Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Chronic viral hepatitis infection affects an estimated 325 million people globally. People who initiate treatment after significant disease progression face increased risk of severe liver complications and death. Data are scarce on the characteristics and risk factors of people who present late to care in Spain and globally. Data were collected from January 2018 to December 2019 to report late presentation (LP) to specialist care at 11 large university hospitals in Spain to assess related risk factors using a multivariable logistic regression model. 2290 (CHB = 505, CHC = 1785) patients were analysed, with 581 (25.2%) presenting late. Hepatitis C patients more frequently reported LP compared to hepatitis B patients (28.1% vs 15.0%; p < 0.001). Older age (p < 0.001), being male (p < 0.001), being Spanish‑born (p < 0.001), and having an unknown origin of referral (p = 0.08) were associated with a higher likelihood of LP. Advanced liver disease was identified in 533 (23%) patients and late‑stage liver disease in 124 (5.4%). LP, including with irreversible liver damage, to viral hepatitis specialist care is frequent in Spain, despite being a country with unrestricted treatment access. Initiatives to reduce LP should specifically target men, older individuals, foreign‑born populations for CHB, and Spanish nationals for CHC

Individual tree attribute estimation and uniformity assessment in fast-growing Eucalyptus spp. forest plantations using lidar and linear mixed-effects models

Fast-growing Eucalyptus spp. forest plantations and their resultant wood products are economically important and may provide a low-cost means to sequester carbon for greenhouse gas reduction. The development of advanced and optimized frameworks for estimating forest plantation attributes from lidar remote sensing data combined with statistical modeling approaches is a step towards forest inventory operationalization and might improve industry e ciency in monitoring and managing forest resources. In this study, we first developed and tested a framework for modeling individual tree attributes in fast-growing Eucalyptus forest plantation using airborne lidar data and linear mixed-e ect models (LME) and assessed the gain in accuracy compared to a conventional linear fixed-e ects model (LFE). Second, we evaluated the potential of using the tree-level estimates for determining tree attribute uniformity across di erent stand ages. In the field, tree measurements, such as tree geolocation, species, genotype, age, height (Ht), and diameter at breast height (dbh) were collected through conventional forest inventory practices, and tree-level aboveground carbon (AGC) was estimated using allometric equations. Individual trees were detected and delineated from lidar-derived canopy height models (CHM), and crown-level metrics (e.g., crown volume and crown projected area) were computed from the lidar 3-D point cloud. Field and lidar-derived crown metrics were combined for ht, dbh, and AGC modeling using an LME. We fitted a varying intercept and slope model, setting species, genotype, and stand (alone and nested) as random e ects. For comparison, we also modeled the same attributes using a conventional LFE model. The tree attribute estimates derived from the best LME model were used for assessing forest uniformity at the tree level using the Lorenz curves and Gini coe cient (GC).We successfully detected 96.6% of the trees from the lidar-derived CHM. The best LME model for estimating the tree attributes was composed of the stand as a random e ect variable, and canopy height, crown volume, and crown projected area as fixed e ects. The %RMSE values for tree-level height, dbh, and AGC were 8.9%, 12.1%, and 23.7% for the LFE model and improved to 7.3%, 7.1%, and 13.6%, respectively, for the LME model. Tree attributes uniformity was assessed with the Lorenz curves and tree-level estimations, especially for the older stands. All stands showed a high level of tree uniformity with GC values approximately 0.2. This study demonstrates that accurate detection of individual trees and their associated crown metrics can be used to estimate Ht, dbh, and AGC stocks as well as forest uniformity in fast-growing Eucalyptus plantations forests using lidar data as inputs to LME models. This further underscores the high potential of our proposed approach to monitor standing stock and growth in Eucalyptus—and similar forest plantations for carbon dynamics and forest product planninginfo:eu-repo/semantics/publishedVersio

Tree canopy extent and height change in Europe, 2001-2021, quantified using Landsat data archive

