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The study focuses on identifying and understanding the ecological dynamics of Triatoma breyeri in Bolivia. Morphological identification and molecular analysis using gene fragments (COI, CytB and 16S) confirms T. breyeri's presence and its relation to other species. The species has been consistently found in the Estancia-Mataral-La Palma region since 2010 but has not spread to other regions in Bolivia. The region of occurrence is a small characteristic dry inter-Andean valley. A MaxEnt model suggests part of the Bolivian Montane Dry Forest ecoregion serves as a unique habitat within its range. The infrequent presence in Bolivia and the distance from its main range in Argentina suggest recent accidental introduction, possibly through human transport. Further research is needed to comprehend its persistence in this small area of Bolivia.

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BACKGROUND: Limited data exist on the prognostic significance of the chronology of VTE in patients with PDAC. METHODS: Medical data and survival characteristics of patients treated for PDAC from 2019 to 2021 were retrospectively reviewed. Early VTE was defined as occurring within the three months of PDAC diagnosis. RESULTS: 197 patients were included, 54 (27.4%) developed a VTE. Early appearance of VTE was associated with worse prognosis: median overall survival (mOS) VTE < 3 months 8.5 months (HR 1.65, 95% CI 1.11-2.46; p = 0.014), mOS VTE > 3 months 12.8 months (HR 0.78, 95% CI 0.39-1.54; p = 0.5) and mOS patients without VTE 11.4 months (95% CI 10.1-15.4). There was no significant association between the patient's VTE risk according to the Khorana risk score (KRS) (chi2 test p-value = 0.9). CONCLUSION: Early VTE is a prognostic factor in PDAC, which may identify a more aggressive subtype.

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Objective: It is necessary to establish the evolution that the pandemic has had in Panama by weeks and months and to clearly establish the existence of surges or peaks, according to cases and deaths and the relationship with age groups. Methodology: We conducted a retrospective cohort study of all confirmed COVID-19 cases reported by the Ministry of Health of Panama during the first 3 years of the epidemic (March 9, 2020, March 11, 2023). All cases were obtained from information provided by the Ministry of Health. We obtained daily information of the population at the national level reported as new cases, deaths, admission to hospitals, admission to intensive care units and by age groups. The information is classified by epidemiological week and by month from the diagnosis of the first case until March 2023. Results: During the three years of the study, 1,032,316 cases of COVID-19 were registered in the Republic of Panama, and the number of deaths reported was 8,621, for a fatality rate of 0.83 % throughout that period. The number of deaths decreased over the 3 years of the pandemic; however, similar to the cases, there were periods of surges (peaks) per year in June/July and in December/January. The lethality progressively increased according to the age of the affected patients. During the first year, the lethality in those under 20 years of age was 0.05 %, and in those over 80 years old, it was 17.54 %. This pattern was maintained during the second year; however, there was a large decrease in all age groups. Conclusion: the highest lethality rate in Panama occurred in the first year of the pandemic, with a great decrease in the third year; the impact of lethality is proportional to the age of the individual, with a high possibility of death in those over 80 years of age. During each pandemic year, there are two peaks (surges of new cases and deaths) per year, which are important times to take into account to generate strategies aimed at reducing the impact.

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There are several methods of analysis used in the metalworking industry for dry machining processes and with Minimum Quantity Lubrication (MQL). Evolutionary methods [1] have been used in the decision-making process in the machining process to select the optimal data and to analyze the behavior of variables such as cutting speed (V), feed rate (f) and cutting depth (ap). This work addresses the use of evolutionary algorithms of low dominance class II and III (NSGA-II and NSGA-III) to analyze from the multicriteria approach the initial wear of the cutting tool (VB), the energy consumption (E) and the machining time (t) in the turning process of the AISI 316L steel workpiece for biomedical purposes. As input variables to the algorithm with 54 records, there are: cutting speed (V: 200, 300, 400 m/min) and feed rate (f: 0.1, 0.15, 0.2 mm/rev). The experiment was developed for a dry (1) turning operation and with the use of MQL (-1). For the MQL lubrication regime, a TRI-COOL MD-1 lubricant was employed, a vegetable type used in ferrous and non-ferrous metal cutting operations. A BIDEMICS JX1 ceramic cutting tool was used.

