Characterization of initial North American pediatric surgical response to the COVID-19 pandemic

INTRODUCTION: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America. METHODS: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus. RESULTS: Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment. CONCLUSIONS: The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes. LEVEL OF EVIDENCE: III

Consensus in Guidelines for Evaluation of DSD by the Texas Children's Hospital Multidisciplinary Gender Medicine Team

The Gender Medicine Team (GMT), comprised of members with expertise in endocrinology, ethics, genetics, gynecology, pediatric surgery, psychology, and urology, at Texas Children's Hospital and Baylor College of Medicine formed a task force to formulate a consensus statement on practice guidelines for managing disorders of sexual differentiation (DSD) and for making sex assignments. The GMT task force reviewed published evidence and incorporated findings from clinical experience. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence presented in the literature for establishing evidence-based guidelines. The task force presents a consensus statement regarding specific diagnostic and therapeutic issues in the management of individuals who present with DSD. The consensus statement includes recommendations for (1) laboratory workup, (2) acute management, (3) sex assignment in an ethical framework that includes education and involvement of the parents, and (4) surgical management

Time trends in cancer incidence in Navarra and Zaragoza, spain.

[ES] Objetivo Conocer los cambios que se producen en los patrones de incidencia y mortalidad por cáncer con el paso del tiempo es un elemento básico para su control. En este trabajo se presentan los resultados sobre la evolución temporal de la incidencia de los tumores más importantes en Navarra y Zaragoza. Métodos Se ha utilizado un modelo log-lineal para evaluar el efecto de la edad, el período de diagnóstico y la cohorte de nacimiento en las tendencias de la incidencia de cáncer empleando los datos de los registros de Navarra y Zaragoza. Los resultados se muestran en forma gráfica para los diferentes tumores, en cada registro y sexo. Resultados En hombres, destaca el fuerte aumento de la incidencia en cáncer de pulmón (5% anual), próstata (> 2% anual) y linfomas no hodgkinianos. En mujeres, los incrementos más altos se han producido en linfomas no hodgkinianos con aumentos superiores al 7% anual y en el cáncer de ovario (4% anual). El cáncer de mama en mujeres ha aumentado en ambas provincias (Navarra 3,5% y Zaragoza 0,9%), siendo una parte del incremento en Navarra derivado de una mayor detección de casos. En ambos registros y en los dos sexos se han producido incrementos de la incidencia superiores al 3% anual en cáncer colorrectal, de vejiga y de riñón. Para la mayor parte de los tumores el riesgo de padecer un cáncer se incrementa en las sucesivas generaciones, con la excepción del cáncer de estómago y del cáncer de hígado. Conclusiones El importante incremento de la incidencia de cáncer pone de manifiesto la insuficiencia de las políticas de prevención primaria, la importancia de disponer de datos de incidencia en series prolongadas en el tiempo y la necesidad de aumentar la cobertura poblacional de los registros de cáncer en España. [EN] The knowledge of time-related changes occurring in cancer incidence and mortality is an essential element for cancer control. This paper aims to describe the time trends of the more important cancer sites in Navarra and Zaragoza. The influence of age, diagnosis period and birth cohort on the observed time trend cancer incidence in Navarre and Zaragoza was assessed using a log-linear model. Results are showed graphically, for the different tumour sites by sex and each registry. Among males, a considerable rise in the incidence of lung cancer (5% per year), prostate cancer (> 2% per year) and non-Hodgkin's lymphomas was found. Among females, the highest increases corresponded to non-Hodgkin's lymphomas, with a yearly rise greater than 7%, and ovarian cancer (4% per year). Breast cancer in women increased in both registries (3.5% per year in Navarre and 0.9% per year in Zaragoza), part of the increment in Navarra being explained by a higher case detection rate. Finally, the incidence of colorectal, bladder and kidney cancer rose more than a 3% per year in both registries and sexes. For most types of tumours, cancer risk increased with subsequent generations. The substantial cancer increment observed points out the inefficacy of primary prevention policies, the importance of studying cancer incidence for long time periods and the need to increase the population coverage of Spanish cancer registries.S

