In weather forecasting,generating atmospheric variables for regions with complex topography,such as the Andean regions with peaks reaching 6500 m above sea level,poses significant challenges.Traditional regional clima...In weather forecasting,generating atmospheric variables for regions with complex topography,such as the Andean regions with peaks reaching 6500 m above sea level,poses significant challenges.Traditional regional climate models often struggle to accurately represent the atmospheric behavior in such areas.Furthermore,the capability to produce high spatio-temporal resolution data(less than 27 km and hourly)is limited to a few institutions globally due to the substantial computational resources required.This study presents the results of atmospheric data generated using a new type of artificial intelligence(AI)models,aimed to reduce the computational cost of generating downscaled climate data using climate regional models like the Weather Research and Forecasting(WRF)model over the Andes.The WRF model was selected for this comparison due to its frequent use in simulating atmospheric variables in the Andes.Our results demonstrate a higher downscaling performance for the four target weather variables studied(temperature,relative humidity,zonal and meridional wind)over coastal,mountain,and jungle regions.Moreover,this AI model offers several advantages,including lower computational costs compared to dynamic models like WRF and continuous improvement potential with additional training data.展开更多
Lima is the capital of the Republic of Peru. It is the most important city in the country and as other Latin America metropolises have multiple problems, including air pollution due to particulate material above air q...Lima is the capital of the Republic of Peru. It is the most important city in the country and as other Latin America metropolises have multiple problems, including air pollution due to particulate material above air quality standards, emitted by 1.6 million vehicles. The “on-line” coupled model of meteorology and chemistry of transport and meteorological/chemistry, WRF/Chem (Weather and Research Forecasting with Chemistry) has been used in the Lima Metropolitan Area, and validated against data observed at ground level with ten air quality stations of the National Service of Meteorology and Hydrology for the year 2016. The goal of this study was to estimate the concentration of PM2.5 particulate matter in the months of February and July of 2016. In both months, the model satisfactorily predicts temperature and relative humidity. The average observed PM2.5 concentrations in the month of July are higher than in February, probably because the relative humidity in July is greater than the relative humidity in February. In the months of February and July the standard observed deviations of the model have a factor of 2.4 and 3.7 respectively, indicating a greater dispersion in the data of the model. In the month of July, the model captures the characteristics of transport, shows characteristic peaks during peak hours, therefore, the model estimates transport behavior better in July than in February. The quality of the air is strongly influenced by the vehicular transport. The PM2.5 particulate material in February had an average bias that varied from [?13.2 to 4.4 μg/m3] and in July [?9.63 to 11.65 μg/m3] and a normalized average bias in February that varied from [?0.68 to 0.43] and in July of [?0.46 to 0.48].展开更多
The potato crop in Peru is the main income and food source for the smallholder of the highland grower of the Peruvian Andes.For urban population,it represents one of the main components of the food basket and for comm...The potato crop in Peru is the main income and food source for the smallholder of the highland grower of the Peruvian Andes.For urban population,it represents one of the main components of the food basket and for commercial intermediaries.It is the main brokerage product considering its volume and value.To facilitate the adoption and diffusion of new potato cultivars after its release,adequate methodologies are necessary to apply during the process of evaluation and selection.One of these methodologies is called participatory varietal selection(PVS).The objective of this study was to identify new potato cultivars and/or genotypes with resistance or tolerance to adverse effects of climate change applying PVS,in order to obtain new varieties with acceptable economic yields.In this way potato growers of the Peruvian highland Andes should benefit through the improvement of their economic status,food security and overall life quality.During 2016-2017,three potato clones(CIP393079.4,CIP387096.2 and CIP396034.268)and two commercial varieties(Unica,Canchan)were evaluated at eight Peruvian locations in three regions(Huánuco,Junín and Huancavelica).Data were analyzed using a randomized complete block design,with three replications.Main criteria for selection were late blight resistance,abundant foliage,drought tolerance,yield and uniform and healthy tubers.In all three regions the three best clones selected were CIP396034.268,CIP393079.4 and CIP387096.2,ranking in first,second and third place,respectively.Men and women selected the same clones,but in a different order.Commercial cultivars ranked 4th and 5th.However,local growers selected Canchan,CIP387096.2 and CIP393079.4 based on appearance,texture and taste tests.The last two clones(CIP387096.2 and CIP393079.4)should be considered for a future release.展开更多
