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Abstract Objective For treatment of medication-related osteonecrosis of the jaw, one proposed approach is the use of a topical agent to block entry of these medications in oral soft tissues. We tested the ability of phosphonoformic acid (PFA), an inhibitor of bisphosphonate entry through certain sodium-dependent phosphate contransporters (SLC20A1, 20A2, 34A1-3) as well as Dynasore, a macropinocytosis inhibitor, for their abilities to prevent zoledronate-induced (ZOL) death in human gingival fibroblasts (HGFs). Methodology MTT assay dose-response curves were performed to determine non-cytotoxic levels of both PFA and Dynasore. In the presence of 50 μM ZOL, optimized PFA and Dynasore doses were tested for their ability to restore HGF viability. To determine SLC expression in HGFs, total HGF RNA was subjected to quantitative real-time RT-PCR. Confocal fluorescence microscopy was employed to see if Dynasore inhibited macropinocytotic HGF entry of AF647-ZOL. Endosomal acidification in the presence of Dynasore was measured by live cell imaging utilizing LysoSensor Green DND-189. As a further test of Dynasore's ability to interfere with ZOL-containing endosomal maturation, perinuclear localization of mature endosomes containing AF647-ZOL or TRITC-dextran as a control were assessed via confocal fluorescence microscopy with CellProfiler™ software analysis of the resulting photomicrographs. Results 0.5 mM PFA did not rescue HGFs from ZOL-induced viability loss at 72 hours while 10 and 30 μM geranylgeraniol did partially rescue. HGFs did not express the SLC transporters as compared to the expression in positive control tissues. 10 μM Dynasore completely prevented ZOL-induced viability loss. In the presence of Dynasore, AF647-ZOL and FITC-dextran co-localized in endosomes. Endosomal acidification was inhibited by Dynasore and perinuclear localization of both TRITC-dextran- and AF647-ZOL-containing endosomes was inhibited by 30 μM Dynasore. Conclusion Dynasore prevents ZOL-induced viability loss in HGFs by partially interfering with macropinocytosis and by inhibiting the endosomal maturation pathway thought to be needed for ZOL delivery to the cytoplasm.

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The article analyzes the perceived challenges and strategies implemented in five Latin American and Caribbean countries to ensure continuity of care and access to health services for women, newborns, children, and adolescents during the COVID-19 pandemic. The study corresponds to a quick assessment based on semi-structured interviews with key informants in countries selected by convenience: Colombia, Ecuador, Guatemala, Grenada, and the Dominican Republic. Interviews were conducted with 23 key informants: (a) decision makers at the national and/or subnational level, (b) healthcare professionals, and (c) representatives of civil society organizations; from December 2020 to January 2021. Among the findings, at the beginning of the pandemic, priority was given to the COVID-19 care, with measures to limit the flow of people to health facilities in the countries involved, closing or limiting outpatient visits and restricting care schedule. For women, this affected family planning services and access to contraceptive methods, implying a reduction in prenatal check-ups. As a result of this deinstitutionalization of care, among newborns, a decrease in pediatric check-ups, a decrease in timely immunization and late detection of pathologies or growth problems were reported. Among adolescents, a strong restriction of family planning services, the limitation of other friendly counseling spaces and difficulties in accessing contraceptives were observed.

El artículo analiza los desafíos percibidos y las estrategias implementadas en cinco países de América Latina y el Caribe para garantizar la continuidad de los cuidados y el acceso a servicios de salud de mujeres, recién nacidos/as, niños/as y adolescentes durante la pandemia por COVID-19. El estudio corresponde a una evaluación rápida basada en entrevistas semi-estructuradas a informantes clave de países seleccionados por conveniencia: Colombia, Ecuador, Guatemala, Granada y República Dominicana. Se realizaron entrevistas con 23 informantes clave: (a) referentes de la toma de decisión a nivel nacional y/o subnacional, (b) referentes de servicios de salud, y (c) representantes de organizaciones de la sociedad civil, durante diciembre de 2020 y enero de 2021. Entre los hallazgos, al inicio de la pandemia se priorizó la atención del COVID-19, con medidas para limitar la afluencia de personas a los establecimientos de salud en los países involucrados, procediendo al cierre o limitación de consultas externas y restricción de horarios de atención. Para las mujeres, esto impactó en los servicios de planificación familiar y el acceso a métodos anticonceptivos, e implicó una reducción de los controles prenatales. Por esta desinstitucionalización de la atención, entre recién nacidos/as fue reportada una disminución de los controles pediátricos, una disminución de su vacunación oportuna y una detección tardía de patologías o problemas de crecimiento. Entre adolescentes, se señaló una fuerte restricción de los servicios de planificación familiar, la limitación de otros espacios amigables de consejería y dificultades para acceder a anticonceptivos.

