Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain

BACKGROUND: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. METHODS: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. RESULTS: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4-6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4-39.6%). CONCLUSIONS: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations

Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer's disease and three causality networks : The GR@ACE project

Introduction: Large variability among Alzheimer's disease (AD) cases might impact genetic discoveries and complicate dissection of underlying biological pathways. Methods: Genome Research at Fundacio ACE (GR@ACE) is a genome-wide study of dementia and its clinical endophenotypes, defined based on AD's clinical certainty and vascular burden. We assessed the impact of known AD loci across endophenotypes to generate loci categories. We incorporated gene coexpression data and conducted pathway analysis per category. Finally, to evaluate the effect of heterogeneity in genetic studies, GR@ACE series were meta-analyzed with additional genome-wide association study data sets. Results: We classified known AD loci into three categories, which might reflect the disease clinical heterogeneity. Vascular processes were only detected as a causal mechanism in probable AD. The meta-analysis strategy revealed the ANKRD31-rs4704171 and NDUFAF6-rs10098778 and confirmed SCIMP-rs7225151 and CD33-rs3865444. Discussion: The regulation of vasculature is a prominent causal component of probable AD. GR@ACE meta-analysis revealed novel AD genetic signals, strongly driven by the presence of clinical heterogeneity in the AD series

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Sostenibilidad, calidad, innovación y ventaja competitiva en el sector hotelero: Un estudio de caso

The purpose of this paper is to analyze why there are more competitive and profitable hotels. To answer this question, two recent theoretical approaches are integrated in the field of strategic management of the company, such as microfoundations and dynamic capabilities. Specifically, it analyzes how sustainability, quality management and innovation, as dynamic capabilities, influence hotel competitiveness. The analysis is carried out through qualitative research through in-depth interviews with experts from the Spanish hotel sectoEl propósito de este trabajo es analizar por qué hay hoteles más competitivos y rentables que otros. Para responder a esta pregunta, se integran dos enfoques teóricos recientes en el campo de la dirección estratégica de la empresa como son los microfundamentos y las capacidades dinámicas. Concretamente, se analiza cómo la sostenibilidad, la gestión de la calidad y la innovación, como capacidades dinámicas, son capaces de incidir en la competitividad hotelera. El análisis se realiza mediante una investigación cualitativa a través de entrevistas en profundidad a expertos del sector hotelero español

Effect of different concentrations of O 2 under inert and CO 2 atmospheres on the swine manure combustion process

The oxy-fuel combustion of swine manure has been evaluated by thermogravimetric-mass spectrometric analysis. Manure samples showed a two-stage decomposition profile. The first stage is related to devolatilization of the sample and the second stage involved oxidation of the char formed in situ. Replacement of the inert carrier gas by CO2 did not seem to affect the first stage. However, this change in carrier gas delayed the oxidation of the samples during the second stage. This finding is mainly attributed to the slower transfer of thermal energy to the fuels in CO2/O2 atmospheres. The increase in the oxygen partial pressure in the reaction medium had a marked effect on the oxidation stage by shifting the process to lower temperatures (from 514 to 478 °C and from 525 to 475 °C for Ar/O2 and CO2/O2, respectively). The kinetics of the process were evaluated by the integral iso-conversional method of Kissinger–Akahira–Sunose (KAS). The two aforementioned stages were clearly identified as two regions of apparent activation energy were obtained. A similar profile was found for the gaseous products released in the process in both atmospheres, as evidenced by a distribution with two emission peaks, which is consistent with the two combustion regions. However, the formation of light products such as H2, CO and CH4 was favored on using high proportions of CO2 (∼80 vol.%).La combustión de oxicombustible del estiércol porcino ha sido evaluada mediante análisis termogravimétrico-espectrométrico de masas. Las muestras de estiércol mostraron un perfil de descomposición de dos etapas. La primera etapa está relacionada con la desvolatilización de la muestra y la segunda etapa involucró la oxidación del carbón formado in situ . La sustitución del gas portador inerte por CO 2 no pareció afectar a la primera etapa. Sin embargo, este cambio en el gas portador retrasó la oxidación de las muestras durante la segunda etapa. Este hallazgo se atribuye principalmente a la transferencia más lenta de energía térmica a los combustibles en CO 2 /O 2atmósferas. El aumento de la presión parcial de oxígeno en el medio de reacción tuvo un marcado efecto en la etapa de oxidación al desplazar el proceso a temperaturas más bajas (de 514 a 478 °C y de 525 a 475 °C para Ar/O 2 y CO 2 /O 2 , respectivamente). La cinética del proceso se evaluó mediante el método iso-conversional integral de Kissinger-Akahira-Sunose (KAS). Las dos etapas antes mencionadas se identificaron claramente ya que se obtuvieron dos regiones de energía de activación aparente. Se encontró un perfil similar para los productos gaseosos liberados en el proceso en ambas atmósferas, como lo demuestra una distribución con dos picos de emisión, lo cual es consistente con las dos regiones de combustión. Sin embargo, la formación de productos ligeros como H2 , CO y CH 4 se vio favorecida al utilizar altas proporciones de CO 2 (∼80 vol.%)