Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits

Análisis de la estructura del sector agua en Nuevo León y sus relaciones intersectoriales : (segunda parte)

En este estudio se construye un modelo regional de insumoproducto para el estado de Nuevo León, el cual se caracteriza por sufrir frecuente escasez de agua. El modelo que se propone enfatiza las interrelaciones económicas del sector agua con los demás sectores de la economía

Análisis de la estructura del sector agua en Nuevo León y sus relaciones intersectoriales : (primera parte)

El estudio traza los efectos de la oferta de agua en el producto, ingreso y empleo del estado de Nuevo León, entidad que se localiza en el noreste de México. Para ello se construye un modelo de insumo-producto regional con énfasis en el sector agua. En primer lugar, se separa el agua del sector de electricidad y gas, y segundo, se le desagrega en cuatro categorías: agua potable, agua subterránea, aguas negras y aguas residuales. Los resultados sugieren que el sector en cuestión, particularmente la provisión de agua potable, tiene impactos económicos significativos sobre el resto de la economía, mismos que actualmente son subestimados por la falta de desagregación.This study traces the effect of water supply on output, employment and labor income in the Mexican state of Nuevo Leon. For this purpose, an input-output model with emphasis on the water sector is constructed. Firstly, water is isolated from electricity and gas as these utilities are recorded as a single sector. Secondly, water is disaggregated into four categories: drinking water, aquifers, sewage and treated wastewater. The results suggest that the water sector, particularly the provision of drinking water, has significant knock-on effects on the rest of the economy, which currently are sub estimated due to the lack of disaggregation

Gallstone ileus an uncommon cause of bowel obstruction

Gallstone ileus is caused by the impaction of one or more gallstones within the gastrointestinal tract leading to mechanical obstruction. Thomas Bartholin described the first case in 1654 during an autopsy. This manuscript describes a case of gallstone ileus in a 39-year-old woman who presented data of intestinal occlusion and hemodynamic instability, being managed with intestinal resection for a 7 cm stone and entero-entero anastomosis, achieving an adequate post-surgical evolution. It is a rare complication of cholelithiasis and is found in 2 to 3% of all cases associated with recurrent episodes of cholecystitis, it occurs predominantly in women. In elderly patients (>65 years) it accounts for 25% of all cases of small bowel obstruction and carries a fivefold increased risk of morbidity (20 to 57%) compared to other causes of small bowel obstruction

Sequía experimental en plántulas en un claro y en el sotobosque de un bosque de niebla, Veracruz, México

Background and Aims: Droughts induced by climate change are expected to affect tropical cloud forests. As functional traits are useful indicators of plant species performance, this study aimed to determine the effect of light environment and drought on leaf area (LA), specific leaf area (SLA), chlorophyll content, leaf thickness and toughness, survival and relative growth rate (RGR) of seedlings in forest understory and gap. Methods: In a cloud forest from Veracruz, Mexico, rainout shelters to simulate drought in the forest understory and gap were used. Leaf area, SLA, chlorophyll content, leaf thickness and toughness, survival, and RGR in Eugenia capuli (shade-tolerant understory tree), Liquidambar styraciflua (intermediate shade-tolerant canopy tree), and Trema micranthum (pioneer tree that colonizes gaps) in understory-control and -drought, and gap-control and -drought were measured. Key results: Leaf area increased with drought in E. capuli in gaps and decreased in L. styraciflua in both light environments. Chlorophyll content was similar between water treatments for E. capuli and L. styraciflua in the understory. Leaf thickness and toughness differed with drought for E. capuli and L. styraciflua in the gap. Leaf traits of T. micranthum tended to change in understory and not in gap. Overall, the highest survival occurred in gap. Eugenia capuli displayed the highest and similar survival across treatments. Liquidambar styraciflua displayed higher survival in gap-drought, and T. micranthum in gap conditions. Eugenia capuli had the highest RGR in understory, whereas T. micranthum has the highest RGR in gap. Conclusions: Plant functional traits of E. capuli and L. styraciflua seedlings responded to moderate drought more in gap than in understory. The results suggest that functional traits of intermediate and shade-tolerant species may shift less under a moderate drought than those of a pioneer tree, as long as the forest light environment is maintained.Antecedentes y Objetivos: Se espera que las sequías inducidas por el cambio climático afecten al bosque de niebla. Como los rasgos funcionales son indicadores útiles del desempeño de especies vegetales, el objetivo de este trabajo fue determinar el efecto del ambiente lumínico y la sequía sobre área foliar (AF), área foliar específica (AFE), contenido de clorofila, grosor, dureza foliar, supervivencia y tasas de crecimiento relativo (TCR) de plántulas en sotobosque y claro. Métodos: En un bosque de niebla en Veracruz, México, se usaron exclusiones de lluvia para simular sequía en sotobosque y claro. Se midieron AF, AFE, contenido de clorofila, grosor, dureza, supervivencia y TCR en Eugenia capuli (especie de sotobosque tolerante a la sombra), Liquidambar styraciflua (especie del dosel de tolerancia intermedia) y Trema micranthum (árbol pionero colonizador de claros) en sotobosque-control y -sequía, y claro-control y -sequía. Resultados clave: El AF aumentó con sequía en E. capuli en claro y decreció para L. styraciflua en ambos ambientes lumínicos. El contenido de clorofila fue similar entre tratamientos de agua para E. capuli y L. styraciflua en sotobosque. El grosor y dureza foliares difirieron con sequía para E. capuli y L. styraciflua en claro. Los rasgos foliares de T. micranthum cambiaron solo en sotobosque. Eugenia capuli presentó la mayor y similar supervivencia entre tratamientos. Liquidambar styraciflua mostró una mayor supervivencia en claro-sequía, y T. micranthum en claro. Eugenia capuli tuvo la mayor TCR en sotobosque, mientras que T. micranthum en claro. Conclusiones: Los rasgos funcionales de plántulas de E. capuli y L. styraciflua respondieron a sequía moderada más en claro que en sotobosque. Los resultados sugieren que los rasgos funcionales de las especies intermedia y tolerante a la sombra tienden a cambiar menos bajo una sequía moderada, que los del árbol pionero si se mantiene el ambiente lumínico forestal