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Introducción: Existen varios sistemas de puntuación para predecir los resultados adversos en los pacientes con hemorragia digestiva alta no varicosa, pero no se han validado lo suficiente y cada uno pertenece a distintas poblaciones fuentes. Objetivo: Demostrar la utilidad de una escala propuesta para predecir las probabilidades de resangrado, de mortalidad y de necesidad de cirugía en los pacientes con hemorragia digestiva alta no varicosa. Métodos: Se realizó un estudio retrospectivo de una prueba diagnóstica en el hospital de Prenda, Luanda, Angola desde enero del 2021 hasta mayo del 2022. El universo estuvo formado por 93 pacientes atendidos durante ese período con el criterio de inclusión de tener el diagnóstico de hemorragia digestiva alta de origen no varicoso. Resultados: De un total de 93 pacientes se obtuvo como desenlace primario una recurrencia del sangrado de 18 pacientes para un 19,35 por ciento del total, seguido con 12 fallecidos para un 12,90 por ciento del total y cuatro fallecidos para un 4,40 por ciento del total. Los valores predictivos de la escala de forma general fueron, al ser aplicada una sensibilidad de 0,91, la especificidad de un 0,92, el valor predictivo negativo de un 0,95 y el valor predictivo negativo de un 0,86. Conclusiones: La escala propuesta tiene una sensibilidad y especificidad adecuada para predecir, en los pacientes con hemorragia digestiva alta no varicosa, la probabilidad de resangrado, de mortalidad y la necesidad de cirugía(AU)

Introduction: Several scoring systems exist to predict adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding, but they have not been sufficiently validated and each pertains to different source populations. Objective: To demonstrate the usefulness of a proposed scoring scale to predict the probability of rebleeding, mortality, and need for surgery in patients with nonvariceal upper gastrointestinal bleeding. Methods: A retrospective study of a diagnostic test was performed at the hospital of Prenda, Luanda, Angola, from January 2021 to May 2022. The study universe consisted of 93 patients attended during that period, with the inclusion criterion of having a diagnosis of upper gastrointestinal bleeding of nonvariceal origin. Results: From a total of 93 patients, the primary outcome was a recurrence of bleeding in 18 patients, accounting for 19.35 percent of the total; followed by 12 deaths, representing 12.90 percent of the total, and four deaths, accounting for 4.40 percent of the total. After the scale was applied, the following general predictive values were obtained: sensitivity of 0.91, specificity of 0.92, negative predictive value of 0.95 and negative predictive value of 0.86. Conclusions: The proposed scale presents adequate sensitivity and specificity for predicting the probability of fatal rebleeding and the need for surgery in patients with nonvariceal upper gastrointestinal bleeding(AU)

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Polyglutamine spinocerebellar ataxias (polyQ SCAs) are a group of neurodegenerative diseases, clinically and genetically heterogeneous, characterized by loss of balance and motor coordination due to dysfunction of the cerebellum and its connections. The diagnosis of each type of polyQ SCA, alongside with genetic tests, includes medical images analysis, and its automation may help specialists to distinguish between each type. Convolutional neural networks (ConvNets or CNNs) have been recently used for medical image processing, with outstanding results. In this work, we present the main clinical and imaging features of polyglutamine SCAs, and the basics of CNNs. Finally, we review studies that have used this approach to automatically process brain medical images and may be applied to SCAs detection. We conclude by discussing the possible limitations and opportunities of using ConvNets for SCAs diagnose in the future.

