A precise measurement of the magnetic field in the corona of the black hole binary V404 Cygni

Observations of binary stars containing an accreting black hole or neutron star often show x-ray emission extending to high energies (>10 kilo­–electron volts), which is ascribed to an accretion disk corona of energetic particles akin to those seen in the solar corona. Despite their ubiquity, the physical conditions in accretion disk coronae remain poorly constrained. Using simultaneous infrared, optical, x-ray, and radio observations of the Galactic black hole system V404 Cygni, showing a rapid synchrotron cooling event in its 2015 outburst, we present a precise 461 ± 12 gauss magnetic field measurement in the corona. This measurement is substantially lower than previous estimates for such systems, providing constraints on physical models of accretion physics in black hole and neutron star binary systems. This article has a correction. Please see: http://science.sciencemag.org/content/360/6386/eaat927

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Erratum for the Report “A precise measurement of the magnetic field in the corona of the black hole binary V404 Cygni”

In the Report “A precise measurement of the magnetic field in the corona of the black hole binary V404 Cygni,” a calculation error led to values of the magnetic field that were about 14 times too high. The mathematical expressions given in the Report were correct, but the code used to calculate the numerical values included an extraneous factor, which led to incorrect results. The magnetic fields calculated from the observations at different wavelengths were all scaled by the same factor, so after this is removed they remain consistent with each other. The corrected value of the magnetic field is lower than previously calculated, making the field in V404 Cygni even more unlike those estimated for other systems. However, the lower magnetic field is no longer consistent with the value predicted from the equipartition model. The text, materials and methods, Table S1, and Figure S3 have been updated to reflect the corrected magnetic field values and to state that the system was not in equipartition. No other results or conclusions of the study were affected. The authors thank J. Malzac (Institut de Recherche en Astrophysique et Planétologie, Université de Toulouse) for alerting them to this error

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

El papel de la transitividad y de las inferencias transitivas en la adquisición del concepto de número

Determinar el papel que juegan las conductas transitivas en la adquisición de las nociones numéricas elementales a fin de determinar la situación de la transitividad en el currículum de Matemáticas en la EGB. 84 sujetos de Preescolar y Ciclo Inicial de tres colegios del Ayuntamiento de Murcia extraídos al azar en tres estratos -capital, extramuros y pedanías-. Los sujetos fueron, igualmente, seleccionados al azar. Muestreo aleatorio estratificado. Partiendo del modelo propuesto por la escuela de Ginebra, revisado y ampliado por alguno de los autores que, en cierta medida, es un modelo integrador de las posturas cardinalistas y ordinalistas, se propone un modelo no causal para determinar el papel que la transitividad juega en el desarrollo del número, puesto que, tanto las relaciones de equivalencia como las de orden -seriación-, que son las relaciones sobre las que se construye el número, son transitivas. La variable independiente fue el aprendizaje y las variables dependientes: conservación y transitividad. Pruebas operatorias de conservación de cantidades (discretas y continuas). Tareas de aprendizaje por autodescubrimiento. Tareas de aprendizaje de reglas. Tareas de aprendizaje en situaciones transitivas. Prueba de transitividad. Se utilizó una prueba no paramétrica para el análisis de las tablas de contingencia. La prueba utilizada fue 'Chi cuadrado' de Pearson. Los sujetos llegan a conservar el número sin necesidad de recurrir a la ley transitiva. Los sujetos que fueron sometidos a aprendizaje en situaciones transitivas no generalizan su conducta a otros contextos. La transitividad no juega ningún papel en la adquisición de las nociones numéricas elementales que se construyen, únicamente, mediante el recurso a relaciones reflexivas, simétricas y asimétricas. La transitividad verifica lo que los autores han denominado 'Teoría de la economía del pensamiento' y según la cual, el sujeto procede, en primer lugar, en extensión, incorporando a sus esquemas cognitivos nuevos elementos mediante las relaciones antes descritas hasta que, en un momento determinado y dependiendo de la 'norma de acomodaciones' de cada individuo, se produce una reorganización que enriquece el esquema en comprensión y lo simplifica en extensión. La transitividad es, desde esta perspectiva, una ley de simplificación.MurciaES