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Purpose – The objective of this article is to evaluate the quality of tourism services in the city of Cartagena de Indias, Colombia, from the perspective of foreign tourists arriving there, and to identify the elements that have the greatest influence on satisfaction and future behaviour, the latter expressed in the desire to return to enjoy the destination and/or recommend the city to third parties. Design – The paper proposes a Formative Type Model, where observable variables affect latent or structural variables. Five factors have been considered in this valuation: Tangibility, Reliability, Responsiveness, Security and Empathy. Methodology – The multivariate Partial Least Squares Regression technique is used, belonging to the set of methods of Structural Equation Systems. 390 surveys were applied to Spanish, English, and Italian-speaking international tourists, with a confidence level of 95% and a margin of error of 5%, assuming an infinite population. Findings – The results show that international tourists intend to return to the destination and overall satisfaction was positive. Originality – The results of this study contribute to the scientific literature on new methods for evaluating the quality of tourism services, using analysis techniques that place the customer at the center of decision-making.

mHealth apps (MHA) are emerging as promising tools for cardiovascular risk assessment, but few meet the standards required for clinical use. We aim to evaluate the quality and functionality of mHealth apps for cardiovascular risk assessment by healthcare professionals. We conducted a systematic review of MHA for cardiovascular risk assessment in the Apple Store, Play Store, and Microsoft Store until August 2023. Our eligibility criteria were based on the 2021 European Society Cardiology Guidelines on Cardiovascular Disease Prevention in Clinical Practice, the Framingham Risk Score, and the Atherosclerotic Cardiovascular Disease score. Our protocol was drafted using the Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. To assess quality, we used the validated Mobile Apps Rating Scale (MARS) score, which includes 19 items across four objective scales (engagement, functionality, aesthetics, and information quality) and one additional subjective scale. For functionality evaluation, we used the IMS Institute for Healthcare Informatics functionality scale. We performed data synthesis by generating descriptive statistics. A total of 18 MHA were included in the review. The most common scores used were the Framingham score, ASCVD score, and Score 2. Only six apps achieved an overall score of 4 or greater in the MARS evaluation. The MHA with the highest MARS score was ESC CVD Risk Calculation (5 points), followed by ASCVD Risk Estimator Plus (4.9 points). In the IMS scale, four MHA had a high functionality score: ASCVD Risk Estimator Plus (5 points), ESC CVD Risk Calculation (5 points), MDCalc Medical Calculator (4 points), and Calculate by QsMD (4 points). A gap exists in the availability of high-quality MHA designed for healthcare professionals to facilitate shared decision-making in cardiovascular risk assessment. The International Prospective Register of Systematic Reviews, identifier CRD42023453807.

An understanding of the interaction between rice and dark septate endophytic (DSE) fungi, under green fertilization, may lead to sustainable agricultural practices. Nevertheless, this interaction is still poorly understood. Therefore, in this study, we aimed to evaluate the accumulation of macro- and micronutrients, dry matter, and protein and N recovery efficiency from Canavalia ensiformis (L.)-15N in rice inoculated with DSE fungi. An experiment under greenhouse conditions was conducted in a randomized complete block design comprising split-plots, with five replicates of rice plants potted in non-sterilized soil. Rice (Piauí variety) seedlings were inoculated with DSE fungi, A101 and A103, or left uninoculated (control) and transplanted into pots containing 12 kg of soil, which had previously been supplemented with dry, finely ground shoot biomass of C. ensiformis enriched with 2.15 atom % 15N. Two collections were performed in the experiment: one at 54 days after transplanting (DAT) and one at 130 DAT (at maturation). Growth indicators (at 54 DAT), grain yield, nutrient content, recovery efficiency, and the amount of N derived from C. ensiformis were quantified. At 54 DAT, the N content, chlorophyll content, and plant height of inoculated plants had increased significantly compared with the control, and these plants were more proficient in the use of N derived from C. ensiformis . At maturation, plants inoculated with A103 were distinguished by the recovery efficiency and amount of N derived from C. ensiformis and N content in the grain and shoot being equal to that in A101 inoculation and higher than that in the control, resulting in a higher accumulation of crude protein and dry matter in the full grain and panicle of DSE-rice interaction. In addition, Fe and Ni contents in the grains of rice inoculated with these fungi doubled with respect to the control, and in A103 inoculation, we observed Mn accumulation that was three times higher than in the other treatments. Our results suggest that the inoculation of rice with DSE fungi represents a strategy to improve green manure-N recovery, grain yield per plant, and grain quality in terms of micronutrients contents in cropping systems with a low N input.

