Longevity, from a Maltese family doctor's perspective

This article is largely derived from an assignment submitted in March 2005 by the first author as part of a Masters in Primary Care and General Practice near the University of Ulster in Northern Ireland. The essay was written for the purposes of summative assessment of the module on "Primary Care Concepts and Principles" led by Mrs. Paula Walls. The assignment question was: "Consider how increased longevity has affected disease patterns and what effect this is likely to have on your practice in the next decade. Compare and contrast your thoughts with your fellow students. Can you identify any patterns;"peer-reviewe

Decoherence, tunneling and noise-activation in a double-potential well at high and zero temperature

We study the effects of the environment on tunneling in an open system described by a static double-well potential. We describe the evolution of a quantum state localized in one of the minima of the potential at $t=0$, both in the limits of high and zero environment temperature. We show that the evolution of the system can be summarized in terms of three main physical phenomena, namely decoherence, quantum tunneling and noise-induced activation, and we obtain analytical estimates for the corresponding time-scales. These analytical predictions are confirmed by large-scale numerical simulations, providing a detailed picture of the main stages of the evolution and of the relevant dynamical processes.Comment: Version to appear in Phys. Rev. E. 15 pages, 12 figures (low quality due to upload size limitations). Good quality figures in a pdf file can be downloaded from http://www.df.uba.ar/users/lombardo/tunne

Open Science principles for accelerating trait-based science across the Tree of Life.

Synthesizing trait observations and knowledge across the Tree of Life remains a grand challenge for biodiversity science. Species traits are widely used in ecological and evolutionary science, and new data and methods have proliferated rapidly. Yet accessing and integrating disparate data sources remains a considerable challenge, slowing progress toward a global synthesis to integrate trait data across organisms. Trait science needs a vision for achieving global integration across all organisms. Here, we outline how the adoption of key Open Science principles-open data, open source and open methods-is transforming trait science, increasing transparency, democratizing access and accelerating global synthesis. To enhance widespread adoption of these principles, we introduce the Open Traits Network (OTN), a global, decentralized community welcoming all researchers and institutions pursuing the collaborative goal of standardizing and integrating trait data across organisms. We demonstrate how adherence to Open Science principles is key to the OTN community and outline five activities that can accelerate the synthesis of trait data across the Tree of Life, thereby facilitating rapid advances to address scientific inquiries and environmental issues. Lessons learned along the path to a global synthesis of trait data will provide a framework for addressing similarly complex data science and informatics challenges

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Nutritional Recommendations for Healthcare and Essential Personnel Exposed to COVID-19 in Latin America

