Lessons Learned from Applying Adaptation Pathways in Heatwave Risk Management in Antwerp and Key Challenges for Further Development

Heat exposure is a well-known health hazard, which causes several problems ranging from thermal discomfort or productivity reduction to the aggravation of existing illnesses and death. Climate projections foresee an increase in the frequency and intensity of heat-related impacts on human health. To reduce these climate risks, governments need a better understanding of not only the scale and the factors affecting those risks, but also how to prepare and protect the city and citizens against these risks and prevent them through effective policy making. Therefore, climate adaptation decisions need to be made in complex systems with manifold uncertainties. In response to these deep uncertainties, different planning approaches have been developed to assist policymakers in decision making. This paper is focused on one of the dynamic adaptive policy planning approaches: the adaptation pathway. This approach allows designing alternative feasible plans that are flexible and can respond when new information appears or when conditions in the environment change. This paper presents a structured methodology for designing adaptation pathways. The work describes a high-level adaptation pathway covering heatwave impacts on productivity and health at city level in Antwerp to ensure the city adapts to future conditions. Lastly, a summary is provided of the lessons learned and the challenges of this approach are discussed.This work was supported by the European Community’s Seventh Framework Programme (grant agreement no. 308497), Project RAMSES “Reconciling Adaptation, Mitigation and Sustainable Development for Cities” (2012–2017). In addition, this study has received partial funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 653522 (RESIN−Climate Resilient Cities and Infrastructures project)

Diseño y validación de un instrumento que permita identificar los factores que influyen en la productividad laboral

Uno de los objetivos de toda organización sea pública o privada es maximizar la productividad de sus trabajadores para poder ser más eficientes y eficaces al brindar los productos y servicios que ofrecen. En este sentido uno de los grandes problemas de los sistemas de justicia es la falta de presupuesto para hacerle frente a las necesidades de mejora en las diversas áreas de la organización. Es así como el objetivo de este trabajo se centró en diseñar y validar un instrumento que permitiera detectar aquellos factores o variables que influyen en la productividad laboral de los notificadores del Centro de Justicia Penal unidad Río Nuevo, en la ciudad de Mexicali, Baja California; y así, poder enfocar el recurso económico en un área que provoque un mayor impacto. El instrumento diseñado consistió en un cuestionario de 69 ítems que se validó mediante diversas pruebas estadísticas: entre ellas el alfa de Cronbach, KMO, esfericidad de Bartlett y comunalidades. Se demostró que de entre las variables analizadas existe mayor correlación entre la productividad laboral y capacitación, quedando en evidencia que existe asociación entre las variables analizadas. Es así, que el instrumento validado podrá ser de utilidad para analizar la productividad laboral en diversos campos de estudio debido a su construcción de carácter general

A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults

Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient’s symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis

Variation in natural exposure to anopheles mosquitoes and its effects on malaria transmission.

Variation in biting frequency by Anopheles mosquitoes can explain some of the heterogeneity in malaria transmission in endemic areas. In this study in Burkina Faso, we assessed natural exposure to mosquitoes by matching the genotype of blood meals from 1066 mosquitoes with blood from residents of local households. We observed that the distribution of mosquito bites exceeded the Pareto rule (20/80) in two of the three surveys performed (20/85, 76, and 96) and, at its most pronounced, is estimated to have profound epidemiological consequences, inflating the basic reproduction number of malaria by 8-fold. The distribution of bites from sporozoite-positive mosquitoes followed a similar pattern, with a small number of individuals within households receiving multiple potentially infectious bites over the period of a few days. Together, our findings indicate that heterogeneity in mosquito exposure contributes considerably to heterogeneity in infection risk and suggest significant variation in malaria transmission potential

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Autoregulation of the LIM kinases by their PDZ domain

Abstract LIM domain kinases (LIMK) are important regulators of actin cytoskeletal remodeling. These protein kinases phosphorylate the actin depolymerizing factor cofilin to suppress filament severing, and are key nodes between Rho GTPase cascades and actin. The two mammalian LIMKs, LIMK1 and LIMK2, contain consecutive LIM domains and a PDZ domain upstream of the C-terminal kinase domain. The roles of the N-terminal regions are not fully understood, and the function of the PDZ domain remains elusive. Here, we determine the 2.0 Å crystal structure of the PDZ domain of LIMK2 and reveal features not previously observed in PDZ domains including a core-facing arginine residue located at the second position of the ‘x-Φ-G-Φ’ motif, and that the expected peptide binding cleft is shallow and poorly conserved. We find a distal extended surface to be highly conserved, and when LIMK1 was ectopically expressed in yeast we find targeted mutagenesis of this surface decreases growth, implying increased LIMK activity. PDZ domain LIMK1 mutants expressed in yeast are hyperphosphorylated and show elevated activity in vitro. This surface in both LIMK1 and LIMK2 is critical for autoregulation independent of activation loop phosphorylation. Overall, our study demonstrates the functional importance of the PDZ domain to autoregulation of LIMKs