Deep shear-wave velocity profiles at eight places in Lima Peru were estimated based on the inversion of dispersion curves. The dispersion curves were calculated from small and large microtremor arrays using two method...Deep shear-wave velocity profiles at eight places in Lima Peru were estimated based on the inversion of dispersion curves. The dispersion curves were calculated from small and large microtremor arrays using two methods： the F-k proposed by Capon （1969） and the CCA proposed by Cho et al. （2004）. For the purpose of large array measurement we introduced a new type of sensor. Important results are the relative shallow depths to the basement rock in the area classified as alluvial gravel that covers most of the area of Lima city; and the relative large depth to the bedrock in places identified as VSV and CMA. It is recommended that this study be complemented with PS loggings in order to verify the estimated profiles.展开更多
Dengue is one of the most prominent tropical epidemic diseases present in the Rio de Janeiro city and Southeast part of Brazil, due to the widespread conditions of occurrence of the dengue vector, the mosquito Aedesae...Dengue is one of the most prominent tropical epidemic diseases present in the Rio de Janeiro city and Southeast part of Brazil, due to the widespread conditions of occurrence of the dengue vector, the mosquito Aedesaegypti, such as high-temperature days interlaced with afternoon or nocturnal rainstorms in summer. This work has the objective of investigating the relationships between variabilities of the El Ni?o-South Oscillation (ENSO) and greater epidemics of dengue in Rio de Janeiro city. To accomplish this goal, the analysis and signal decomposition by cross-wavelet transform (WT) was applied to obtain the cross variability associated with variations of power and phase of both signals by characteristic periods and along with the time series. Data considered in the analysis are (the decimal logarithm of normalized value) of the monthly available notifications of dengue worsening, provided by the public health system of Brazil, and the Southern Oscillation Index (SOI) Ni?o 3.4 data, provided by the National Oceanic and Atmospheric Administration (NOAA), in the period 2000-2017. A maximum cross-wavelet power close to 0.45 was obtained for the representative period of 1 year and also to periods between 3 and 4 years, associated with the positive phase of the SOI index (i.e. , La Ni?a) or with a transition to the positive phase. The evolution of the combined variability of SOI and dengue can be expressed by progressive differences in phase along the time, eventually resulting in yielding phases (i.e., La Niña-Dengue epidemic).展开更多
The Sendai Framework for Disaster Risk Reduction 2015-2030(SFDRR)is at its 10th anniversary amidst a rapidly changing climate,which,together with social vulnerabilities,have led to significant impacts on human health ...The Sendai Framework for Disaster Risk Reduction 2015-2030(SFDRR)is at its 10th anniversary amidst a rapidly changing climate,which,together with social vulnerabilities,have led to significant impacts on human health and well-being.In the climate change and health field,the term“climate-related health risks”is often used while the term“health disaster”is less common.This article identifies opportunities and challenges that the SFDRR presents for the intersection between climate change and health.The SFDRR,through disaster risk reduction for climate change and health,complements international health-and climate change-related agendas.It expands the perspective of climate change and health beyond the classical health sphere by highlighting the importance of addressing the underlying drivers of disaster risk,most of them related to social vulnerabilities.Additionally,strong governance and leadership from the health sector might foster the integration of health-centered perspectives into climate change policies.However,the SFDRR faces challenges due to differential capacities among countries,which limit effective implementation.The role of politics,power,and diverse interests needs to be recognized in disaster-related decision-making processes,as well as the many barriers for global and systematic disaster-related data structures that limit a comprehensive understanding of disaster risk.The 10th anniversary of the SFDRR represents an opportunity to reflect on the many opportunities that it represents and on the challenges that need to be addressed.By looking for synergies among diverse agendas,initiatives,and collaborations,the SFDRR sheds some light on protecting people’s health and well-being.展开更多
