The Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) Trial to Avoid Adverse Perinatal Outcomes: Protocol for a Multicenter, Open-Label, Randomized Controlled Trial

Angiogenic factors; Fetal growth restriction; Small for gestational ageFactores angiogénicos; Restricción del crecimiento fetal; Pequeño para la edad gestacionalFactors angiogènics; Restricció del creixement fetal; Petit per a l'edat gestacionalBackground: Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective: The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods: This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ≤10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ≥38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ≥37 weeks and the small for gestational age group at ≥40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results: Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions: The angiogenic factor-based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities

A Health Sector Online Toolkit for Implementing Learning into Practice from Violence Against Women Trainings (TILPVAWT)

Violence against women (VAW) is a major public health and human rights concern. Intimate partner violence and sexual violence are among the most pervasive forms of violence against women. Training health professionals in VAW is essential to raise awareness and improve the care for victims with a comprehensive approach. One of the objectives of this project was the development of a set of 28 tools to facilitate VAW training of health professionals, using certain common content, and the transfer of this knowledge into their clinical practice. This toolkit has been presented on the website http://www.toolner.com/en/. This website has been designed in an easy to use and friendly way, and is oriented to trainers, organisations and individuals interested in improving their teaching skills in VAW, but with the potential to be adapted and used independently by different organisations. The toolkit is divided into five phases of training: preparation, development, implementation, post-training, and assessment; each containing different tools and examples. Training in VAW is the first step to change attitudes but it is necessary to motivate professionals, adapt content, methodology and assess the impact of the training. This website is a tool by which to achieve this

Identification of seasonal variation in the diagnosis of acute myeloid leukaemia:a population-based study

Until now, the role that seasonal factors play in the aetiology of acute myeloid leukaemia (AML) has been unclear. Demonstration of seasonality in AML diagnosis would provide supportive evidence of an underlying seasonal aetiology. To investigate the potential seasonal and long‐term trends in AML diagnosis in an overall population and in subgroups according to sex and age, we used population‐based data from a Spanish hospital discharge registry. We conducted a larger study than any to date of 26 472 cases of AML diagnosed in Spain between 2004 and 2015. Using multivariable Poisson generalized linear autoregressive moving average modelling, we found an upward long‐term trend, with monthly incidence rates of AML annually increasing by 0.4% [95% confidence interval (CI), 0.2%–0.6%; p = 0.0011]. January displayed the highest incidence rate of AML, with a minimum average difference of 7% when compared to February (95% CI, 2%–12%; p = 0.0143) and a maximum average difference of 16% compared to November (95% CI, 11%–21%; p < 0.0001) and August (95% CI, 10%–21%; p < 0.0001). Such seasonal effect was consistent among subgroups according to sex and age. Our finding that AML diagnosis is seasonal strongly implies that seasonal factors, such as infectious agents or environmental triggers, influence the development and/or proliferation of disease, pointing to prevention opportunities

Industrial pilot-scale anaerobic biodigestion of semisolid wastes of lemon processing

Lemon is processed to obtain essential oil, concentrated juice and dehydrated peel and this generates different kinds of wastewater. From this wastewater, it is possible to separate a semisolid residue with high humidity through filters or primary treatment. This paper analyzes the anaerobic digestion of these semisolid residues, organic load reduction and biogas production using a complete mix tank.La industrialización del limón para obtener aceite esencial, jugos concentrados y cáscara deshidratada, genera diferentes tipos de efluentes. A partir de estos efluentes es posible separar, mediante tamizado o tratamiento primario, un desecho semisólido de alto contenido de humedad. El propósito del presente trabajo fue estudiar la digestión anaeróbica de este desecho, el grado de abatimiento de la carga orgánica y la producción de biogás, empleando un reactor de mezcla completa.Asociación de Universidades Grupo Montevide

Correction: Muñoz-Fernández et al. A new ultrasound-guided percutaneous electrolysis and exercise treatment in patellar tendinopathy: three case reports. Frontiers in Bioscience-Landmark. 2021; 26: 1166–1175

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DESIS Calibration: Status and Results after 4 Years of Operation

The DESIS Hyperspectral instrument is approaching four years in operation at the MUSES platform on the International Space Station. DESIS operates in the VNIR range (400-1000 nm) and has some unique properties among spaceborne hyperspectral instruments like a narrow spectral sampling distance (2.55 nm), the use of a pointing unit and a LED equipped calibration unit. During this time, the instrument has been calibrated using a combination of vicarious calibration and calibration unit data. The calibration unit is used for the spectral calibration of the sensor. The analysis of the LED data has shown two different operation modes depending on the temperature gradient inside the instrument. Moreover, the data shows that the spectral calibration is stable within 0.1 nm (RMS) for each temperature gradient mode, with a separation between them of around 0.5 nm. The vicarious calibration is used for the radiometric calibration and uses as input Earth images over homogeneous areas and reference data from RadCalNet stations. Data from the homogeneous areas are used to update individual pixel coefficients in order to provide a uniform spatial and spectral sensor response. Later, RadCalNet data are used for an adjustment of the absolute calibration scale. With this approach the DESIS instrument can be calibrated within 4% (RMS) and absolute mean bias within 2% at wavelengths above 500 nm. The long-term analysis of the DESIS calibration data also shows that the sensor experiences a mean degradation of around 3.4%/year above 500 nm. Below 500 nm the instrument shows a stronger degradation (up to 20%/year at the shortest wavelengths) between the start of operations and July 2021, being stable after this date. Finally, the orthorectification process achieves a RMSE of 20 m in North and East directions with the automatic extraction of ground control points and comparison with reference images