Over the period 2002–11, the Colombian labour market saw a marked improvement in employment opportunities, accompanied by an increase in nonstandard forms of employment. The authors look at how this affected employment quality, using a composite index based on Categorical Principal Components Analysis (CATPCA). They observe a small but widespread improvement in employment quality – mainly for self‐employed women – brought about by higher earnings, increased social protection and less time‐related underemployment. However, a considerable “quality deficit” remains, which calls for policies to strengthen labour market institutions and stimulate productivity and investment.

Nonbacterial thrombotic endocarditis (NBTE) is a sterile fibrin-platelet valvular condition associated with malignancy and hypercoagulable states. It produces friable vegetations prone to systemic embolization, often presenting as multifocal ischemic stroke. While modestly linked to advanced adenocarcinomas, its association with melanoma is exceedingly rare; We present a 43-year-old man with recently diagnosed metastatic melanoma who presented with fever, confusion and abdominal pain. Brain magnetic resonance imaging (MRI) revealed multifocal bilateral acute infarcts. Additional imaging demonstrated splenic and bilateral renal infarcts. Transesophageal echocardiography (TEE) revealed an 8 mm × 7 mm multilobar lesion on the posterior mitral valve leaflet. Blood cultures remained persistently negative; autoimmune and infectious workup were unrevealing, and positron emission tomography-computed tomography (PET-CT) showed no cardiac hypermetabolism. Despite empiric antibiotics for suspected infective endocarditis (IE), progressive embolic infarcts occurred. After exclusion of infection, NBTE was considered, and therapeutic enoxaparin was initiated, resulting in clinical stabilization without hemorrhagic conversion; Distinguishing NBTE from IE remains challenging due to overlapping and nonspecific imaging findings. TEE is the preferred diagnostic modality because of its high sensitivity for detecting small valvular vegetations. Adjunctive imaging modalities such as brain MRI and PET-CT may support the diagnosis by demonstrating embolic patterns or excluding metabolically active infectious vegetations. Management primarily relies on systemic anticoagulation, while percutaneous vegetation aspiration may represent a potential diagnostic and therapeutic strategy. Clinicians should maintain high suspicion of this condition in patients with advanced melanoma and other malignancies presenting with multifocal embolic phenomena and negative cultures to enable timely anticoagulation.

This work presents an implementation of a Nested Decomposition Algorithm (NDA) applied to co-optimizing generation and transmission capacity expansion planning problems in power systems, including operational flexibility constraints. The proposed methodology has been gaining relevance in recent years, as it can efficiently solve large mixed-integer problems faster than the conventional extensive formulation (mixed-integer linear programming). Three case studies are conducted on two IEEE test power systems to evaluate the algorithm’s performance and cut configuration. The first case study compares the performance between the NDA and the extensive formulation. The second case study compares the performance of each cut type, analyzing differences in simulation times and algorithm convergence. The third case study proposes a set of cut patterns based on the prior outcomes, whose performance and convergence are tested. Based on the simulation results, conclusions are drawn about the capability and performance of the NDA applied to the capacity expansion planning problem. The study shows that obtaining results with reasonable convergence in less simulation time is possible using a particular pattern.

This research attempts to answer which is the most recommended structural equation model (SEM) technique while evaluating healthcare services' quality in Cartagena de Indias city (Colombia). CB-SEM and PLSSEM techniques were used in this paper for comparing the results in the local context. For assessment, robust weighted least squares with mean and variance adjustments (WLS) for CB-SEM technique and PLSSEM with centroid scheme were utilized. Data were collected with a final valid sample of 582 adults aged over 18 years, residents of Cartagena city. Also used was a questionnaire designed in three parts: demographic profiles, quality perceptions (overall quality services, infrastructure, coverage, and access), and satisfaction levels. In terms of quality, the findings reveal that infrastructure and access have a significant effect on service quality levels and this variable has a strong effect on satisfaction for both techniques. In term of structural equation model (SEM) techniques, the results indicate that coverage does not present a significant effect on service quality only in CB-SEM technique. In this case, the positive association between coverage and overall services quality was rejected. Both techniques were validated with different results, concluding the applicability of CB-SEM and PLS-SEM in this context.