The COVID-19 pandemic that emerged in Wuhan China has generated substantial morbidity and mortality impact around the world during the last four months.The daily trend in reported cases has been rapidly rising in Lati...The COVID-19 pandemic that emerged in Wuhan China has generated substantial morbidity and mortality impact around the world during the last four months.The daily trend in reported cases has been rapidly rising in Latin America since March 2020 with the great majority of the cases reported in Brazil followed by Peru as of April 15th,2020.Although Peru implemented a range of social distancing measures soon after the confirmation of its first case on March 6th,2020,the daily number of new COVID-19 cases continues to accumulate in this country.We assessed the early COVID-19 transmission dynamics and the effect of social distancing interventions in Lima,Peru.We estimated the reproduction number,R,during the early transmission phase in Lima from the daily series of imported and autochthonous cases by the date of symptoms onset as of March 30th,2020.We also assessed the effect of social distancing interventions in Lima by generating short-term forecasts grounded on the early transmission dynamics before interventions were put in place.Prior to the implementation of the social distancing measures in Lima,the local incidence curve by the date of symptoms onset displays near exponential growth dynamics with the mean scaling of growth parameter,p,estimated at 0.96(95%CI:0.87,1.0)and the reproduction number at 2.3(95%CI:2.0,2.5).Our analysis indicates that school closures and other social distancing interventions have helped slow down the spread of the novel coronavirus,with the nearly exponential growth trend shifting to an approximately linear growth trend soon after the broad scale social distancing interventions were put in place by the government.While the interventions appear to have slowed the transmission rate in Lima,the number of new COVID-19 cases continue to accumulate,highlighting the need to strengthen social distancing and active case finding efforts to mitigate disease transmission in the region.展开更多
Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis(TB),however,such studies have never been conducted in Peru.Considering the association between air pol...Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis(TB),however,such studies have never been conducted in Peru.Considering the association between air pollution and specific geographic areas,our objective was to determine the spatial distribution and clustering of TB incident cases in Lima and their co-occurrence with clusters of fine particulate matter(PM2.5)and poverty.We found co-occurrences of clusters of elevated concentrations of air pollutants such as PM2.5,high poverty indexes,and high TB incidence in Lima.These findings suggest an interplay of socio-economic and environmental in driving TB incidence.展开更多
This paper evaluates rail transit within the context of the transit policies implemented in Lima,Peru.First it reviews the implementation of rapid transit,and bus reform.Secondly,it evaluates the outcomes of such poli...This paper evaluates rail transit within the context of the transit policies implemented in Lima,Peru.First it reviews the implementation of rapid transit,and bus reform.Secondly,it evaluates the outcomes of such policies by using Total Factor Productivity for policy effectiveness,Data Envelopment Analysis for rapid transit performance,and Generalized Cost of Travel for improvements.This paper finds that implementation failed in enforcing key requirements for rail transit regarding penetration of CBD and short transfers to bus transit;and that the basic assumptions of bus reform did not hold regarding bus oversupply,bus congestion or bus pollution.This paper also finds that outcomes of policies failed dramatically in achieving the planning goals;however,rail transit(Metro)shows high level of resilience in serving large ridership at high speed.On the other hand,bus reform was associated with a disproportionate increase of motorization,well over the effect of income growth or car attractiveness,and more related to the excessive reduction of bus transit capacity ill-advised from unproved bus reform assumptions.This paper recommends expanding rail rapid transit due to its intensive use of green renewable energy and its potential of demand growth if combined with modern Intelligent Transportation services,but this opportunity can be wasted without the proposed policy constraint to achieve lower Generalized Cost of Travel at any governmental intervention for bus reform,instead of just reducing bus transit capacity as implemented.Finally,this paper recommends government to government contracts to build rail transit and to enforce proper planning.展开更多