O artigo analisa os desafios observados e as estratégias implementadas em cinco países da América Latina e do Caribe para garantir a continuidade do atendimento e o acesso aos serviços de saúde para mulheres, recém-nascidos/as, crianças e adolescentes durante a pandemia de COVID-19. O estudo é uma avaliação rápida baseada em entrevistas semiestruturadas com informantes-chave em países selecionados por conveniência: Colômbia, Equador, Guatemala, Granada e República Dominicana. Foram realizadas entrevistas com 23 informantes-chave: (a) tomadores de decisão em nível nacional e/ou subnacional, (b) prestadores de serviços de saúde e (c) representantes de organizações da sociedade civil; durante dezembro de 2020 e janeiro de 2021. Entre as conclusões encontrou-se que, no início da pandemia, foi dada prioridade à COVID-19, com medidas para limitar o fluxo de pessoas às instalações de saúde nos países envolvidos, fechando ou limitando as consultas ambulatoriais e restringindo o horário de atendimento. Para as mulheres, a medida impactou os serviços de planejamento familiar e o acesso à contracepção, significando uma redução nos check-ups pré-natais. Como resultado desta desinstitucionalização dos cuidados, uma diminuição dos check-ups pediátricos, uma diminuição das vacinações no período correto e uma detecção tardia de patologias ou problemas de crescimento foram relatados entre os/as recém-nascidos/as. Entre os adolescentes, foi observada uma restrição severa dos serviços de planejamento familiar, a limitação de acesso a espaços de aconselhamento amigável e dificuldades de acesso a contraceptivos.

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El artículo analiza los desafíos percibidos y las estrategias implementadas en cinco países de América Latina y el Caribe para garantizar la continuidad de los cuidados y el acceso a servicios de salud de mujeres, recién nacidos/as, niños/as y adolescentes durante la pandemia por COVID-19. El estudio corresponde a una evaluación rápida basada en entrevistas semi-estructuradas a informantes clave de países seleccionados por conveniencia: Colombia, Ecuador, Guatemala, Granada y República Dominicana. Se realizaron entrevistas con 23 informantes clave: (a) referentes de la toma de decisión a nivel nacional y/o subnacional, (b) referentes de servicios de salud, y (c) representantes de organizaciones de la sociedad civil, durante diciembre de 2020 y enero de 2021. Entre los hallazgos, al inicio de la pandemia se priorizó la atención del COVID-19, con medidas para limitar la afluencia de personas a los establecimientos de salud en los países involucrados, procediendo al cierre o limitación de consultas externas y restricción de horarios de atención. Para las mujeres, esto impactó en los servicios de planificación familiar y el acceso a métodos anticonceptivos, e implicó una reducción de los controles prenatales. Por esta desinstitucionalización de la atención, entre recién nacidos/as fue reportada una disminución de los controles pediátricos, una disminución de su vacunación oportuna y una detección tardía de patologías o problemas de crecimiento. Entre adolescentes, se señaló una fuerte restricción de los servicios de planificación familiar, la limitación de otros espacios amigables de consejería y dificultades para acceder a anticonceptivos.

The article analyzes the perceived challenges and strategies implemented in five Latin American and Caribbean countries to ensure continuity of care and access to health services for women, newborns, children, and adolescents during the COVID-19 pandemic. The study corresponds to a quick assessment based on semi-structured interviews with key informants in countries selected by convenience: Colombia, Ecuador, Guatemala, Grenada, and the Dominican Republic. Interviews were conducted with 23 key informants: (a) decision makers at the national and/or subnational level, (b) healthcare professionals, and (c) representatives of civil society organizations; from December 2020 to January 2021. Among the findings, at the beginning of the pandemic, priority was given to the COVID-19 care, with measures to limit the flow of people to health facilities in the countries involved, closing or limiting outpatient visits and restricting care schedule. For women, this affected family planning services and access to contraceptive methods, implying a reduction in prenatal check-ups. As a result of this deinstitutionalization of care, among newborns, a decrease in pediatric check-ups, a decrease in timely immunization and late detection of pathologies or growth problems were reported. Among adolescents, a strong restriction of family planning services, the limitation of other friendly counseling spaces and difficulties in accessing contraceptives were observed.