Estas recomendaciones se basan en la evidencia científica actual derivada de meta-análisis y revisiones sistemáticas sobre nutrición y prevención de infecciones respiratorias causadas por los virus SARS-CoV, MERS-CoV o influenza, similares en su estructura al SARS-CoV-2. Están dirigidas al personal en la primera línea de atención de salud y al personal que presta servicios esenciales a la comunidad, con alto riesgo de infección por la COVID-19. Estas personas usan equipo de protección personal, cumplen largos turnos laborales, en ocasiones bajo condiciones extremas, lo que puede llevar a descanso insuficiente, alto nivel de estrés, depresión, pobre calidad en la alimentación y deshidratación. Todos estos factores influyen negativamente en el sistema inmune y podrían conllevar un mayor riesgo de infección. Una ingesta adecuada de micronutrientes y otros compuestos bioactivos es esencial para el desempeño óptimo del sistema inmune. Existe evidencia moderada que avala la suplementación, en forma individual, con vitamina C (2 000 mg), vitamina D (1 000-2 000 UI) y zinc (≤ 40 mg) en la prevención de infecciones respiratorias en adultos. No se encontró evidencia suficiente para avalar la suplementación con vitamina A, niacina, ácido fólico, B12, omega 3, probióticos y polifenoles, aunque si se recomienda el consumo de alimentos ricos en estos nutrientes para apoyar al sistema inmune. Se recomienda al personal seguir la recomendación de consumir 5 porciones/día (400 g) de frutas y vegetales/hortalizas, mantenerse hidratado y limitar la cafeína. No hay evidencia del consumo de alimentos alcalinos para prevenir infecciones. Estas recomendaciones son particularmente importantes durante la pandemia.These recommendations are based on current scientific evidence obtained through meta-analysis and systematic reviews on nutrition and the prevention of respiratory infections related to SARS-CoV, MERS-CoV or influenza, similar in structure to SARS-CoV-2. They are aimed at primary health care personnel and to those who provide essential services to the community and are, consequently, at high risk of COVID-19 infection. These individuals wear personal protective equipment, work long shifts, sometimes under extreme conditions, which can lead to insufficient rest, high stress levels, depression, poor nutrition and dehydration. Together, these factors have a negative impact on the immune system and could result in an increased risk of infection. An adequate intake of micronutrients and other bioactive compounds is essential for optimal immune performance. There is moderate evidence supporting supplementation, individually, with vitamin C (2 000 mg), vitamin D (1 000-2 000 IU) and zinc (≤40 mg) for the prevention of respiratory infections in adults. Insufficient evidence was found to support supplementation with vitamin A, niacin, folic acid, B12, omega 3, probiotics and polyphenols; however, the consumption of foods rich in these nutrients is recommended to support immune function. It is recommended that workers follow the recommendation of consuming 400 g/day of fruits and vegetables, remain hydrated and limit caffeine. There is no scientific evidence supporting the consumption of alkaline foods to prevent infections. The aforementioned recommendations are particularly relevant during the pandemic.publishedVersionFil: Palacios, Cristina. Florida International University; United States.Fil: Bernal, Jennifer. Universidad Nacional de Colombia. Observatorio de Seguridad Alimentaria; Colombia.Fil: Bonvecchio, Anabelle. Instituto Nacional de Salud Pública; México.Fil: Gutiérrez, Marlen. Global Nutrition Professionals Consultancy; Venezuela.Fil: Herrera Cuenca, Marianella. Universidad Central de Venezuela; Venezuela.Fil: Herrera Cuenca, Marianella. Fundación Bengoa para la Alimentación y Nutrición, Venezuela.Fil: Irizarry, Laura. Oficina Regional para América Latina y el Caribe. Programa Mundial de Alimentos; Panamá.Fil: Lay Mendivil, Lina. Universidad Tecnológica de Panamá; Panamá.Fil: López Bautista, Fabiola. Universidad Nacional Autónoma de México; México.Fil: López, Marisol. Global Nutrition Professionals Consultancy; España.Fil: Mata, Claret. Universidad Central de Venezuela; Venezuela.Fil: Moliterno, Paula. Universidad de la República; Uruguay.Fil: Moyano, Daniela. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Nutrición; Argentina.Fil: Moyano, Daniela. Universidad Nacional de Córdoba. Secretaría de Extensión Universitaria; Argentina.Fil: Moyano, Daniela. Universidad Nacional de la Matanza; Argentina.Fil: Murillo, Diana. Oficina Regional para América Latina y el Caribe. Programa Mundial de Alimentos; Panamá.Fil: Pacheco Miranda, Selene. Instituto Nacional de Salud Pública; México.Fil: Palomares, Lita. Universidad Peruana Cayetano Heredia; Perú.Fil: Páramo, Kenia. Instituto de Nutrición de Centroamérica y Panamá; Belice y Nicaragua.Fil: Pérez, Analy. Unison Health & Community Services Global Nutrition Professionals Consultancy; Canadá.Fil: Tijerina Walls, María Virginia. Nutrien Nutrición y Salud; México.Fil: Trak-Fellermeier, María Angélica. Florida International University. Global Nutrition Professionals Consultancy; United States

Micronutrient recommendations for vulnerable groups in context of undernutrition, during the COVID-19 pandemic in Latin America