Background:Tuberculosis(TB)prevention through the use of preventive treatment is a critical activity in the elimination ofTB.In multiple settings,limited staffing has been identified as a barrier to managing preventiv...Background:Tuberculosis(TB)prevention through the use of preventive treatment is a critical activity in the elimination ofTB.In multiple settings,limited staffing has been identified as a barrier to managing preventive treatment for TB contacts.This study aims to determine how health center staffing,service type,and TB caseload affects implementation of isoniazid preventive therapy(IPT)forTB contacts in southern Lima.Methods:We conducted an ecological study in 2019 in southern Lima,Peru.Through the review of medical records,we identified contacts ofTB patients who initiated IPT during 2016-2018,and who were 0-19 years old,the age group eligible for IPT according to Peruvian guidelines.We assessed bivariate associations between health center characteristics(numbers of physicians and nurses,types of services available,annual TB caseload)and IPT initiation and completion using binomial logistic regression.Results:Among 977 contacts,69%took more than a week to start IPT and 41%did not complete IPT.For those who successfully completed IPT,58%did not complete full medical follow-up.There was no significant difference in IPT completion or adherence based on whether health centers had more physicians and nurses,more comprehensive services,or higherTB caseloads.Among contacts,female sex was associated with delay in initiating IPT(P=0.005),age 5-19 years old was associated with completion of IPT(P=0.025)and age<5 years old was associated with completion of clinical evaluations(P=0.041).Conclusions:There are significant gaps in IPT implementation in health centers of southern Lima,Peru,but insufficient staffing of health centers may not be responsible.Further research is needed to identify how IPT implementation can be improved,potentially through improving stafftraining or monitoring and supervision.展开更多
Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer,the sixth most common cancer worldwide,and the third leading cause of cancer-related death.Cirrhosis is the predominant risk factor for HCC,...Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer,the sixth most common cancer worldwide,and the third leading cause of cancer-related death.Cirrhosis is the predominant risk factor for HCC,driven by major etiologies including hepatitis B and C,excessive alcohol consumption,and metabolic dysfunction-associated steatotic liver disease(MASLD).While approximately 80%of HCC cases occur in patients with cirrhosis,its incidence among individuals without cirrhosis has significantly increased,particularly in developed countries,driven by the rising prevalence of MASLD.The prevalence of patients with non-cirrhotic HCC varies geographically,yet data on this subgroup remain limited.Consequently,screening and clinical management guidelines for patients with non-cirrhotic HCC are underdeveloped.Current surveillance is typically not recommended for non-cirrhotic populations,except for individuals with hepatitis B,and diagnostic criteria like Liver Imaging Reporting and Data System are designed explicitly for cirrhotic or hepatitis B-associated HCC.Furthermore,treatment strategies for non-cirrhotic HCC are often extrapolated from studies focused on patients with cirrhosis,leading to gaps in knowledge regarding treatment efficacy,survival outcomes,and etiological variability in noncirrhotic cohorts.Thus,emerging evidence must be reviewed to guide the development of enhanced diagnostic and therapeutic strategies for patients with non-cirrhotic HCC.To address these gaps,we comprehensively reviewed the epidemiology,clinical and genetic characteristics,diagnostic modalities,and therapeutic approaches for patients with non-cirrhotic HCC.展开更多
BACKGROUND Well-differentiated rectal neuroendocrine tumors(rNETs)represent approximately 28%of gastrointestinal neuroendocrine tumors,with a rising incidence over recent decades.However,data from Perúremains lim...BACKGROUND Well-differentiated rectal neuroendocrine tumors(rNETs)represent approximately 28%of gastrointestinal neuroendocrine tumors,with a rising incidence over recent decades.However,data from Perúremains limited.AIM To assess overall survival(OS)in patients with rNETs and describe the clinical and pathological characteristics of the study population.METHODS This retrospective study included patients diagnosed with rNETs at the Instituto Nacional de Enfermedades Neoplásicas between 2009 and 2024.Qualitative variables were evaluated using theχ^(2)test through contingency tables.OS was estimated using the Kaplan-Meier method,and differences between groups were assessed with the log-rank test.Cox proportional hazards models were used to evaluate variables associated with OS.All statistical analyses were conducted using R software.RESULTS A total of 52 patients were included,with a mean age of 51.9 years(range:27-74 years)and composed of 65.4%females.The most common stage at diagnosis was stage I(48.1%),followed by stage IV(36.5%).The median OS within the study population was 76 months.The 5-year OS for grade 1 tumors was 92.9%compared to 32.6%for grade 2 tumors(P=0.00032).The median OS was 48 months for tumors exceeding 20 mm in size,whereas it was not reached for tumors measuring 20 mm or less(P=0.0056).Similarly,the median OS for patients classified as lymph node involvement 1 was 46 months,while it was estimated at 112 months for those classified as lymph node involvement 0(P=0.0063).CONCLUSION rNETs exceeding 2 cm in size,classified as grade 2,or presenting with lymph node involvement 1 status were correlated with advanced disease stages and diminished survival outcomes.展开更多