O artigo analisa os desafios observados e as estratégias implementadas em cinco países da América Latina e do Caribe para garantir a continuidade do atendimento e o acesso aos serviços de saúde para mulheres, recém-nascidos/as, crianças e adolescentes durante a pandemia de COVID-19. O estudo é uma avaliação rápida baseada em entrevistas semiestruturadas com informantes-chave em países selecionados por conveniência: Colômbia, Equador, Guatemala, Granada e República Dominicana. Foram realizadas entrevistas com 23 informantes-chave: (a) tomadores de decisão em nível nacional e/ou subnacional, (b) prestadores de serviços de saúde e (c) representantes de organizações da sociedade civil; durante dezembro de 2020 e janeiro de 2021. Entre as conclusões encontrou-se que, no início da pandemia, foi dada prioridade à COVID-19, com medidas para limitar o fluxo de pessoas às instalações de saúde nos países envolvidos, fechando ou limitando as consultas ambulatoriais e restringindo o horário de atendimento. Para as mulheres, a medida impactou os serviços de planejamento familiar e o acesso à contracepção, significando uma redução nos check-ups pré-natais. Como resultado desta desinstitucionalização dos cuidados, uma diminuição dos check-ups pediátricos, uma diminuição das vacinações no período correto e uma detecção tardia de patologias ou problemas de crescimento foram relatados entre os/as recém-nascidos/as. Entre os adolescentes, foi observada uma restrição severa dos serviços de planejamento familiar, a limitação de acesso a espaços de aconselhamento amigável e dificuldades de acesso a contraceptivos.

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Photosynthetic cave communities ("lampenflora") proliferate in Carlsbad Cavern and other show caves worldwide due to artificial lighting. These biofilms mar the esthetics and can degrade underlying cave surfaces. The National Park Service recently modernized the lighting in Carlsbad Cavern to a light-emitting diode (LED) system that allows adjustment of the color temperature and intensity. We hypothesized that lowering the color temperature would reduce photopigment development. We therefore assessed lampenflora responses to changes in lighting by monitoring photosynthetic communities over the course of a year. We measured photopigments using reflected-light spectrophotometric observations and analyzed microbial community composition with 16S and 18S rRNA gene amplicon sequencing. Reflected-light spectrophotometry revealed that photosynthetic biofilm development is affected by lighting intensity, color temperature, substrate type, and cleaning of the substrate. Gene sequencing showed that the most abundant phototrophs were Cyanobacteria and members of the algal phyla Chlorophyta and Ochrophyta At the end of the study, visible growth of lampenflora was seen at all sites. At sites that had no established biofilm at the start of the study period, Cyanobacteria became abundant and outpaced an increase in eukaryotic algae. Microbial diversity also increased over time at these sites, suggesting a possible pattern of early colonization and succession. Bacterial community structure showed significant effects of all variables: color temperature, light intensity, substrate type, site, and previous cleaning of the substrate. These findings provide fundamental information that can inform management practices; they suggest that altering lighting conditions alone may be insufficient to prevent lampenflora growth.IMPORTANCE Artificial lighting in caves visited by tourists ("show caves") can stimulate photosynthetic algae and cyanobacteria, called "lampenflora," which are unsightly and damage speleothems and other cave surfaces. The most common mitigation strategy employs bleach, but altering intensities and wavelengths of light might be effective and less harsh. Carlsbad Cavern in New Mexico, a U.S. National Park and UNESCO World Heritage Site, has visible lampenflora despite adjustment of LED lamps to decrease the energetic blue light. This study characterized the lampenflora communities and tested the effects of color temperature, light intensity, rock or sediment texture, and time on lampenflora development. DNA amplicon sequence data show a variety of algae and cyanobacteria and also heterotrophic bacteria. This study reveals microbial dynamics during colonization of artificially lit surfaces and indicates that while lowering the color temperature may have an effect, management of lampenflora will likely require additional chemical or UV treatment.

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BACKGROUND: Antenatal care providers have a key role in providing appropriate information and immunization recommendations to improve pregnant women's vaccine uptake. The objective of this study is to describe health care providers' perspectives and experience regarding the implementation of maternal immunization programs in Latin America. METHODS: We conducted 33 in-depth interviews of health care providers from Argentina, Brazil, Honduras, Mexico, and Peru (6-7 per country). Qualitative data analysis was conducted using a combination of both manual techniques and the computer software program NVivo. We identified and coded main themes related to maternal immunization. RESULTS: The main themes identified in this analysis were practices related to maternal immunization, knowledge and training, resource availability and interactions with pregnant women. Healthcare providers knew that recommendations exists but some did not know their content; they expressed concerns about insufficient training. Providers from all five countries expressed the need for additional human resources and supplies. They also expressed a desire for women to be more proactive and ask more questions during the health visits. CONCLUSION: This is the first multi-country study assessing the perspectives of health care providers about maternal immunization practices at the facility level in Latin America. Recommendations based on the results from this study include implementing additional trainings around maternal immunization, especially targeting obstetricians and midwives. These trainings should be conducted in coordination with improvements to supply chain and other structural issues.