An Unusual Transmission Spectrum for the Sub-Saturn KELT-11b Suggestive of a Sub-Solar Water Abundance

We present an optical-to-infrared transmission spectrum of the inflated sub-Saturn KELT-11b measured with the Transiting Exoplanet Survey Satellite (TESS), the Hubble Space Telescope (HST) Wide Field Camera 3 G141 spectroscopic grism, and the Spitzer Space Telescope (Spitzer) at 3.6 $\mu$m, in addition to a Spitzer 4.5 $\mu$m secondary eclipse. The precise HST transmission spectrum notably reveals a low-amplitude water feature with an unusual shape. Based on free retrieval analyses with varying molecular abundances, we find strong evidence for water absorption. Depending on model assumptions, we also find tentative evidence for other absorbers (HCN, TiO, and AlO). The retrieved water abundance is generally $\lesssim 0.1\times$ solar (0.001--0.7$\times$ solar over a range of model assumptions), several orders of magnitude lower than expected from planet formation models based on the solar system metallicity trend. We also consider chemical equilibrium and self-consistent 1D radiative-convective equilibrium model fits and find they too prefer low metallicities ($[M/H] \lesssim -2$, consistent with the free retrieval results). However, all the retrievals should be interpreted with some caution since they either require additional absorbers that are far out of chemical equilibrium to explain the shape of the spectrum or are simply poor fits to the data. Finally, we find the Spitzer secondary eclipse is indicative of full heat redistribution from KELT-11b's dayside to nightside, assuming a clear dayside. These potentially unusual results for KELT-11b's composition are suggestive of new challenges on the horizon for atmosphere and formation models in the face of increasingly precise measurements of exoplanet spectra.Comment: Accepted to The Astronomical Journal. 31 pages, 20 figures, 7 table

State of the art and latest advances in exploring business models for nature-based solutions

Nature-based solutions (NBS) offer multiple solutions to urban challenges simultaneously, but realising funding for NBS remains a challenge. When the concept of NBS for societal challenges was first defined by the EC in 2017, financing was recognised as one of the major challenges to its mainstreaming. The complexity of NBS finance has its origin in the multiple benefits/stakeholders involved, which obscures the argument for both public and private sector investment. Since 2017, subsequent waves of EU research-and innovation-funded projects have substantially contributed to the knowledge base of funding and business models for NBS, particularly in the urban context. Collaborating and sharing knowledge through an EU Task Force, this first set of EU projects laid important knowledge foundations, reviewing existing literature, and compiling empirical evidence of different financing approaches and the business models that underpinned them. The second set of EU innovation actions advanced this knowledge base, developing and testing new implementation models, business model tools, and approaches. This paper presents the findings of these projects from a business model perspective to improve our understanding of the value propositions of NBS to support their mainstreaming

High prevalence of autoantibodies to RNA helicase A in Mexican patients with systemic lupus erythematosus

Introduction: Autoantibodies to RNA helicase A (RHA) were reported as a new serological marker of systemic lupus erythematosus (SLE) associated with early stage of the disease. Anti-RHA and other autoantibodies in Mexican SLE patients and their correlation with clinical and immunological features were examined.Methods: Autoantibodies in sera from 62 Mexican SLE patients were tested by immunoprecipitation of 35S-labeled K562 cell extract and enzyme-linked immunosorbent assay (anti-U1RNP/Sm, ribosomal P, ?2GPI, and dsDNA). Anti-RHA was screened based on the immunoprecipitation of the 140-kDa protein, the identity of which was verified by Western blot using rabbit anti-RHA serum. Clinical and immunological characteristics of anti-RHA-positive patients were analyzed.Results: Anti-RHA was detected in 23% (14/62) of patients, a prevalence higher than that of anti-Sm (13%, 8/62). Prevalence and levels of various autoantibodies were not clearly different between anti-RHA (+) vs. (-) cases, although there was a trend of higher levels of anti-RHA antibodies in patients without anti-U1RNP/Sm (P = 0.07). Both anti-RHA and -Sm were common in cases within one year of diagnosis; however, the prevalence and levels of anti-RHA in patients years after diagnosis did not reduce dramatically, unlike a previous report in American patients. This suggests that the high prevalence of anti-RHA in Mexican patients may be due to relatively stable production of anti-RHA.Conclusions: Anti-RHA was detected at high prevalence in Mexican SLE patients. Detection of anti-RHA in races in which anti-Sm is not common should be clinically useful. Racial difference in the clinical significance of anti-RHA should be clarified in future studies. � 2010 V�zques-Del Mercado et al; licensee BioMed Central Ltd