This article presents the optical evaluation of the vibrational behavior of a steel bar,by a non-conventional optoacoustic procedure,the LPD(laser photo deflection)method.On this occasion the bar is located horizontal...This article presents the optical evaluation of the vibrational behavior of a steel bar,by a non-conventional optoacoustic procedure,the LPD(laser photo deflection)method.On this occasion the bar is located horizontal and fixed at both ends.Through our procedure we experimentally find the first 9 Eigen frequencies(21 Hz,60 Hz,116 Hz...)and correlate them using the cantilever theory.展开更多
文摘In weather forecasting,generating atmospheric variables for regions with complex topography,such as the Andean regions with peaks reaching 6500 m above sea level,poses significant challenges.Traditional regional climate models often struggle to accurately represent the atmospheric behavior in such areas.Furthermore,the capability to produce high spatio-temporal resolution data(less than 27 km and hourly)is limited to a few institutions globally due to the substantial computational resources required.This study presents the results of atmospheric data generated using a new type of artificial intelligence(AI)models,aimed to reduce the computational cost of generating downscaled climate data using climate regional models like the Weather Research and Forecasting(WRF)model over the Andes.The WRF model was selected for this comparison due to its frequent use in simulating atmospheric variables in the Andes.Our results demonstrate a higher downscaling performance for the four target weather variables studied(temperature,relative humidity,zonal and meridional wind)over coastal,mountain,and jungle regions.Moreover,this AI model offers several advantages,including lower computational costs compared to dynamic models like WRF and continuous improvement potential with additional training data.
文摘Lima is the capital of the Republic of Peru. It is the most important city in the country and as other Latin America metropolises have multiple problems, including air pollution due to particulate material above air quality standards, emitted by 1.6 million vehicles. The “on-line” coupled model of meteorology and chemistry of transport and meteorological/chemistry, WRF/Chem (Weather and Research Forecasting with Chemistry) has been used in the Lima Metropolitan Area, and validated against data observed at ground level with ten air quality stations of the National Service of Meteorology and Hydrology for the year 2016. The goal of this study was to estimate the concentration of PM2.5 particulate matter in the months of February and July of 2016. In both months, the model satisfactorily predicts temperature and relative humidity. The average observed PM2.5 concentrations in the month of July are higher than in February, probably because the relative humidity in July is greater than the relative humidity in February. In the months of February and July the standard observed deviations of the model have a factor of 2.4 and 3.7 respectively, indicating a greater dispersion in the data of the model. In the month of July, the model captures the characteristics of transport, shows characteristic peaks during peak hours, therefore, the model estimates transport behavior better in July than in February. The quality of the air is strongly influenced by the vehicular transport. The PM2.5 particulate material in February had an average bias that varied from [?13.2 to 4.4 μg/m3] and in July [?9.63 to 11.65 μg/m3] and a normalized average bias in February that varied from [?0.68 to 0.43] and in July of [?0.46 to 0.48].
文摘The potato crop in Peru is the main income and food source for the smallholder of the highland grower of the Peruvian Andes.For urban population,it represents one of the main components of the food basket and for commercial intermediaries.It is the main brokerage product considering its volume and value.To facilitate the adoption and diffusion of new potato cultivars after its release,adequate methodologies are necessary to apply during the process of evaluation and selection.One of these methodologies is called participatory varietal selection(PVS).The objective of this study was to identify new potato cultivars and/or genotypes with resistance or tolerance to adverse effects of climate change applying PVS,in order to obtain new varieties with acceptable economic yields.In this way potato growers of the Peruvian highland Andes should benefit through the improvement of their economic status,food security and overall life quality.During 2016-2017,three potato clones(CIP393079.4,CIP387096.2 and CIP396034.268)and two commercial varieties(Unica,Canchan)were evaluated at eight Peruvian locations in three regions(Huánuco,Junín and Huancavelica).Data were analyzed using a randomized complete block design,with three replications.Main criteria for selection were late blight resistance,abundant foliage,drought tolerance,yield and uniform and healthy tubers.In all three regions the three best clones selected were CIP396034.268,CIP393079.4 and CIP387096.2,ranking in first,second and third place,respectively.Men and women selected the same clones,but in a different order.Commercial cultivars ranked 4th and 5th.However,local growers selected Canchan,CIP387096.2 and CIP393079.4 based on appearance,texture and taste tests.The last two clones(CIP387096.2 and CIP393079.4)should be considered for a future release.