IDENTIDAD Y OTREDAD. CUATRO MUJERES POETAS DEL VALLE DE TOLUCA DESDE LA CRÍTICA LITERARIA FEMINISTA

Hablar de feminismo es darle nombre a la búsqueda de uno de los diversos modos de ser mujer, especialmente aquel que supone el proceso de escribir en la sociedad actual, actividad de vida, íntimamente ligada a la supervivencia en un medio hegemónico, globalizante, cuyo instrumento indispensable para la interpretación de la realidad es el lenguaje. A través de la palabra modelamos una identidad, un discurso con el que ordenamos el medio en el que vivimos, el mundo en el que podemos leer los versos En el lienzo de la tarde/una mujer hilvana la esperanza de Irma Tapia (Tapia, 2007:18) y sutilmente intrigarnos, tener curiosidad sobre la mujer que en esa escritura se nos presenta en un poema; pensar de dónde proviene, qué representa, qué quiere, por qué está ahí y fundamentalmente quién la escribió así.La poesía es un acto discursivo de profundas complejidades en interacción continua con procesos culturales en los que se encuentra inmersa. Procesos políticos, religiosos, sociales, literarios permean la creación poética para plasmar en ella modos de vida de los individuos según el momento histórico y la sociedad

Contributions of a feminist perspective to the analysis of farm viability: the livelihoods reproduction framework

[EN] The agrarian question dealing with peasants' reproduction in adverse global conditions is a topic of deep debate closely linked to farm viability. Approaches that define viability in monetary terms cannot explain peasants' way of farming. Holistic approaches can better analyse this question but existing frameworks leave aside aspects of reproduction. Here, we revise sustainable livelihoods and resilience frameworks through a feminist lens and propose livelihoods reproduction to address some blind spots. We do so through a literature review and a case study of olive oil farms in Spain. Our analysis highlights the importance of household labour distribution for farm viability.This work was supported by Ministerio de Ciencia e Innovacion: [Grant Number CSO2016-78827-R]; the Spanish Ministry of Science, Innovation and Universities (Ministerio de Ciencia, Innovacion y Universidades): [Grant Number PCI2018-093179]; and ARIMNet2 (ERA-NET no. 618127).Manuel, J.; Rivera-Ferre, MG.; López-I-Gelats, F. (2023). Contributions of a feminist perspective to the analysis of farm viability: the livelihoods reproduction framework. The Journal of Peasant Studies. 51(1):185-211. https://doi.org/10.1080/03066150.2023.221050018521151

Esperanza y satisfacción con la vida: probando los roles mediadores de la autoestima en tres culturas asiáticas

The relationship between well-being and the personal strength of hope has been elaborated by the identification of internal (self) and external (family, peers, spiritual) locus-of-hope dimensions. Du, Bernardo, and Yeung (2015) showed that self-esteem (personal and relational) mediates the relationship between locus-of-hope and life satisfaction. Locus-of-hope’s goal-related thoughts involve self-evaluation that may either enhance or diminish self-worth, which then influences life satisfaction. We tested the mediated model in three cultural groups: Malaysians, Macau Chinese, and Filipinos. Participants completed scales measuring locus-of-hope, personal and relational self-esteem, and life satisfaction. Path analysis showed significant indirect effects in all cultures: (a) internal locus-of-hope on life satisfaction, mediated by personal self-esteem, and (b) external-family locus-of-hope on life satisfaction, mediated by relational self-esteem. Other significant indirect effects were found in specific cultural groups. Cross-cultural similarities and differences are discussed with reference to how distinct cultures give different meanings to forms of agency associated with the personal strength of hope, creating distinct pathways towards life satisfaction.