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Introducción: los retos de la contemporaneidad reconocen a la investigación científica, como motor impulsor para el desarrollo económico social de las poblaciones humanas. Objetivo: caracterizar la productividad de los artículos científicos a través de un análisis bibliométricos de las publicaciones relacionadas con los investigadores del Municipio Yara. 2009-2019. Métodos: se tomó como fuente primaria el Registro de publicaciones dentro el período 2009-2019 en materia de investigaciones de artículos científicos. Se analizó un total de 62 artículos publicados que tuvieron relación con la investigación durante esta etapa. Para el análisis, se incluyeron solo los artículos científicos y se excluyeron las editoriales y las reseñas. Se estudiaron las siguientes variables: número de publicaciones por año, número de publicaciones por revistas, tipología de artículos de revistas y número de autores. Resultados: se observó una tendencia al incremento de las publicaciones lideradas por los investigadores. Predominó la distribución en el año 2016 y 2019 así como la revista Multimed con un 56.3 %, la tipología de los artículos originales con un 99.4 % y la distribución con más de cinco autores por publicaciones. Conclusiones: predominó de distribución en el año 2016 y 2019, con gran impacto la revista Multimed, la tipología de los artículos originales y la distribución con más de cinco autores por publicaciones.

Introduction: the challenges of the contemporaneidad recognize to the scientific investigation, as impeller motor for the social economic development of the human populations. Objective: to characterize the productivity of the scientific articles through an analysis bibliométrics of the publications related with the investigators of the Municipality Yara. 2009-2019. Methods: The period took like primary source the Record of publications inside 2009-2019 on the subject of investigations of scientific goods. A total of 62 published goods that had to do with the investigation during this stage was examined. For analysis, they included only the scientific goods and they excluded editorials and reviews. They studied the following variables: Number of publications per year, number of publications for magazines, typology of goods of magazines and authors' number. Results: a tendency was observed to the increment of the publications liderations by the investigators. The distribution prevailed in the year 2016 and 2019 as well as the magazine Multimed with 56.3%, the tipology of the original articles with 99.4% and the distribution with more than five authors for publications. Conclusions: it prevailed of distribution in the year 2016 and 2019, with great impact the magazine Multimed, the tipology of the original articles and the distribution with more than five authors for publications.

Introdução: os desafios da contemporaneidade reconhecem a pesquisa científica como força motriz para o desenvolvimento socioeconômico das populações humanas. Objetivo: caracterizar a produtividade de artigos científicos por meio de uma análise bibliométrica de publicações relacionadas a pesquisadores do Município de Yara. 2009-2019. Métodos: o Registro de publicações no período 2009-2019 no campo da pesquisa de artigos científicos foi tomado como fonte primária. Foram analisados 62 artigos publicados relacionados à pesquisa nessa etapa. Para a análise, apenas artigos científicos foram incluídos e editoriais e revisões foram excluídos. Foram estudadas as seguintes variáveis: número de publicações por ano, número de publicações por periódico, tipo de artigos de periódicos e número de autores. Resultados: houve uma tendência de aumento nas publicações lideradas por pesquisadores. A distribuição prevaleceu em 2016 e 2019, assim como a revista Multimed com 56,3%, a tipologia dos artigos originais com 99,4% e a distribuição com mais de cinco autores por publicação. Conclusões: a distribuição predominou em 2016 e 2019, com grande impacto na revista Multimed, na tipologia dos artigos originais e na distribuição com mais de cinco autores por publicação.

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Fe-substituted YFexCr1-xO3 crystalline compounds show promising magnetic and multiferroic properties. Here we report the synthesis and characterization of several compositions from this series. Using the autocombustion route, various compositions (x = 0.25, 0.50, 0.6, 0.75, 0.9, and 1) were synthesized as high-quality crystalline powders. In order to obtain microscopic and atomic information about their structure and magnetism, characterization was performed using room temperature X-ray diffraction and energy dispersion analysis as well as temperature-dependent neutron diffraction, magnetometry, and 57Fe Mössbauer spectrometry. Rietveld analysis of the diffraction data revealed a crystallite size of 84 (8) nm for YFeO3, while energy dispersion analysis indicated compositions close to the nominal compositions. The magnetic results suggested an enhancement of the weak ferromagnetism for the YFeO3 phase due to two contributions. First, a high magnetocrystalline anisotropy was associated with the crystalline character that favored a unique high canting angle of the antiferromagnetic phase (13°), as indicated by the neutron diffraction analysis. This was also evidenced by the high magnetic hysteresis curves up to 90 kOe by a remarkable high critical coercivity value of 46.7 kOe at room temperature. Second, the Dzyaloshinskii-Moriya interactions between homogenous and heterogeneous magnetic pairs resulted from the inhomogeneous distribution of Fe3+ and Cr3+ ions, as indicated by 57Fe Mössbauer studies. Together, these results point to new methods of controlling the magnetic properties of these materials.