文摘Deep shear-wave velocity profiles at eight places in Lima Peru were estimated based on the inversion of dispersion curves. The dispersion curves were calculated from small and large microtremor arrays using two methods： the F-k proposed by Capon （1969） and the CCA proposed by Cho et al. （2004）. For the purpose of large array measurement we introduced a new type of sensor. Important results are the relative shallow depths to the basement rock in the area classified as alluvial gravel that covers most of the area of Lima city; and the relative large depth to the bedrock in places identified as VSV and CMA. It is recommended that this study be complemented with PS loggings in order to verify the estimated profiles.
文摘Dengue is one of the most prominent tropical epidemic diseases present in the Rio de Janeiro city and Southeast part of Brazil, due to the widespread conditions of occurrence of the dengue vector, the mosquito Aedesaegypti, such as high-temperature days interlaced with afternoon or nocturnal rainstorms in summer. This work has the objective of investigating the relationships between variabilities of the El Ni?o-South Oscillation (ENSO) and greater epidemics of dengue in Rio de Janeiro city. To accomplish this goal, the analysis and signal decomposition by cross-wavelet transform (WT) was applied to obtain the cross variability associated with variations of power and phase of both signals by characteristic periods and along with the time series. Data considered in the analysis are (the decimal logarithm of normalized value) of the monthly available notifications of dengue worsening, provided by the public health system of Brazil, and the Southern Oscillation Index (SOI) Ni?o 3.4 data, provided by the National Oceanic and Atmospheric Administration (NOAA), in the period 2000-2017. A maximum cross-wavelet power close to 0.45 was obtained for the representative period of 1 year and also to periods between 3 and 4 years, associated with the positive phase of the SOI index (i.e. , La Ni?a) or with a transition to the positive phase. The evolution of the combined variability of SOI and dengue can be expressed by progressive differences in phase along the time, eventually resulting in yielding phases (i.e., La Niña-Dengue epidemic).
文摘The Sendai Framework for Disaster Risk Reduction 2015-2030(SFDRR)is at its 10th anniversary amidst a rapidly changing climate,which,together with social vulnerabilities,have led to significant impacts on human health and well-being.In the climate change and health field,the term“climate-related health risks”is often used while the term“health disaster”is less common.This article identifies opportunities and challenges that the SFDRR presents for the intersection between climate change and health.The SFDRR,through disaster risk reduction for climate change and health,complements international health-and climate change-related agendas.It expands the perspective of climate change and health beyond the classical health sphere by highlighting the importance of addressing the underlying drivers of disaster risk,most of them related to social vulnerabilities.Additionally,strong governance and leadership from the health sector might foster the integration of health-centered perspectives into climate change policies.However,the SFDRR faces challenges due to differential capacities among countries,which limit effective implementation.The role of politics,power,and diverse interests needs to be recognized in disaster-related decision-making processes,as well as the many barriers for global and systematic disaster-related data structures that limit a comprehensive understanding of disaster risk.The 10th anniversary of the SFDRR represents an opportunity to reflect on the many opportunities that it represents and on the challenges that need to be addressed.By looking for synergies among diverse agendas,initiatives,and collaborations,the SFDRR sheds some light on protecting people’s health and well-being.
基金G.C.is partially supported from NSF grants 1610429 and 1633381 and R01 GM 130900.