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BACKGROUND: Maternal immunization rates and vaccine uptake in Latin America vary from country to country. This variability stems from factors related to pregnant women, vaccine recommendations from healthcare providers and the health system. The aim of this paper is to describe women's knowledge and attitudes to maternal immunziation, and barriers to access and vaccination related decision-making processes in Latin American countries. METHODS: We conducted focus group discussions (FGD) with pregnant women in five middle-income countries: Argentina, Brazil, Honduras, Mexico and Peru, between July 2016 and July 2018. The FGDs were conducted by trained qualitative researchers in diverse clinics located in the capital cities of these countries. RESULTS: A total of 162 pregnant women participated in the FGDs. In general, participants were aware of the recommendation to receive vaccines during pregnancy but lacked knowledge regarding the diseases prevented by these vaccines. Pregnant women expressed a desire for clearer and more detailed communication on maternal vaccines by their healthcare professionals instead of relying on other sources of information such as the internet. Overall, participants had positive attitudes towards maternal immunization and were open to receiving vaccines in pregnancy based on general trust they have in recommendations made by their healthcare providers. The main obstacles pregnant women said they encounter were mainly centered around their clinical experience: long waiting times, vaccine shortages, and impolite behavior of healthcare providers or clinical staff. CONCLUSION: Important advances have been made in Latin America to promote maternal immunization. Results from this study show that an important aspect that remains to be addressed, and is crucial in improving vaccine uptake in pregnancy, is women's clinical experience. We recommend pregnant women to be treated as a priority population for providing immunization and related healthcare education. It is imperative to train healthcare providers in health communication so they can effectively communicate with pregnant women regarding maternal vaccines and can fill knowledge gaps that otherwise might be covered by unreliable sources dispensing inaccurate information.

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La investigación inicial del proyecto mirar fue la observación del proceso social y legislativo que tuvo lugar en diciembre de 2020: se estudiaron los debates en torno al proyecto de ley de IVE dentro del Congreso y los mensajes difundidos y comunicados tanto en las redes sociales como en los diarios impresos. Esta publicación reúne aquellos tres primeros estudios. El primer estudio, "Mensajes en disputa. El debate legislativo del proyecto de Ley de Interrupción Voluntaria del Embarazo" (Argentina, 2020), a cargo de Paloma Dulbecco, Santiago L. Cunial y Daniel E. Jones, se abocó a describir y analizar cuantitativa y cualitativamente el debate de la Ley de IVE en las dos Cámaras del Congreso de la Nación. El segundo estudio, "Análisis de la cobertura periodística del debate legislativo sobre la Ley de Interrupción Voluntaria del Embarazo" (Argentina, 2020),a cargo de Sara Pérez, Ana Aymá, Florencia Moragas y Emilse Kejner, analiza el discurso de la prensa gráfica digital durante el debate desarrollado en el Congreso sobre el proyecto de Ley de IVE, incluyendo medios de alcance nacional, regional y provincial. El tercer estudio, "#ESLEY | Aprobación de la IVE y activación de narrativas en redes sociales" (Argentina, 2020), de Ernesto Calvo, Natalia Aruguete, Paola Ingrassia y Celeste Gómez Wagner, se concentró en medir y analizar la propagación de noticias y mensajes relativos a la consideración y aprobación de la Ley en las redes sociales.

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The article analyzes interactions between therapeutic experiences and affective relations in the history of patients with chronic health conditions: persons with problematic drug use receiving therapeutic care in religious devices and persons with HIV under clinical care and antiretroviral therapy. The article uses a qualitative methodology based on in-depth interviews. The hypothesis is that the treatments (pharmacological or psychological) usually prove insufficient to provide adequate therapeutic responses to these two chronic conditions. Both groups acknowledged the central importance of affective dimensions for adherence to the proposed treatment regimens and a comprehensive (and thus more effective) approach to HIV and drug addictions. The article concludes by presenting a notion of adherence that extrapolates individual behavior involving mere compliance with prescribed treatments. Adherence is less a personal than a collective experience, in which family, peer networks, and professionals and other therapeutic reference persons play a central role.

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Resumen: El presente artículo analiza los cruces entre experiencias terapéuticas y vínculos afectivos en las trayectorias de dos grupos de pacientes con padecimientos crónicos: personas con consumos problemáticos de drogas en tratamiento en dispositivos religiosos de atención terapéutica; y personas con VIH bajo atención clínica y tratamiento antirretroviral. El artículo parte de una estrategia metodológica cualitativa, basada en entrevistas en profundidad. La hipótesis es que los tratamientos (farmacológicos o psicológicos) usualmente resultan insuficientes para brindar respuestas terapéuticas adecuadas a estos dos padecimientos crónicos. Los grupos entrevistados reconocen la centralidad de las dimensiones afectivas para la adherencia a las pautas de tratamiento propuestas y para un abordaje integral, y consecuentemente más efectivo, del VIH y de las adicciones a las drogas. El artículo concluye presentando una noción de adherencia que excede el comportamiento individual de mero cumplimiento de las prescripciones de los tratamientos. La adherencia es menos una experiencia personal que colectiva, en la que el entorno cercano de familiares, redes de pares y profesionales y otros referentes terapéuticos juegan un papel central.