European forests are among the most extensively studied ecosystems in the world, yet there are still debates about their recent dynamics. We modeled the changes in tree canopy height across Europe from 2001 to 2021 using the multidecadal spectral data from the Landsat archive and calibration data from Airborne Laser Scanning (ALS) and spaceborne Global Ecosystem Dynamics Investigation (GEDI) lidars. Annual tree canopy height was modeled using regression tree ensembles and integrated with annual tree canopy removal maps to produce harmonized tree height map time series. From these time series, we derived annual tree canopy extent maps using a >= 5 m tree height threshold. The root-mean-square error (RMSE) for both ALS-calibrated and GEDI-calibrated tree canopy height maps was = 94% for the tree canopy extent maps and >= 80% for the annual tree canopy removal maps. Analyzing the map time series, we found that the European tree canopy extent area increased by nearly 1% overall during the past two decades, with the largest increase observed in Eastern Europe, Southern Europe, and the British Isles. However, after the year 2016, the tree canopy extent in Europe declined. Some regions reduced their tree canopy extent between 2001 and 2021, with the highest reduction observed in Fennoscandia (3.5% net decrease). The continental extent of tall tree canopy forests (>= 15 m height) decreased by 3% from 2001 to 2021. The recent decline in tree canopy extent agrees with the FAO statistics on timber harvesting intensification and with the increasing extent and severity of natural disturbances. The observed decreasing tree canopy height indicates a reduction in forest carbon storage capacity in Europe

Propuesta en Supply Chain Management y Logística en la empresa Esgrim.

En la actualidad el mundo empresarial ha tenido una evolución y un cambio paradigmático gracias a la revolución tecnológica e industrial en la que nos encontramos envueltos. A partir de estos escenarios contemporáneos las empresas necesariamente han tenido que ir mejorando e incorporando sustancialmente diferentes procesos y estrategias modernas que gracias a los diversos aportes que podemos encontrar con la implementación del modelo de supply chain management han transformado el uso de recursos y herramientas en una empresa permitiendo alcanzar el objetivo principal de las redes de valor, aprovechando el potencial de nuevos vínculos, alianzas y procesos que facilitan la sincronización de información y la integración entre los proveedores, distribuidores y clientes finales. La recopilación de este trabajo tiene como objetivo ofrecer un acercamiento global a los temas más importantes de la propuesta realizada en supply chain management y logística orientada y desarrollada a la empresa esgrim. En ese sentido, el grupo colaborativo procede a realizar la escogencia de la empresa, partiendo del conocimiento de la estrategia corporativa y el enfoque de la organización que ofrece estrategias y soluciones integrales e innovadoras en gestión de riesgos, calidad y ambiente, buscando superar las necesidades y expectativas de sus clientes y principales aliados, ubicados en los diferentes sectores económicos; soportado en un equipo de profesionales especializados, con amplio conocimiento y experiencia, y en alianzas con entidades estratégicas. Esta propuesta demostró la pertinencia de incorporar este método de supply chain management y logística en las organizaciones que mejorara significativamente su estructura interna porque permitirá su evolución y los hará perdurables en el tiempo adaptándose a las necesidades del mercado actual con el desarrollo tecnológico, gracias a la buena gestión de la cadena de suministros la cual desarrollara una ventaja competitiva sostenible. Por su parte, los inventarios se consideran como la cantidad con que se dispone de un producto o material. Partiendo del hecho que la demanda no es constante en el tiempo, ninguna empresa tiene certeza de la cantidad de productos que va a vender un día cualquiera, pero si puede realizar pronósticos al respecto. Lo ideal es que se debe dar un equilibrio entre los productos que más se venden y los que no, pues para cualquier negocio es fundamental tener un buen flujo de caja, es decir, las empresas quieren y necesitan que sus productos se vendan rápido y así poder pagar puntualmente a sus proveedores, préstamos, entre otros. Por otro lado, al analizar el conjunto de elementos que interactuan en cualquier organización que coadyuvan a lograr sus objetivos, se pueden tener en cuenta dos opciones: el modelo SCOR del Supply Chain Council y el modelo GSCF de Supply Chain Forum. El primero con 5 procesos busca la colaboración entre las empresas cuya experiencia permite que dicho modelo evolucione con el tiempo. Mientras que el segundo con 8 procesos, se enfoca en la reducción de costos y aumento en la utilidad mediante una armoniosa relación entre los clientes y proveedores en pro de diseñar toda la red y monitorear las actividades claves que generen valor a dicha red.Today the business world has undergone an evolution and a paradigmatic shift thanks to the technological and industrial revolution in which we are involved. From these contemporary scenarios, companies have necessarily had to improve and substantially incorporate different modern processes and strategies that, thanks to the various contributions that we can find with the implementation of the supply chain management model, have transformed the use of resources and tools into a company allowing the main objective of value networks to be achieved, taking advantage of the potential of new links, alliances and processes that facilitate the synchronization of information and integration between suppliers, distributors and end customers. The compilation of this work aims to offer a global approach to the most important issues of the proposal made in supply chain management and logistics oriented and developed to the fencing company. In this sense, the collaborative group proceeds to make the choice of the company, based on the knowledge of the corporate strategy and the approach of the organization that offers comprehensive and innovative strategies and solutions in risk management, quality and environment, seeking to overcome the needs and expectations of its clients and main allies, located in the different economic sectors; supported by a team of specialized professionals, with extensive knowledge and experience, and in alliances with strategic entities. This proposal demonstrated the relevance of incorporating this method of supply chain management and logistics in organizations that would significantly improve their internal structure because it will allow their evolution and will make them durable over time, adapting to the needs of the current market with technological development, thanks to the good management of the supply chain which will develop a sustainable competitive advantage. For its part, inventories are considered as the quantity with which a product or material is available. Based on the fact that demand is not constant over time, no company is certain of the number of products it will sell on any given day, but it can make forecasts about it. Ideally, there should be a balance between the products that are sold the most and those that do not, because for any business it is essential to have a good cash flow, that is, companies want and need their products to sell quickly and thus to be able to pay their suppliers, loans, among others on time. On the other hand, when analyzing the set of elements that interact in any organization that contribute to achieving its objectives, two options can be taken into account: the SCOR model of the Supply Chain Council and the GSCF model of the Supply Chain Forum. The first with 5 processes seeks collaboration between companies whose experience allows this model to evolve over time. While the second with 8 processes, focuses on reducing costs and increasing profits through a harmonious relationship between customers and suppliers in order to design the entire network and monitor the key activities that generate value to said network