Origin and function of short-latency inputs to the neural substrates underlying the acoustic startle reflex

The acoustic startle reflex (ASR) is a survival mechanism of alarm, which rapidly alerts the organism to a sudden loud auditory stimulus. In rats, the primary ASR circuit encompasses three serially connected structures: cochlear root neurons (CRNs), neurons in the caudal pontine reticular nucleus (PnC), and motoneurons in the medulla and spinal cord. It is well-established that both CRNs and PnC neurons receive short-latency auditory inputs to mediate the ASR. Here, we investigated the anatomical origin and functional role of these inputs using a multidisciplinary approach that combines morphological, electrophysiological and behavioral techniques. Anterograde tracer injections into the cochlea suggest that CRNs somata and dendrites receive inputs depending, respectively, on their basal or apical cochlear origin. Confocal colocalization experiments demonstrated that these cochlear inputs are immunopositive for the vesicular glutamate transporter 1 (VGLUT1). Using extracellular recordings in vivo followed by subsequent tracer injections, we investigated the response of PnC neurons after contra-, ipsi-, and bilateral acoustic stimulation and identified the source of their auditory afferents. Our results showed that the binaural firing rate of PnC neurons was higher than the monaural, exhibiting higher spike discharges with contralateral than ipsilateral acoustic stimulations. Our histological analysis confirmed the CRNs as the principal source of short-latency acoustic inputs, and indicated that other areas of the cochlear nucleus complex are not likely to innervate PnC. Behaviorally, we observed a strong reduction of ASR amplitude in monaural earplugged rats that corresponds with the binaural summation process shown in our electrophysiological findings. Our study contributes to understand better the role of neuronal mechanisms in auditory alerting behaviors and provides strong evidence that the CRNs-PnC pathway mediates fast neurotransmission and binaural summation of the ASR

Massive star formation and tidal structures in HCG 31

We present new broad-band optical and near-infrared CCD imaging together with deep optical intermediate-resolution spectroscopy of the Hickson Compact Group 31. We analyze the morphology and colors of the stellar populations of the galaxies, as well as the kinematics, physical conditions and chemical composition of the ionized gas in order to get a more complete view on the origin and evolution of the system. We estimate the ages of the most recent star formation bursts of the system, finding an excellent consistency among the values obtained with different indicators and starburst models. We find that member F hosts the youngest starburst of the group, showing a substantial population of Wolf-Rayet stars. The chemical abundances are fairly similar in all the members of the group despite their very different absolute magnitudes. We argue that the use of traditional metallicity-luminosity relations based on the absolute $B$-magnitude is not appropriate for dwarf starburst galaxies, because their luminosity is dominated by the transient contribution of the starburst to the blue luminosity. We think that members E and F of the group are candidate tidal dwarf galaxies because of their high metallicity, their kinematics, and the absence of underlying old stellar populations. Finally, we propose that HCG~31 is suffering several almost simultaneous interaction processes. The most relevant of these processes are: (a) the merging of members A and C, that would have produced two optical tidal tails; and (b) a fly-by encounter between G and the A+C complex, that would have produced an \ion{H}{1} tidal tail from the stripping of the external gas of A+C, from which members F and E have originated.Comment: Accepted for publication in ApJS, 41 pages, 15 figures, 9 table