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The human cerebellum plays an important role in coordination tasks. Diseases such as spinocerebellar ataxias tend to cause severe damage to the cerebellum, leading patients to a progressive loss of motor coordination. The detection of such damages can help specialists to approximate the state of the disease, as well as to perform statistical analysis, in order to propose treatment therapies for the patients. Manual segmentation of such patterns from magnetic resonance imaging is a very difficult and time-consuming task, and is not a viable solution if the number of images to process is relatively large. In recent years, deep learning techniques such as convolutional neural networks (CNNs or convnets) have experienced an increased development, and many researchers have used them to automatically segment medical images. In this research, we propose the use of convolutional neural networks for automatically segmenting the cerebellar fissures from brain magnetic resonance imaging. Three models are presented, based on the same CNN architecture, for obtaining three different binary masks: fissures, cerebellum with fissures, and cerebellum without fissures. The models perform well in terms of precision and efficiency. Evaluation results show that convnets can be trained for such purposes, and could be considered as additional tools in the diagnosis and characterization of neurodegenerative diseases.

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Today is a reality that the novel coronavirus SARS-Cov-2 has become a global pandemic. For this reason, the study of real microscopic images of this coronavirus is of great importance, as it allows us to carry out a more precise research on it. However, as we pointed out in a former paper as reported by Roberto Rodríguez (SARS-CoV-2: Enhancement and Segmentation of High-Resolution Microscopy Images. Part I", Sent to Signal, Image and Video Processing Video Processing, Springer, New York, 2020), many times these microscopic images present some blurring problems, which are always susceptible to be improved. The aim of this work is to carry out a theoretical analysis of the proposed algorithms to enhancement and segmentation of these microscopic images, which is important for the design and development of future algorithms before new epidemics.

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BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

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BACKGROUND: To date, there are no data available on the safety of COVID-19 vaccines in Latin American patients with Multiple Sclerosis (MS). OBJECTIVE: Characterize safety of COVID-19 vaccines in Latin American (LATAM) patients with Multiple Sclerosis (pwMS). METHODS: A cross-sectional study between February 1, 2021, and April 30, 2021. Individuals with MS from LATAM countries were invited to participate in a self-administered web-based survey, through MS patient organizations from the region. RESULTS: 393 vaccinated pwMS from 10 different Latin American countries were included. The vaccines administered were: inactivated virus vaccines (IVV) in 38.2% of patients, adenovirus vector vaccines (AdV) in 48.8% and mRNA vaccines 13%. All patients received at least one dose of any of the COVID-19 vaccines and 123 (31.3%) declared receiving a second dose. Mean (SD) age 41.5 (11.8) years, 82.4% female, MS disease duration: 8.4 (8.2) years. No serious adverse events were reported with any of the COVID-19 vaccines after either the first or second dose. A lower frequency of adverse events was found with IVV (22%) in comparison with AdV (46.4%) and mRNA (35.3%) (p < 0.01). Five participants reported having an MS relapse after IVV first dose. CONCLUSION: COVID-19 vaccines applied in LATAM proved safe for MS patients.