Multi-band high resolution spectroscopy rules out the hot Jupiter BD+20 1790b - First data from the GIARPS Commissioning

Context. Stellar activity is currently challenging the detection of young planets via the radial velocity (RV) technique. Aims. We attempt to definitively discriminate the nature of the RV variations for the young active K5 star BD+20 1790, for which visible (VIS) RV measurements show divergent results on the existence of a substellar companion. Methods. We compare VIS data with high precision RVs in the near infrared (NIR) range by using the GIANO - B and IGRINS spectrographs. In addition, we present for the first time simultaneous VIS-NIR observations obtained with GIARPS (GIANO - B and HARPS - N) at Telescopio Nazionale Galileo (TNG). Orbital RVs are achromatic, so the RV amplitude does not change at different wavelengths, while stellar activity induces wavelength-dependent RV variations, which are significantly reduced in the NIR range with respect to the VIS. Results. The NIR radial velocity measurements from GIANO - B and IGRINS show an average amplitude of about one quarter with respect to previously published VIS data, as expected when the RV jitter is due to stellar activity. Coeval multi-band photometry surprisingly shows larger amplitudes in the NIR range, explainable with a mixture of cool and hot spots in the same active region. Conclusions. In this work, the claimed massive planet around BD+20 1790 is ruled out by our data. We exploited the crucial role of multi- wavelength spectroscopy when observing young active stars: thanks to facilities like GIARPS that provide simultaneous observations, this method can reach its maximum potential.Comment: 12 pages, 7 figure