文摘The COVID-19 pandemic that emerged in Wuhan China has generated substantial morbidity and mortality impact around the world during the last four months.The daily trend in reported cases has been rapidly rising in Latin America since March 2020 with the great majority of the cases reported in Brazil followed by Peru as of April 15th,2020.Although Peru implemented a range of social distancing measures soon after the confirmation of its first case on March 6th,2020,the daily number of new COVID-19 cases continues to accumulate in this country.We assessed the early COVID-19 transmission dynamics and the effect of social distancing interventions in Lima,Peru.We estimated the reproduction number,R,during the early transmission phase in Lima from the daily series of imported and autochthonous cases by the date of symptoms onset as of March 30th,2020.We also assessed the effect of social distancing interventions in Lima by generating short-term forecasts grounded on the early transmission dynamics before interventions were put in place.Prior to the implementation of the social distancing measures in Lima,the local incidence curve by the date of symptoms onset displays near exponential growth dynamics with the mean scaling of growth parameter,p,estimated at 0.96(95%CI:0.87,1.0)and the reproduction number at 2.3(95%CI:2.0,2.5).Our analysis indicates that school closures and other social distancing interventions have helped slow down the spread of the novel coronavirus,with the nearly exponential growth trend shifting to an approximately linear growth trend soon after the broad scale social distancing interventions were put in place by the government.While the interventions appear to have slowed the transmission rate in Lima,the number of new COVID-19 cases continue to accumulate,highlighting the need to strengthen social distancing and active case finding efforts to mitigate disease transmission in the region.
基金Gabriel Carrasco-Escobar was supported by NIH/Fogarty International Center Global Infectious Diseases Training Program (D43 TW007120)The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
文摘Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis(TB),however,such studies have never been conducted in Peru.Considering the association between air pollution and specific geographic areas,our objective was to determine the spatial distribution and clustering of TB incident cases in Lima and their co-occurrence with clusters of fine particulate matter(PM2.5)and poverty.We found co-occurrences of clusters of elevated concentrations of air pollutants such as PM2.5,high poverty indexes,and high TB incidence in Lima.These findings suggest an interplay of socio-economic and environmental in driving TB incidence.
文摘This paper evaluates rail transit within the context of the transit policies implemented in Lima,Peru.First it reviews the implementation of rapid transit,and bus reform.Secondly,it evaluates the outcomes of such policies by using Total Factor Productivity for policy effectiveness,Data Envelopment Analysis for rapid transit performance,and Generalized Cost of Travel for improvements.This paper finds that implementation failed in enforcing key requirements for rail transit regarding penetration of CBD and short transfers to bus transit;and that the basic assumptions of bus reform did not hold regarding bus oversupply,bus congestion or bus pollution.This paper also finds that outcomes of policies failed dramatically in achieving the planning goals;however,rail transit(Metro)shows high level of resilience in serving large ridership at high speed.On the other hand,bus reform was associated with a disproportionate increase of motorization,well over the effect of income growth or car attractiveness,and more related to the excessive reduction of bus transit capacity ill-advised from unproved bus reform assumptions.This paper recommends expanding rail rapid transit due to its intensive use of green renewable energy and its potential of demand growth if combined with modern Intelligent Transportation services,but this opportunity can be wasted without the proposed policy constraint to achieve lower Generalized Cost of Travel at any governmental intervention for bus reform,instead of just reducing bus transit capacity as implemented.Finally,this paper recommends government to government contracts to build rail transit and to enforce proper planning.
文摘Background:Tuberculosis(TB)prevention through the use of preventive treatment is a critical activity in the elimination ofTB.In multiple settings,limited staffing has been identified as a barrier to managing preventive treatment for TB contacts.This study aims to determine how health center staffing,service type,and TB caseload affects implementation of isoniazid preventive therapy(IPT)forTB contacts in southern Lima.Methods:We conducted an ecological study in 2019 in southern Lima,Peru.Through the review of medical records,we identified contacts ofTB patients who initiated IPT during 2016-2018,and who were 0-19 years old,the age group eligible for IPT according to Peruvian guidelines.We assessed bivariate associations between health center characteristics(numbers of physicians and nurses,types of services available,annual TB caseload)and IPT initiation and completion using binomial logistic regression.Results:Among 977 contacts,69%took more than a week to start IPT and 41%did not complete IPT.For those who successfully completed IPT,58%did not complete full medical follow-up.There was no significant difference in IPT completion or adherence based on whether health centers had more physicians and nurses,more comprehensive services,or higherTB caseloads.Among contacts,female sex was associated with delay in initiating IPT(P=0.005),age 5-19 years old was associated with completion of IPT(P=0.025)and age<5 years old was associated with completion of clinical evaluations(P=0.041).Conclusions:There are significant gaps in IPT implementation in health centers of southern Lima,Peru,but insufficient staffing of health centers may not be responsible.Further research is needed to identify how IPT implementation can be improved,potentially through improving stafftraining or monitoring and supervision.