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Here, we analyzed the effects on Capsicum annuum plants of Trichoderma atroviride P. Karst strains altered in the expression of SWOLLENIN (SWO1), a protein with amorphogenic activity on plant cell wall components. Strains of T. atroviride that overexpressed the Taswo1 gene were constructed as well as deletion mutants. A novel, cheap and accurate method for assessing root colonization was developed. Colonization assays showed that the Taswo1 overexpressing strains invaded the host root better than the WT, resulting in a stronger plant growth-promoting effect. The expression of plant defense marker genes for both the systemic acquired resistance and induced systemic resistance pathways was enhanced in plants inoculated with Taswo1 overexpressing strains, while inoculation with deletion mutant strains resulted in a similar level of expression to that observed upon inoculation with the wild-type strain. Response to pathogen infection was also enhanced in the plants inoculated with the Taswo1 overexpressing strains, and surprisingly, an intermediate level of protection was achieved with the mutant strains. Tolerance to abiotic stresses was also higher in plants inoculated with the Taswo1 overexpressing strains but was similar in plants inoculated with the wild-type or the mutant strains. Compatible osmolyte production in drought conditions was studied. This study may contribute to improving Trichoderma biocontrol and biofertilization abilities.

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BACKGROUND: The novel coronavirus SARS-CoV-2 is the etiological agent of COVID-19. This virus has become one of the most dangerous in recent times with a very high rate of transmission. At present, several publications show the typical crown-shape of the novel coronavirus grown in cell cultures. However, an integral ultramicroscopy study done directly from clinical specimens has not been published. METHODS: Nasopharyngeal swabs were collected from 12 Cuban individuals, six asymptomatic and RT-PCR negative (negative control) and six others from a COVID-19 symptomatic and RT-PCR positive for SARS CoV-2. Samples were treated with an aldehyde solution and processed by scanning electron microscopy (SEM), confocal microscopy (CM) and, atomic force microscopy. Improvement and segmentation of coronavirus images were performed by a novel mathematical image enhancement algorithm. RESULTS: The images of the negative control sample showed the characteristic healthy microvilli morphology at the apical region of the nasal epithelial cells. As expected, they do not display virus-like structures. The images of the positive sample showed characteristic coronavirus-like particles and evident destruction of microvilli. In some regions, virions budding through the cell membrane were observed. Microvilli destruction could explain the anosmia reported by some patients. Virus-particles emerging from the cell-surface with a variable size ranging from 80 to 400 nm were observed by SEM. Viral antigen was identified in the apical cells zone by CM. CONCLUSIONS: The integral microscopy study showed that SARS-CoV-2 has a similar image to SARS-CoV. The application of several high-resolution microscopy techniques to nasopharyngeal samples awaits future use.

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Mexican fruit fly Anastrepha ludens (Loew) (Diptera: Tephritidae) is a key economic pest of citrus and represents a quarantine issue along the United States and Mexico Border. In order to respond to this threat, the United States Department of Agriculture produces approximately 175 million sterile Mexican fruit fly pupae per week and releases approximately 150 million adult flies per week via conventional fixed wing aircraft. Unmanned aircraft systems (UAS) offer a novel means of releasing sterile insects aerially, can be deployed on short notice in rapid response scenarios, require a small footprint to operate, and offer an alternative means to releasing sterile insects to traditional manned aircraft. UAS, however, are currently limited in two key areas, range and payload capacity. Swarm technology, flying multiple UAS at once, may increase the utility of UAS by distributing payloads and release patterns across multiple UAS. In order to test the viability of swarm technology in the release of sterile insects we conducted multiple mark release recapture experiments over south Texas citrus groves during 2017, 2018, and 2019. The results of this study demonstrate improved release rates from 89.9% (n = 5) of flies released with ca. 0.64% recapture during 2018, to 98.2% (n = 6) released with ca. 0.74% recapture during 2019. These results demonstrate that swarm technology is a viable technique for increasing aerial release capacity and flexibility of sterile insect technique (SIT) programs.