Etiology, management, and outcome of the Budd-Chiari syndrome

Background: The Budd-Chiari syndrome (BCS) is hepatic venous outflow obstruction. What is known about the syndrome is based on small studies of prevalent cases. Objective: To characterize the causes and treatment of incident BCS. Design: Consecutive case series of patients with incident BCS, enrolled from October 2003 to October 2005 and followed until May 2006. Setting: Academic and nonacademic hospitals in France, Spain, Italy, Great Britain, Germany, Belgium, the Netherlands, Portugal, and Switzerland. Patients: Persons older than 16 years with definite hepatic outflow obstruction diagnosed by imaging. Persons with hepatic outflow obstruction due to heart failure, sinusoidal obstruction syndrome, cancer, or liver transplantation were excluded. Measurements: Signs and symptoms; laboratory and imaging findings; diagnosis; treatment; and overall, transplantation-free, and intervention-free survival. Results: 163 incident cases of BCS were identified. Median follow-up was 17 months (range, 0.1 to 31 months). Most patients (84%) had at least 1 thrombotic risk factor, and many (46%) had more than 1; the most common was myeloproliferative disorders (49% of 103 tested patients). Patients were mainly treated with anticoagulation (140 patients [86%]), transjugular intrahepatic portosystemic shunting (56 patients [34%]), or liver transplantation (20 patients [12%]), and 80 patients (49%) were managed noninvasively. Only 3 patients underwent surgical shunting. The survival rate was 87% (95% CI, 82% to 93%) at 1 year and 82% (CI, 75% to 88%) at 2 years. Limitation: Treatment was not standardized across all centers, and data on important clinical variables were missing for some patients. Conclusion: Most patients with BCS have at least 1 thrombotic risk factor, and many have more than 1; myeloproliferative disorders are most common. One- and 2-year survival rates are good with contemporary management, which includes noninvasive therapies (anticoagulation and diuretics) and invasive techniques. Transjugular intrahepatic portosystemic shunting seems to have replaced surgical shunting as the most common invasive therapeutic procedure. Primary Funding Source: Fifth Framework Programme of the European Commission

Axicabtagene ciloleucel compared to tisagenlecleucel for the treatment of aggressive B-cell lymphoma

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-targeted chimeric antigen receptor (CAR) T cells approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). We performed a retrospective study to evaluate safety and efficacy of axi-cel and tisa-cel outside the setting of a clinical trial. Data from consecutive patients with R/R LBCL who underwent apheresis for axi-cel or tisa-cel were retrospectively collected from 12 Spanish centers. A total of 307 patients underwent apheresis for axi-cel (n=152) and tisa-cel (n=155) from November 2018 to August 2021, of which 261 (85%) received a CAR T infusion (88% and 82%, respectively). Median time from apheresis to infusion was 41 days for axi-cel and 52 days for tisa-cel (P=0.006). None of the baseline characteristics were significantly different between both cohorts. Both cytokine release syndrome and neurologic events (NE) were more frequent in the axi-cel group (88% vs. 73%, P=0.003, and 42% vs. 16%, P= 2 and progressive disease before lympho-depletion. Safety and efficacy results in our real-world experience were comparable with those reported in the pivotal trials. Patients treated with axi-cel experienced more toxicity but similar non-relapse mortality compared with those re-ceiving tisa-cel. Efficacy was not significantly different between both products

Axicabtagene ciloleucel compared to tisagenlecleucel for the treatment of aggressive B-cell lymphoma