文摘Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer,the sixth most common cancer worldwide,and the third leading cause of cancer-related death.Cirrhosis is the predominant risk factor for HCC,driven by major etiologies including hepatitis B and C,excessive alcohol consumption,and metabolic dysfunction-associated steatotic liver disease(MASLD).While approximately 80%of HCC cases occur in patients with cirrhosis,its incidence among individuals without cirrhosis has significantly increased,particularly in developed countries,driven by the rising prevalence of MASLD.The prevalence of patients with non-cirrhotic HCC varies geographically,yet data on this subgroup remain limited.Consequently,screening and clinical management guidelines for patients with non-cirrhotic HCC are underdeveloped.Current surveillance is typically not recommended for non-cirrhotic populations,except for individuals with hepatitis B,and diagnostic criteria like Liver Imaging Reporting and Data System are designed explicitly for cirrhotic or hepatitis B-associated HCC.Furthermore,treatment strategies for non-cirrhotic HCC are often extrapolated from studies focused on patients with cirrhosis,leading to gaps in knowledge regarding treatment efficacy,survival outcomes,and etiological variability in noncirrhotic cohorts.Thus,emerging evidence must be reviewed to guide the development of enhanced diagnostic and therapeutic strategies for patients with non-cirrhotic HCC.To address these gaps,we comprehensively reviewed the epidemiology,clinical and genetic characteristics,diagnostic modalities,and therapeutic approaches for patients with non-cirrhotic HCC.
文摘BACKGROUND Well-differentiated rectal neuroendocrine tumors(rNETs)represent approximately 28%of gastrointestinal neuroendocrine tumors,with a rising incidence over recent decades.However,data from Perúremains limited.AIM To assess overall survival(OS)in patients with rNETs and describe the clinical and pathological characteristics of the study population.METHODS This retrospective study included patients diagnosed with rNETs at the Instituto Nacional de Enfermedades Neoplásicas between 2009 and 2024.Qualitative variables were evaluated using theχ^(2)test through contingency tables.OS was estimated using the Kaplan-Meier method,and differences between groups were assessed with the log-rank test.Cox proportional hazards models were used to evaluate variables associated with OS.All statistical analyses were conducted using R software.RESULTS A total of 52 patients were included,with a mean age of 51.9 years(range:27-74 years)and composed of 65.4%females.The most common stage at diagnosis was stage I(48.1%),followed by stage IV(36.5%).The median OS within the study population was 76 months.The 5-year OS for grade 1 tumors was 92.9%compared to 32.6%for grade 2 tumors(P=0.00032).The median OS was 48 months for tumors exceeding 20 mm in size,whereas it was not reached for tumors measuring 20 mm or less(P=0.0056).Similarly,the median OS for patients classified as lymph node involvement 1 was 46 months,while it was estimated at 112 months for those classified as lymph node involvement 0(P=0.0063).CONCLUSION rNETs exceeding 2 cm in size,classified as grade 2,or presenting with lymph node involvement 1 status were correlated with advanced disease stages and diminished survival outcomes.
文摘This article presents the optical evaluation of the vibrational behavior of a steel bar,by a non-conventional optoacoustic procedure,the LPD(laser photo deflection)method.On this occasion the bar is located horizontal and fixed at both ends.Through our procedure we experimentally find the first 9 Eigen frequencies(21 Hz,60 Hz,116 Hz...)and correlate them using the cantilever theory.