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Possibly, and due to poor eating habits and unhealthy lifestyle, many viruses are transmitted to human people. Such is the case, of the novel coronavirus SARS-Cov-2, which has expanded of exponential way, practically, to whole world population. For this reason, the enhancement of real microscopic images of this coronavirus is of great importance. Of this way, one can highlight the S-spikes and visualizing those areas that show a high density, which are related to active zones of viral germination and major spread of the virus. The SARS-Cov-2 images were captured from nasopharyngeal samples of Cuban symptomatic individuals (RT-PCR positives for SARS-CoV-2) and processed via scanning electron microscopy. However, many times these microscopic images present some blurring problems, and the S-spikes do not look well defined. Therefore, the aim of this work is to propose new computational methods to carry out enhancement and segmentation of SARS-Cov-2 high-resolution microscopic images. The proposed strategy obtained very satisfactory results, and we validated its performance, together with specialist physicians, on a set of 1005 images. Due to the importance of the obtained results, this first work will be addressed to the application of the proposed algorithm. A second paper will deeply analyze the theory related to these algorithms.

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RESUMEN Fundamento: Florence Nightingale fue una enfermera, escritora y estadística británica, considerada pionera de la enfermería moderna y creadora del primer modelo conceptual de enfermería. Objetivo: analizar a Florence Nightingale como la primera enfermera investigadora. Métodos: se realizó una revisión bibliográfica con el método de análisis bibliográfico a través de una búsqueda realizada entre los años 1994 al 2017, donde se consultaron bases de datos especializadas y se seleccionaron 28 publicaciones científicas sobre el tema. Resultados: se insistió en algunos tópicos dentro del tema, como los conocimientos de Florence Nigthingale en cuanto a la filosofía, historia, artes, matemáticas, estadísticas, religión que le permitieron desarrollar innovaciones de técnicas en los análisis estadísticos con lo cual mostró, como un fenómeno social que podía ser medido de manera objetiva y analizado matemáticamente. Conclusiones: Florence Nightingale fue la primera enfermera investigadora, su experiencia ha ejercido una gran influencia en el mundo de las matemáticas, las estadísticas y la Enfermería.

ABSTRACT Background: Florence Nightingale was a British nurse, writer and statistician, considered to be a pioneer of the modern infirmary and creator of the first conceptual model of infirmary. Objective: to analyze Florence Nightingale as the first research nurse. Methods: a bibliographical review was carried out with the method of bibliographical analysis through a search donefrom 1994 to 2017, where specialized databases were consulted and 28 scientific publications on the topic were selected. Results: it was insisted on some topics, as the knowledge of Florence Nigthingale as for the philosophy, history, arts, mathematics, statistics, religion that allowed her to develop technique innovations in the statistical analyses with which she showed, as a social phenomenon that could be measured in an objective way and analyzed mathematically. Conclusions: Florence Nightingale was the first reearch nurse, her experience has exercised a great influence in the world of the mathematics, the statistics and the Infirmary.

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Background: In Costa Rica, the leading cause of preventable death is smoking. Adults spend one third of their lives at work making the workplace an optimal site for smoking cessation interventions. Therefore, we developed a workplace smoking cessation pilot program among Costa Rican Justice Department government employees based on key Costa Rican values and best practices. Methods: First, focus groups were conducted among exsmokers and smokers. Participants in the focus groups and in the subsequent smoking cessation pilot study were invited to take part in the study through flyers, information sheets, and announcements from the Justice Department. The focus groups revealed that social factors were fundamental to quitting. Therefore, based on these results two programs (14 participants) were conducted consisting of seven sessions encouraging employees to utilize their family and exsmokers. Data were collected before and after the seven sessions on smoking behavior, social influence, and other factors. Findings: Five of 14 (36%) quit smoking. None of the quitters lived with a smoker, as compared with 56% of nonquitters who lived with a smoker. Also, quitters were less likely to have friends (40% vs. 67%) and coworkers (20% vs. 33%) who smoked compared with nonquitters. Conclusion/Application to Practice: Workplace smoking cessation programs should help smokers to increase their social contacts with nonsmokers/exsmokers. Smoking cessation programs should assess not only smoking patterns, but also social contacts, such as family, friends, and coworkers. Based on these assessments, smokers should be encouraged to seek-out nonsmokers/exsmokers to assist them in quitting.

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