Resumo: O presente artigo analisa as intersecções entre experiências terapêuticas e vínculos afetivos nas trajetórias de dois grupos de pacientes com padecimentos crônicos: pessoas com consumos problemáticos de drogas em tratamento dentro de locais religiosos de atenção terapêutica; e pessoas com HIV sob os cuidados clínicos e tratamento antirretroviral. O artigo parte de uma estratégia metodológica qualitativa, baseada em entrevistas em profundidade. A hipótese é que os tratamentos (farmacológicos ou psicológicos) comumente resultam insuficientes para proporcionar respostas terapêuticas adequadas para estas duas doenças crônicas. Os grupos entrevistados reconhecem a centralidade das dimensões afetivas para a aderência nas pautas dos tratamentos propostos e para uma abordagem integral, e consequentemente mais efetiva, do HIV e da dependência as drogas. O artigo conclui apresentando uma noção de aderência que excede o comportamento individual de mero cumprimento das prescrições dos tratamentos. A aderência é menos uma experiência pessoal do que coletiva, em que o ambiente familiar, as redes de pares e profissionais junto com outros referentes terapêuticos jogam um papel central.

Abstract: The article analyzes interactions between therapeutic experiences and affective relations in the history of patients with chronic health conditions: persons with problematic drug use receiving therapeutic care in religious devices and persons with HIV under clinical care and antiretroviral therapy. The article uses a qualitative methodology based on in-depth interviews. The hypothesis is that the treatments (pharmacological or psychological) usually prove insufficient to provide adequate therapeutic responses to these two chronic conditions. Both groups acknowledged the central importance of affective dimensions for adherence to the proposed treatment regimens and a comprehensive (and thus more effective) approach to HIV and drug addictions. The article concludes by presenting a notion of adherence that extrapolates individual behavior involving mere compliance with prescribed treatments. Adherence is less a personal than a collective experience, in which family, peer networks, and professionals and other therapeutic reference persons play a central role.

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This article presents the results of a dialogue between decision-makers and experts in Latin America and the Caribbean on priority-setting for interventions and studies on Aedes aegypti control. The article is part of a project that included a systematic review of mosquito control strategies and a qualitative study with key informants from the region. Using a collective deliberative process assisted by the results of the above-mentioned projects, a list of priorities was developed by consensus for the implementation of vector control strategies and the development of key regional research lines. It was agreed that the best strategy is integrated vector management, divided into: (a) chemical control; (b) biological control; (c) environmental management; (d) community participation; and (e) integrated surveillance. The workshop highlighted the crucial role of government leadership and inter-sector coordination between government agencies and civil society stakeholders. The proposed priorities for research lines were: Ae. aegypti vector competence and associated factors; community components of interventions; incorporation of technology into vector control and monitoring; most efficient modalities of integrated surveillance; entomological indicators with the best predictive capacity; and resistance to insecticides. The policy dialogue methodology allowed validating and enriching the results of other levels of research, besides establishing priorities for regional research and control strategies.

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This article presents the results of a dialogue between decision-makers and experts in Latin America and the Caribbean on priority-setting for interventions and studies on Aedes aegypti control. The article is part of a project that included a systematic review of mosquito control strategies and a qualitative study with key informants from the region. Using a collective deliberative process assisted by the results of the above-mentioned projects, a list of priorities was developed by consensus for the implementation of vector control strategies and the development of key regional research lines. It was agreed that the best strategy is integrated vector management, divided into: (a) chemical control; (b) biological control; (c) environmental management; (d) community participation; and (e) integrated surveillance. The workshop highlighted the crucial role of government leadership and inter-sector coordination between government agencies and civil society stakeholders. The proposed priorities for research lines were: Ae. aegypti vector competence and associated factors; community components of interventions; incorporation of technology into vector control and monitoring; most efficient modalities of integrated surveillance; entomological indicators with the best predictive capacity; and resistance to insecticides. The policy dialogue methodology allowed validating and enriching the results of other levels of research, besides establishing priorities for regional research and control strategies.

