Environmental selection of the cosmological constant and electroweak scales

We investigate whether selfish/Goldilocks Higgs models can be extended to accomodate vacua with both the right Higgs mass and cosmological constant. Through the introduction of multiple four-form fields coupled with the Higgs scalar boson we find that both the cosmological constant and the electroweak hierarchy problems can be addressed simultaneously, without inserting the relevant physical scales by hand and avoiding fine tuning. The resulting bounds on the brane charges, the only dimensionful free parameter of the theory, depend on the strength of the four-form scalar coupling and can be of the same order of magnitude as those necessary for a solution to the cosmological constant problem alone via the Bousso-Polchinski mechanism

Superior Vena Cava Syndrome: An Uncommon Presentation of a Rare Colon Carcinoma Metastasis

Introduction:Superior vena cava (SVC) syndrome is caused by obstruction of the superior vena cava due to vascular compression by a mass or intrinsic obstruction. The authors describe SVC syndrome caused by an isolated metastatic mediastinal mass from a resected primary colon carcinoma. Case Report: An 81-year-old woman was referred to the hospital with swelling of the neck and upper left limb, dysphonia and dysphagia, associated with an involuntary weight loss of 16 kg. Mediastinal metastasis of colon adenocarcinoma was found, causing the SVC syndrome. The mass was unresectable and the patient was referred to palliative radiotherapy. Discussion: Only 12 cases of mediastinal metastasis from colorectal cancer have been reported in the English literature. Conclusion: As a rare manifestation of colorectal cancer, the presented case highlights the need for clinicians to be aware of rare metastases at the time of diagnosis

Low impact of different SNP panels from two building-loci pipelines on RAD-Seq population genomic metrics: case study on five diverse aquatic species

Información complementaria: https://doi.org/10.1186/s12864-021-07465-w.Background: The irruption of Next-generation sequencing (NGS) and restriction site-associated DNA sequencing (RAD-seq) in the last decade has led to the identification of thousands of molecular markers and their genotyping for refined genomic screening. This approach has been especially useful for non-model organisms with limited genomic resources. Many building-loci pipelines have been developed to obtain robust single nucleotide polymorphism (SNPs) genotyping datasets using a de novo RAD-seq approach, i.e. without reference genomes. Here, the performances of two building-loci pipelines, STACKS 2 and Meyer’s 2b-RAD v2.1 pipeline, were compared using a diverse set of aquatic species representing different genomic and/or population structure scenarios. Two bivalve species (Manila clam and common edible cockle) and three fish species (brown trout, silver catfish and small-spotted catshark) were studied. Four SNP panels were evaluated in each species to test both different building-loci pipelines and criteria for SNP selection. Furthermore, for Manila clam and brown trout, a reference genome approach was used as control. Results: Despite different outcomes were observed between pipelines and species with the diverse SNP calling and filtering steps tested, no remarkable differences were found on genetic diversity and differentiation within species with the SNP panels obtained with a de novo approach. The main differences were found in brown trout between the de novo and reference genome approaches. Genotyped vs missing data mismatches were the main genotyping difference detected between the two building-loci pipelines or between the de novo and reference genome comparisons. Conclusions: Tested building-loci pipelines for selection of SNP panels seem to have low influence on population genetics inference across the diverse case-study scenarios here studied. However, preliminary trials with different bioinformatic pipelines are suggested to evaluate their influence on population parameters according with the specific goals of each study

Necessidades, Recursos e Desafios

Introduction: The demographic and professional characteristics of specialists in Obstetrics and Gynecology registered in Portugal are presented and current and future needs assessed. Material and Methods: An analysis of the data from Instituto Nacional de Estatística, Ordem dos Médicos and a survey sent to the directors of the departments of Obstetrics and Gynecology of Portuguese hospitals was perfomed. In order to calculate the necessary number of specialists, established indicators of the activity of the specialty were used. Results: In 2018, there were 1 437 441 consultations of Obstetrics and Gynecology, 89 110 major gynecologic surgeries and 85 604 deliveries. For that, 1065 Obstetrics and Gynecology physicians, working 40 hours per week, with no more than 40% aged 55 years of age and older or including 30 residents per year, are deemed necessary. According to the National Institute of Statistics, in the same year there were 1143 specialists in Portuguese hospitals, of which 234 worked in private hospitals. On the other hand, 1772 specialists were registered with the Ordem dos Médicos: 1163 (66%) were aged 55 years old or above and 84% of specialists under the age of 40 were females. In 2020, there were 864 specialists, 46% of which aged years of age and older working in 39 out of the 41 public or public-private departments that answered the survey. In 2035, an increase of 7% in the required number of specialists is expected. Conclusion: In Portugal, there is not lack of Obstetrics and Gynecology specialists in absolute numbers, but the large number of specialists aged 55 years of age and older, who are exempt from shifts in emergency department work, and the existence of regional asymmetries contribute to the perpetuation of some shortages of these healthcare professionals in several departments, namely in public hospitals.publishersversionpublishe

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air (R) App

Background In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.Peer reviewe

Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study

Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12143 users were registered. A total of 6949 users reported at least one VAS data recording. Among them, 1887 users reported >= 7 VAS data. About 1195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR >= 70% and PDC = 70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting.Peer reviewe

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018) : Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.Peer reviewe

Guidance to 2018 good practice : ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

AimsMobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.MethodsMASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.StakeholdersInclude patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors.ResultsMASK is deployed in 23 countries and 17 languages. 26,000 users have registered.EU grants (2018)MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).Lessons learnt(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.Peer reviewe