La crisis por COVID-19 (SARS-CoV-2) puede convertirse en una catástrofe alimentaria para Latinoamérica, aumentando las personas que padecen hambre de 135 a 265 millones, especialmente en Venezuela, Guatemala, Honduras, Haití y El Salvador, que ya enfrentaban crisis económicas y sanitarias. Este manuscrito presenta la posición de un grupo de expertos latinoamericanos sobre las recomendaciones de consumo y/o suplementación con vitamina A, C, D, zinc, hierro, folatos y micronutrientes múltiples, en contextos de desnutrición, para grupos vulnerables: mujeres embarazadas y lactantes, niñas y niños menores de 5 años y adultos mayores. Las recomendaciones buscan disminuir el impacto potencial que tendrá COVID-19 en el estado nutricional, durante la pandemia. La posición surge de la discusión de dichos expertos con base a la revisión de evidencia científica actual para estos grupos vulnerables. Está dirigida a tomadores de decisiones, encargados de políticas públicas, personal de salud y organismos de la sociedad civil. Después de la lactancia materna y una dieta suficiente en cantidad y calidad, la suplementación con los micronutrientes presentados, puede contribuir a prevenir y tratar enfermedades virales, reforzar el sistema inmune y reducir complicaciones. La lactancia materna con medidas de higiene respiratoria, el suministro de múltiples micronutrientes en polvo para niños desde los 6 meses hasta los 5 años y el aporte de hierro y folatos o micronutrientes múltiples para la embarazada, son estrategias comprobadas y eficaces que deben seguirse implementando en tiempos de COVID-19. Para los adultos mayores la suplementación con vitamina C, D y zinc puede estar indicada.The COVID-19 crisis (SARS-CoV-2) might transform into a food catastrophe in Latin America and would increase the number of people suffering from hunger from 135 to 265 million, particularly in Venezuela, Guatemala, Honduras, Haiti and El Salvador, already facing economic and health crises. This manuscript presents the position of a group of Latin American experts in nutrition for establishing the recommendations for consumption and / or supplementation with vitamin A, C, D, zinc, iron, folates and multiple micronutrients, in undernutrition contexts, for vulnerable population of pregnant and lactating women, children under 5 years and the elderly. The recommendations seek to decrease the potential impact that COVID-19 will have on nutritional status during the pandemic. The position arises from the discussion of the experts based on the review of current scientific evidence for these vulnerable groups. It aims to reach stakeholders, public policy makers, health personnel and civil society organizations. Only after breastfeeding and a sufficient diet in terms of quantity and quality, a supplementation with the micronutrients mentioned above can help prevent and treat viral diseases, strengthen the immune system and even reduce complications. Breastfeeding with respiratory higiene measures, the provision of multiple micronutrients powders for children from 6 moths to 5 years of age and the supply of iron and folates or multiple micronutrients tablets for pregnant women are proven and effective strategies that must continue to be implemented during COVID-19 pandemic. For older adults, supplementation with vitamin C, D and zinc might be indicated.publishedVersionFil: Bonvecchio Arenas, Anabelle. Instituto Nacional de Salud Pública; México.Fil: Bernal, Jennifer. Universidad Nacional de Colombia. Observatorio de Seguridad Alimentaria; Colombia.Fil: Herrera Cuenca, Marianella. Universidad Central de Venezuela; Venezuela.Fil: Herrera Cuenca, Marianella. Fundación Bengoa para la Alimentación y Nutrición, Venezuela.Fil: Flores Aldana, Mario. Instituto Nacional de Salud Pública; México.Fil: Gutiérrez, Marlén. Global Nutrition Professionals Consultancy; Venezuela.Fil: Irizarry, Laura. Oficina Regional para América Latina y el Caribe. Programa Mundial de Alimentos (WFP); Panamá.Fil: Lay Mendivil, Lina. Universidad Tecnológica de Panamá; Panamá.Fil: López Bautista, Fabiola. Universidad Nacional Autónoma de México; México.Fil: López Reyes, Marisol. Global Nutrition Professionals Consultancy; España.Fil: Mata, Claret. Universidad Central de Venezuela; Venezuela.Fil: Moliterno, Paula. Universidad de la República; Uruguay.Fil: Moyano, Daniela. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Nutrición; Argentina.Fil: Moyano, Daniela. Universidad Nacional de Córdoba. Secretaría de Extensión Universitaria; Argentina.Fil: Moyano, Daniela. Universidad Nacional de la Matanza; Argentina.Fil: Murillo, Diana. Oficina Regional para América Latina y el Caribe. Programa Mundial de Alimentos; Panamá.Fil: Pacheco Miranda, Selene. Instituto Nacional de Salud Pública; México.Fil: Palacios, Cristina. Florida International University; United States.Fil: Palomares, Lita. Universidad Peruana Cayetano Heredia; Perú.Fil: Páramo, Kenia. Instituto de Nutrición de Centroamérica y Panamá; Belice y Nicaragua.Fil: Pérez, Analy. Unison Health & Community Services Global Nutrition Professionals Consultancy; Canadá.Fil: Tijerina Walls, María Virginia. Nutrien Nutrición y Salud; México.Fil: Trak-Fellermeier, María Angélica. Florida International University. Global Nutrition Professionals Consultancy; United States.Fil: Venosa López, Mónica. Instituto Nacional de Salud Pública; México

Finding Our Way through Phenotypes

Despite a large and multifaceted effort to understand the vast landscape of phenotypic data, their current form inhibits productive data analysis. The lack of a community-wide, consensus-based, human- and machine-interpretable language for describing phenotypes and their genomic and environmental contexts is perhaps the most pressing scientific bottleneck to integration across many key fields in biology, including genomics, systems biology, development, medicine, evolution, ecology, and systematics. Here we survey the current phenomics landscape, including data resources and handling, and the progress that has been made to accurately capture relevant data descriptions for phenotypes. We present an example of the kind of integration across domains that computable phenotypes would enable, and we call upon the broader biology community, publishers, and relevant funding agencies to support efforts to surmount today's data barriers and facilitate analytical reproducibility

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Finding Our Way through Phenotypes

Despite a large and multifaceted effort to understand the vast landscape of phenotypic data, their current form inhibits productive data analysis. The lack of a community-wide, consensus-based, human- and machine-interpretable language for describing phenotypes and their genomic and environmental contexts is perhaps the most pressing scientific bottleneck to integration across many key fields in biology, including genomics, systems biology, development, medicine, evolution, ecology, and systematics. Here we survey the current phenomics landscape, including data resources and handling, and the progress that has been made to accurately capture relevant data descriptions for phenotypes. We present an example of the kind of integration across domains that computable phenotypes would enable, and we call upon the broader biology community, publishers, and relevant funding agencies to support efforts to surmount today's data barriers and facilitate analytical reproducibility