Este trabalho apresenta os resultados de um diálogo entre tomadores de decisão e expertos da América Latina e do Caribe sobre a priorização de intervenções e pesquisas para o controle do mosquito Aedes aegypti. Faz parte de um projeto que compreendeu uma revisão sistemática sobre estratégias e controle do mosquito e um estudo qualitativo com informantes chave da região. Através de um processo deliberativo em instâncias coletivas, assistido pelos resultados dos mencionados projetos, foi elaborada uma listagem consensuada de prioridades de implementação de estratégias de controle vetorial e de desenvolvimento regional de linhas essenciais de pesquisa. Foi acordado que a melhor estratégia é a gestão integrada de vetores ou Estratégia de Gestão Integrada, desagregada em: (a) controle químico; (b) controle biológico; (c) gestão ambiental; (d) participação comunitária; (e) vigilância integrada. Foi destacado o rol fundamental e indelegável da direção do estado e a coordenação intersetorial entre agências estaduais com atores da sociedade civil. Foi proposto priorizar como linhas de pesquisa: a capacidade vetorial do Ae. aegypti e fatores associados; componentes comunitários das intervenções; a incorporação de tecnologia para o controle vetorial e para o monitoramento; modos mais eficientes de vigilância integrada; indicadores entomológicos com melhor capacidade preditiva e resistência a pesticidas. A metodologia do diálogo de políticas permitiu validar e enriquecer os resultados de outras áreas de pesquisa, possibilitou estabelecer prioridades a propósito da pesquisa, além de estratégias para o controle regional.

Este trabajo presenta los resultados de un diálogo entre tomadores de decisión y expertos de América Latina y el Caribe sobre la priorización de intervenciones e investigaciones para el control del mosquito Aedes aegypti. Forma parte de un proyecto que comprendió una revisión sistemática sobre estrategias control del mosquito y un estudio cualitativo con informantes clave de la región. Mediante un proceso deliberativo en instancias colectivas, asistido por los resultados de los mencionados proyectos, se elaboró un listado consensuado de prioridades de implementación de estrategias de control vectorial y de desarrollo regional de líneas clave de investigación. Se convino en que la mejor estrategia es el manejo integrado de vectores o Estrategia de Gestión Integrada, desagregada en: (a) control químico; (b) control biológico; (c) manejo ambiental; (d) participación comunitaria; y (e) vigilancia integrada. Se destacó el fundamental e indelegable rol de rectoría del estado y la coordinación intersectorial entre agencias estatales y con actores de la sociedad civil. Se propuso priorizar como líneas de investigación: la capacidad vectorial del Ae. aegypti y factores asociados; componentes comunitarios de las intervenciones; la incorporación de tecnología al control vectorial y al monitoreo; los modos más eficientes de vigilancia integrada; indicadores entomológicos con mejor capacidad predictiva y resistencia a insecticidas. La metodología del diálogo de políticas permitió validar y enriquecer los resultados de otras instancias de investigación, y permitió establecer prioridades sobre investigación y estrategias para el control regional.

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ABSTRACT OBJECTIVE: To evaluate the results and benefits obtained from the topical use of negative pressure wound therapy (NPWT) in patients with infected wounds. METHODS: This was a retrospective study of 20 patients (17 males and three females, mean age 42 years) with infected wounds treated using NPWT. The infected wounds were caused by trauma. The treatment system used was VAC.(r) (Vacuum Assisted Closure, KCI, San Antonio, United States) applied to the wound in continuous mode from 100 to 125 mmHg. The parameters related to the wounds (location, number of VAC changes, the size of the defects in the soft parts, and the evolution of the state of the wound), length of hospital stay, length of intravenous antibiotic therapy, and complications related to the use of this therapy were evaluated. RESULTS: The mean length of the hospital stay, use of NPWT, and antibacterial therapy were 41 days, 22.5 days, and 20 days respectively. The use of the VAC led to a mean reduction of 29% in the wound area (95.65-68.1 cm2; p < 0.05). Only one patient did not show any improvement in the final appearance of the wound with complete eradication of the infection. No complication directly caused by NPWT was observed. CONCLUSION: NPWT stimulates infection-free scar tissue formation in a short time, and is a quick and comfortable alternative to conventional infected wounds treatment methods.

RESUMO OBJETIVO: Avaliar os resultados e benefícios trazidos pela aplicação tópica da terapia por pressão negativa (TPN) em pacientes com feridas infectadas. MÉTODOS: Estudo retrospectivo de série de casos composta por 20 pacientes (17 homens e três mulheres e média de 42 anos) com feridas infectadas tratadas pela TPN. As feridas infectadas em sua maioria foram de causa traumática. O sistema de pressão a vácuo usado foi o VAC(r) (Vacuum Assisted Closure, KCI, San Antonio, Estados Unidos), aplicado à ferida em modo contínuo na ordem de 100 a 125 mmHg. Na casuística, os parâmetros relacionados à ferida (localização, quantidade de trocas do VAC, tamanhos dos defeitos de partes moles, evolução do grau da ferida), o tempo de internamento, o tempo de antibioticoterapia venosa e as complicações relacionadas ao uso da terapia foram avaliados. RESULTADOS: O tempo médio de internamento, uso da terapia a vácuo e antibioticoterapia foi, respectivamente, de 41, 22,5 e 20 dias. O uso do VAC promoveu uma redução média da área das feridas de 29% (95,65 cm2 para 68,1 cm2; p < 0,05). Apenas um paciente não obteve melhoria do aspecto final da ferida, com erradicação completa da infecção. Nenhuma complicação atribuída diretamente ao uso da TPN foi observada. CONCLUSÃO: A terapia por pressão negativa, por facilitar a formação de um tecido de cicatrização ausente de infecção local num curto intervalo de tempo, representa uma opção rápida e confortável aos métodos convencionais no tratamento de feridas infectadas.