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-targeted chimeric antigen receptor (CAR) T cells approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). We performed a retrospective study to evaluate safety and efficacy of axi-cel and tisa-cel outside the setting of a clinical trial. Data from consecutive patients with R/R LBCL who underwent apheresis for axi-cel or tisa-cel were retrospectively collected from 12 Spanish centers. A total of 307 patients underwent apheresis for axi-cel (n=152) and tisa-cel (n=155) from November 2018 to August 2021, of which 261 (85%) received a CAR T infusion (88% and 82%, respectively). Median time from apheresis to infusion was 41 days for axi-cel and 52 days for tisa-cel (P =0.006). None of the baseline characteristics were significantly different between both cohorts. Both cytokine release syndrome and neurologic events (NE) were more frequent in the axi-cel group (88% vs. 73%, P =0.003, and 42% vs. 16%, P <0.001, respectively). Infections in the first 6 months post-infusion were also more common in patients treated with axi-cel (38% vs. 25%, P =0.033). Non-relapse mortality was not significantly different between the axi-cel and tisa-cel groups (7% and 4%, respectively, P =0.298). With a median follow-up of 9.2 months, median PFS and OS were 5.9 and 3 months, and 13.9 and 11.2 months for axi-cel and tisa-cel, respectively. The 12-month PFS and OS for axi-cel and tisa-cel were 41% and 33% (P =0.195), 51% and 47% (P =0.191), respectively. Factors associated with lower OS in the multivariate analysis were increased lactate dehydrogenase, ECOG ≥2 and progressive disease before lympho-depletion. Safety and efficacy results in our real-world experience were comparable with those reported in the pivotal trials. Patients treated with axi-cel experienced more toxicity but similar non-relapse mortality compared with those receiving tisa-cel. Efficacy was not significantly different between both products

GIARPS: commissioning and first scientific results

GIARPS (GIAno \& haRPS) is a project devoted to have on the same focal station of the Telescopio Nazionale Galileo (TNG) both high resolution spectrographs, HARPS-N (VIS) and GIANO-B (NIR), working simultaneously. This could be considered the first and unique worldwide instrument providing cross-dispersed echelle spectroscopy at a resolution of 50,000 in the NIR range and 115,000 in the VIS and over in a wide spectral range ($0.383 - 2.45\ \mu$m) in a single exposure. The science case is very broad, given the versatility of such an instrument and its large wavelength range. A number of outstanding science cases encompassing mainly extra-solar planet science starting from rocky planets search and hot Jupiters to atmosphere characterization can be considered. Furthermore both instruments can measure high precision radial velocities by means the simultaneous thorium technique (HARPS-N) and absorbing cell technique (GIANO-B) in a single exposure. Other science cases are also possible. GIARPS, as a brand new observing mode of the TNG started after the moving of GIANO-A (fiber fed spectrograph) from Nasmyth-A to Nasmyth-B where it was re-born as GIANO-B (no more fiber feed spectrograph). The official Commissioning finished on March 2017 and then it was offered to the community. Despite the work is not finished yet. In this paper we describe the preliminary scientific results obtained with GIANO-B and GIARPS observing mode with data taken during commissioning and first open time observations.Comment: 10 pages, 11 figures, Telescopes and Astronomical instrumentation, SPIE Conf. 201

Turismo y Género. Una mirada desde Iberoamérica

En las últimas cuatro décadas ha crecido el interés de la academia, gobiernos y organizaciones internacionales por estudiar cómo ha sido, en qué circunstancias y qué efectos ha traído la incorporación de las mujeres al turismo. De esta forma se inicia un debate internacional en el que se cuestionan, por un lado, los efectos negativos de esta actividad en la vida de las mujeres y, por el otro, se realzan beneficios económicos que mejoran su calidad de vida y la de sus familias. A pesar del interés y la importante participación de mujeres en el sector turístico, aún son insuficientes los estudios enfocados en explicar y evidenciar su situación laboral. En este contexto, surge la idea de publicar un libro que compilara trabajos recientes en torno a las condiciones de las trabajadoras en el sector turístico de Iberoamérica.Esta obra se compone de tres secciones, Aproximaciones teórico metodológicas, Mujer y turismo en zonas rurales y La mujer en empresas turísticas, cuyas investigaciones abordan distintos temas para evidenciar los problemas enfrentados por las mujeres, proponer diversas soluciones y comprender su escenario laboral. En la primera sección, hay dos capítulos que proponen marcos teóricos para analizar el empoderamiento de las mujeres en el turismo rural. Los resultados de investigaciones de la segunda sección visibilizan las desigualdades, reflexionan y proponen acciones para mejorar las condiciones de las trabajadoras turísticas. En la última, en los tres capítulos, concentrados en las actividades empresariales, se estudian las desventajas y obstáculos de la empleada en alguna compañía turística.Universidad Autónoma del Estado de México