Background Dengue fever remains a significant public health challenge in tropical and subtropical regions, with its transmission dynamics being influenced by both environmental factors and human mobility. The Dominican Republic, a biodiversity hotspot in the Caribbean, has experienced recurrent dengue outbreaks, yet detailed understanding of the virus's transmission pathways and the impact of climatic factors remains limited. This study aims to elucidate the recent transmission dynamics of the dengue virus (DENV) in the Dominican Republic, utilizing a combination of genomic sequencing and epidemiological data analysis, alongside an examination of historical climate patterns. Methods We conducted a comprehensive study involving the genomic sequencing of DENV samples collected from patients across different regions of the Dominican Republic over a two-year period. Phylogenetic analyses were performed to identify the circulation of DENV lineages and to trace transmission pathways. Epidemiological data were integrated to analyze trends in dengue incidence and distribution. Additionally, we integrated historical climate data spanning several decades to assess trends in temperature and their potential impact on DENV transmission potential. Results Our results highlight a previously unknown north–south transmission pathway within the country, with the co-circulation of multiple virus lineages. Additionally, we examine the historical climate data, revealing long-term trends towards higher theoretical potential for dengue transmission due to rising temperatures. Conclusion This multidisciplinary study reveals intricate patterns of dengue virus transmission in the Dominican Republic, characterized by the co-circulation of multiple DENV lineages and a novel transmission pathway. The observed correlation between rising temperatures and increased dengue transmission potential emphasizes the need for integrated climate-informed strategies in dengue control efforts. Our findings offer critical insights for public health authorities in the Dominican Republic and similar settings, guiding resource allocation and the development of preparedness strategies to mitigate the impacts of climate change on dengue transmission.

Sunflower plants are source of oilseeds with great importance for agroenergy. Nitrogen deficiency is considered one of the factors limiting growth and yield. The objective of this study was to assess the nitrogen uptake (high and low supply of nitrate and ammonium) and to determine the uptake kinetics parameters (Km and Vmax) of these ions in sunflower plants (Neon hybrid). The experiment was carried out in a growth chamber using a hydroponic system. The following treatments were applied: 0.2 and 2.0 mmol L-1 of N-NO3- and N-NH4+. The two kinetics parameters (Km and Vmax) involved in the uptake of nitrate and ammonium were determined, as well as the soluble fractions (N-NO3-, N-NH4+, amino-N and sugars) and total N, in different plant tissues. The plants grown with ammonium showed higher Vmax than those cultivated with nitrate. High ammonium rates caused reduction of root volume and the plants supplied with 2.0 mmol L-1 of N-NO3- produced more biomass from the roots and aerial part. The highest concentrations of N-NO3- were found in the petioles. Analyzed together, the data suggest a greater potential for use of nitric-N as a nitrogen source for fertilization in the cultivation of sunflower.

This study aimed to evaluate the proteomic profile of seminal plasma from young Nellore bulls. We used 20 bulls aged between 19.8 and 22.7 months, divided into two groups according to the results of the Breeding Soundness Evaluation (BSE): approved (FIT n = 10) and not approved (UNFIT n = 10). The scrotal perimeter was measured and a semen collection was performed through electroejaculation. The percentage of sperm motility, mass motility, and sperm vigor were calculated using conventional microscopy, and the percentage of sperm abnormalities was calculated using phase-contrast microscopy of all ejaculates. Seminal plasma was separated from spermatozoa using centrifugation and processed for proteomic analysis by LC-MS/MS. Seminal plasma proteins were identified using MASCOT Daemon software v.2.4.0 and label-free quantification analysis was carried out by SCAFFOLD Q+ software v.4.0 using the Exponentially Modified Protein Abundance Index (emPAI) method. Functional classification of proteins was performed based on their genetic ontology terms using KOG. Functional cluster analysis was performed on DAVID. There were no differences in scrotal perimeter and physical semen characteristics between FIT and UNFIT groups of bulls. The percentage of sperm abnormalities was higher (p < 0.05) in the UNFIT group of bulls. A total of 297 proteins were identified for the two groups. There were a total of 11 differentially abundant proteins (p < 0.05), two of them more abundant in FIT bulls (Spermadhesin-1 and Ig gamma-1 chain C region) and nine in UNFIT bulls (Vasoactive intestinal peptide, Metalloproteinase inhibitor 2, Ig lambda-1 chain C regions, Protein FAM3C, Hemoglobin beta, Seminal ribonuclease, Spermadhesin 2, Seminal plasma protein BSP-30kDa, and Spermadhesin Z13). Spermadhesin-1 was the protein with the highest relative abundance (36.7%) in the seminal plasma among all bulls, corresponding to 47.7% for the FIT bulls and 25,7% for the UNFIT bulls. Posttranslational modification, protein turnover, and chaperones were the functional categories with the highest number of classified proteins. Protein functional annotation clusters were related to Phospholipid efflux, ATP binding, and chaperonin-containing T-complex. The differentially abundant proteins in the group of FIT bulls were related to sperm capacitation and protection against reactive species of oxygen. In contrast, differentially expressed proteins in the group of UNFIT bulls were related to motility inhibition, intramembrane cholesterol removal and oxidative stress. In conclusion, the proteomic profile of the seminal plasma of FIT bulls presents proteins with participation in several biological processes favorable to fertilization, while the proteins of the seminal plasma of UNFIT bulls indicate a series of alterations that can compromise the fertilizing capacity of the spermatozoa. In addition, the relative abundance of spermadhesin-1 found in the seminal plasma of young Nellore bulls could be studied as a reproductive parameter for selection.