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Extremely acidic (pH 0-1.5) Acidithiobacillus-dominated biofilms known as snottites are found in sulfide-rich caves around the world. Given the extreme geochemistry and subsurface location of the biofilms, we hypothesized that snottite Acidithiobacillus populations would be genetically isolated. We therefore investigated biogeographic relationships among snottite Acidithiobacillus spp. separated by geographic distances ranging from meters to 1000s of kilometers. We determined genetic relationships among the populations using techniques with three levels of resolution: (i) 16S rRNA gene sequencing, (ii) 16S-23S intergenic transcribed spacer (ITS) region sequencing and (iii) multi-locus sequencing typing (MLST). We also used metagenomics to compare functional gene characteristics of select populations. Based on 16S rRNA genes, snottites in Italy and Mexico are dominated by different sulfur-oxidizing Acidithiobacillus spp. Based on ITS sequences, Acidithiobacillus thiooxidans strains from different cave systems in Italy are genetically distinct. Based on MLST of isolates from Italy, genetic distance is positively correlated with geographic distance both among and within caves. However, metagenomics revealed that At. thiooxidans populations from different cave systems in Italy have different sulfur oxidation pathways and potentially other significant differences in metabolic capabilities. In light of those genomic differences, we argue that the observed correlation between genetic and geographic distance among snottite Acidithiobacillus populations is partially explained by an evolutionary model in which separate cave systems were stochastically colonized by different ancestral surface populations, which then continued to diverge and adapt in situ.

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OBJECTIVE: To evaluate the results and benefits obtained from the topical use of negative pressure wound therapy (NPWT) in patients with infected wounds. METHODS: This was a retrospective study of 20 patients (17 males and three females, mean age 42 years) with infected wounds treated using NPWT. The infected wounds were caused by trauma. The treatment system used was VAC.® (Vacuum Assisted Closure, KCI, San Antonio, United States) applied to the wound in continuous mode from 100 to 125 mmHg. The parameters related to the wounds (location, number of VAC changes, the size of the defects in the soft parts, and the evolution of the state of the wound), length of hospital stay, length of intravenous antibiotic therapy, and complications related to the use of this therapy were evaluated. RESULTS: The mean length of the hospital stay, use of NPWT, and antibacterial therapy were 41 days, 22.5 days, and 20 days respectively. The use of the VAC led to a mean reduction of 29% in the wound area (95.65-68.1 cm2; p < 0.05). Only one patient did not show any improvement in the final appearance of the wound with complete eradication of the infection. No complication directly caused by NPWT was observed. CONCLUSION: NPWT stimulates infection-free scar tissue formation in a short time, and is a quick and comfortable alternative to conventional infected wounds treatment methods.

OBJETIVO: Avaliar os resultados e benefícios trazidos pela aplicação tópica da terapia por pressão negativa (TPN) em pacientes com feridas infectadas. MÉTODOS: Estudo retrospectivo de série de casos composta por 20 pacientes (17 homens e três mulheres e média de 42 anos) com feridas infectadas tratadas pela TPN. As feridas infectadas em sua maioria foram de causa traumática. O sistema de pressão a vácuo usado foi o VAC® (Vacuum Assisted Closure, KCI, San Antonio, Estados Unidos), aplicado à ferida em modo contínuo na ordem de 100 a 125 mmHg. Na casuística, os parâmetros relacionados à ferida (localização, quantidade de trocas do VAC, tamanhos dos defeitos de partes moles, evolução do grau da ferida), o tempo de internamento, o tempo de antibioticoterapia venosa e as complicações relacionadas ao uso da terapia foram avaliados. RESULTADOS: O tempo médio de internamento, uso da terapia a vácuo e antibioticoterapia foi, respectivamente, de 41, 22,5 e 20 dias. O uso do VAC promoveu uma redução média da área das feridas de 29% (95,65 cm2 para 68,1 cm2; p < 0,05). Apenas um paciente não obteve melhoria do aspecto final da ferida, com erradicação completa da infecção. Nenhuma complicação atribuída diretamente ao uso da TPN foi observada. CONCLUSÃO: A terapia por pressão negativa, por facilitar a formação de um tecido de cicatrização ausente de infecção local num curto intervalo de tempo, representa uma opção rápida e confortável aos métodos convencionais no tratamento de feridas infectadas.

