition are candidates for receipt of a very well-structured and protocolized treatment. All patients should receive the fundamental pillars of sepsis management, which are infection control, initial resuscitation, and multiorgan support. However, specific subgroups of patients may benefit from a personalized approach with interventions targeted towards specific pathophysiological mechanisms. Herein, we will review the framework for identifying subpopulations of patients with sepsis, septic shock, and multiorgan dysfunction who may benefit from specific therapies. Some of these approaches are still in the early stages of research, while others are already in routine use in clinical practice, but together will help in the effective generation and safe implementation of precision medicine in sepsis

Linking accretionary orogens with continental crustal growth and stabilization: Lessons from Patagonia

The origin of the continental crust and the tectonic significance of Paleozoic magmatic rocks of Patagonia (southernmost South America) remain one of the main enigmas in the history of the Gondwana supercontinent. Here, new whole-rock geochemistry together with coupled zircon U-Pb and Lu-Hf isotopic data of Devonian to Permian intrusive rocks of northern Patagonia are integrated with a revised geochemical and isotopic database of the region, providing a novel model for the tectonomagmatic evolution and related crustal growth mechanisms. The development of a Devonian retreating accretionary orogen associated with crustal thinning was succeeded by a late Carboniferous to Permian advancing orogen and crustal shortening, resulting from slab shallowing. The latter was related to the Gondwanide Orogeny, a major transpressional tectonic event that led to the maturation and stabilization of the continental crust of Patagonia due to widespread magmatism and crustal thickening, which culminated with Permian-Triassic slab break-off. Addition of juvenile mantle-derived magmas is more significant during the Devonian, whereas a progressively increase in crustal reworking is documented from the late Carboniferous to the Permian due to crustal thickening. Therefore, this non-collisional model favors an in situ middle to late Paleozoic crustal growth of Patagonia during changing dynamics of accretionary orogens at the proto-Pacific margin of southwestern Gondwana.Fil: Oriolo, Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Gonzalez, Pablo Diego. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Secretaría de Industria y Minería. Servicio Geológico Minero Argentino; ArgentinaFil: Renda, Emiliano Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Stipp Basei, Miguel Angelo. Universidade de Sao Paulo; BrasilFil: Otamendi, Juan Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Instituto de Ciencias de la Tierra, Biodiversidad y Ambiente; Argentina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Fisicoquímicas y Naturales. Departamento de Geología; ArgentinaFil: Cordenons, Pablo Damián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Marcos, Paulo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Yoya, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Ballivian Justiniano, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Suárez, Rodrigo Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; Argentin

Accuracy and Precision of the COSMED K5 Portable Analyser

The main aims of this study were to determine the accuracy of the portable metabolic cart K5 by comparison with a stationary metabolic cart (Vyntus CPX), to check on the validity of Vyntus CPX using a butane combustion test, and to assess the reliability of K5 during prolonged walks in the field. For validation, measurements were consecutively performed tests with both devices at rest and during submaximal exercise (bicycling) at low (60 W) and moderate intensities (130–160 W) in 16 volunteers. For the reliability study, 14 subjects were measured two times during prolonged walks (13 km, at 5 km/h), with the K5 set in mixing chamber (Mix) mode. Vyntus measured the stoichiometric RQ of butane combustion with high accuracy (error &lt;1.6%) and precision (CV &lt;0.5%), at VO2 values between 0.788 and 6.395 L/min. At rest and 60 W, there was good agreement between Vyntus and K5 (breath-by-breath, B×B) in VO2, VCO2, RER, and energy expenditure, while in Mix mode the K5 overestimated VO2 by 13.4 and 5.8%, respectively. Compared to Vyntus, at moderate intensity the K5 in B×B mode underestimated VO2, VCO2, and energy expenditure by 6.6, 6.9, and 6.6%, respectively. However, at this intensity there was an excellent agreement between methods in RER and fat oxidation. In Mix mode, K5 overestimated VO2 by 5.8 and 4.8%, at 60 W and the higher intensity, respectively. The K5 had excellent reliability during the field tests. Total energy expenditure per Km was determined with a CV for repeated measurements of 4.5% (CI: 3.2–6.9%) and a concordance correlation coefficient of 0.91, similar to the variability in VO2. This high reproducibility was explained by the low variation of FEO2 measurements, which had a CV of 0.9% (CI: 0.7–1.5%) combined with a slightly greater variability of FECO2, VE, VCO2, and RER. In conclusion, the K5 is an excellent portable metabolic cart which is almost as accurate as a state-of-art stationary metabolic cart, capable of measuring precisely energy expenditure in the field, showing a reliable performance during more than 2 h of continuous work. At high intensities, the mixing-chamber mode is more accurate than the B×B mode