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Large sulfur-oxidizing bacteria in the family Beggiatoaceae are important players in the global sulfur cycle. This group contains members of the well-known genera Beggiatoa, Thioploca, and Thiomargarita but also recently identified and relatively unknown candidate taxa, including "Candidatus Thiopilula" spp. and "Ca. Thiophysa" spp. We discovered a population of "Ca. Thiopilula" spp. colonizing cold seeps near Barbados at a ∼4.7-km water depth. The Barbados population consists of spherical cells that are morphologically similar to Thiomargarita spp., with elemental sulfur inclusions and a central vacuole, but have much smaller cell diameters (5 to 40 µm). Metatranscriptomic analysis revealed that when exposed to anoxic sulfidic conditions, Barbados "Ca. Thiopilula" organisms expressed genes for the oxidation of elemental sulfur and the reduction of nitrogenous compounds, consistent with their vacuolated morphology and intracellular sulfur storage capability. Metatranscriptomic analysis further revealed that anaerobic methane-oxidizing and sulfate-reducing organisms were active in the sediment, which likely provided reduced sulfur substrates for "Ca. Thiopilula" and other sulfur-oxidizing microorganisms in the community. The novel observations of "Ca. Thiopilula" and associated organisms reported here expand our knowledge of the globally distributed and ecologically successful Beggiatoaceae group and thus offer insight into the composition and ecology of deep cold seep microbial communities.

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OBJECTIVE: To review the current state of simulation use in surgery and to offer direction for future research and implementation of evidence-based findings. BACKGROUND: Simulation-based training (SBT) in surgery has surged in recent years. Although several new simulators and curricula have become available, their optimization and implementation into surgical training has been lagging. METHODS: Members of the Association for Surgical Education Simulation Committee with expertise in surgical simulation review and interpret the literature and describe the current status of the use of simulation in surgery, identify the challenges to its widespread adoption, and offer potential solutions to these challenges. The review focuses on simulation research and implementation of existing knowledge and explores possible future directions for the field. RESULTS: Skill acquired on simulators has repeatedly and consistently been demonstrated to transfer to the operating room, and proficiency-based training maximizes this benefit. Several simulation-based curricula have been developed by national organizations to support resident training, but their implementation is lagging because of inadequate human resources, difficult integration of SBT into educational strategy, and logistical barriers. In research, lack of coordinated effort, flaws in study design, changes in simulator-validation concepts, limited attention to skill retention, and other areas are in need of improvement. CONCLUSIONS: Future research in surgical simulation should focus on demonstrating the cost-effectiveness of SBT and its impact on patient outcomes. Furthermore, to enable the more widespread incorporation of best practices and existing simulation curricula in surgery, effective implementation strategies need to be developed.

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Resumen El rápido pasaje del laboratorio a la cabecera del paciente que se ha constatado en la aplicación de la medicina regenerativa en cardiología ha llevado a nuevos avances muy interesantes en nuestra comprensión de algunos de los mecanismos fundamentales de la biología humana. La primera generación de células usadas en ensayos fases I y II (fundamentalmente células mononucleares de la médula ósea) están ingresando ahora en ensayos clínicos fase III con la meta de obtener una terapia celular que pueda cambiar el desenlace de la enfermedad cardíaca. La terapia celular de primera generación parece haber abordado las preocupaciones sobre la seguridad del tratamiento, además de demostrar su ‘actividad’ en numerosos metaanálisis que han sido publicados. Considerando lo que se sabe hasta la fecha, la investigación está apuntando a la siguiente generación de células: las células sometidas a ‘proceso de ingeniería’ para hacer que presenten un fenotipo que mejore aun más el proceso de reparación o rescate del miocardio. Esta revisión del anuario cubre la investigación básica más reciente pasible de aplicación en humanos en el corto plazo, así como los resultados de los últimos ensayos clínicos

Summary The rapid translation from bench to bedside that has been seen in the application of regenerative medicine to cardiology has led to exciting new advances in our understanding of some of the fundamental mechanisms related to human biology. The first generation of cells used in phase I-II trials (mainly bone marrow mononuclear cells) are now entering phase III clinical trials with the goal of producing a cell based therapeutic that can change the outcome of cardiac disease. First generation cell therapy appears to have addressed safety concerns as well as showing ‘activity’ in numerous published meta- analyses. With the knowledge gained to date, the field is moving towards the next generation of cells-the ‘engineered’ cell-that have been developed to display a phenotype that will further enhance the myocardial repair/salvage process. This almanac review covers the latest basic research that may soon have application to humans as well as the results of the latest clinical trials

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