Background/Objectives To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain. Design Epidemiological study. Setting Six open LTCFs in Albacete (Spain). Participants 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents. Measurements Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed. Results The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals. Conclusion The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high.

Abstract-The manufacture of dual-mode circular waveguide filter is a complex and labor intensive task that could be greatly simplified with the use of accurate and fast CAD tools to predict the electrical behavior of the structures being developed. This is especially true for the "tuning screws assembly" that is an integral part of this type of filters. A method is proposed for the rigorous and efficient analysis of the tuning screws assembly for dualmode filters in circular waveguide. The method is based on the introduction of a new waveguide called ridged circular waveguide and in its use as a key component for the implementation of dual-mode filters. The modal spectrum of the ridged circular waveguide is investigated using the finite-element technique to show how the introduction of this waveguide can effectively resolve the problem of the CAD of the tuning screws in dual-mode filters in circular waveguide.

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hormones in human follicular fluid. Acta Endocrinol 1992;127:403-6. ISSN 0001-5598Considerable evidence indicates that adrenal hormones may affect gonadal function. To assess the role of some adrenal hormones in human follicular fluid and their relationship with the ability of the oocyte to be fertilized and then to cleave in vitro, cortisol and dehydroepiandrosterone sulfate were measured in follicular fluid obtained at the time of oocyte recovery for in vitro fertilization from cycles stimulated by clomiphene citrate, human menopausal gonadotropin and human chorionic gonadotropin. Thirty-six follicular fluid containing mature oocyte-corona-cumulus complexes and free of visible blood contamination were included in this study. There was no significant difference in follicular fluid dehydroepiandrosterone sulfate concentration between follicles with oocytes which did or did not fertilize (5.1 \ m=+-\ 1.1 vs 5.8 \m=+-\2.0\g=m\mol/l).However, follicular fluid from follicles whose oocytes were not fertilized had levels of cortisol significantly higher than those in follicular fluid from follicles containing successfully fertilized oocytes (406.0\m=+-\75.9 vs 339.2\m=+-\37.0nmol/l; p<0.005). No significant correlations were found between rates of embryo cleavage and cortisol and dehydroepiandrosterone levels in follicular fluid. We conclude that cortisol levels in follicular fluid may provide an index of fertilization outcome, at least in stimulated cycles by clomiphene citrate, human menopausal gonadotropin and human chorionic gonadotropin.Inhibition of normal ovarian function has been observed during periods of adrenal hyperactivity (1-3), but the question as to how the hypothalamic-pituitary-adrenal axis affects fertility remains to be answered. An adrenal hormone-mediated decrease in pituitary responsiveness to gonadotropin-releasing hormone and a centrally mediated inhibition of GnRH release (4) have been suggested. However, Suter and Schwartz (5) have suggested that the adverse effects of glucocorticoids on reproduction in vivo are not exerted on the pituitary. Another possibility is that adrenal hormones may alter normal reproductive function by acting at the ovarian level (6-9). Cortisol is the main glucocorticoid secreted by the adrenal cortex. Cortisol and cortisolbinding protein (CBP) are present in follicular fluid (FF) (10-13). It is generally accepted that the actions of glucocorticoids are mediated through specific receptors, and glucocorticoid receptors have been shown to exist in ovaries (14).The main androgen secreted by adrenal gland is dehydroepiandrosterone sulfate (DHEA-S). More than 90% of DHEA-S is of adrenal origin. DHEA-S is present in FF (15-17) and serves as an ovarian prehormone (18,19). Evidence of the possible importance of DHEA-S in ovarian function has recently been published (20, 21). This study was designed to determine whether adrenal hormones play a role in follicular physiology. We correlate cortisol and DHEA-S FF levels from cycles stimulated by clomiphene citrate (CC), human men...

Our data reflect the dynamic state of male fetal endocrinological status in comparison to female fetuses, and strongly suggest that the mechanisms of hormonal regulation differ in the two sexes.

This study was undertaken to evaluate the relationship between concentrations of insulin and insulin-like growth factor I (IGF-I) in follicular fluid and fertilization and cleavage of human oocytes fertilized in vitro. The concentration of oestradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, testosterone, insulin and IGF-I was determined in 36 follicular fluids, free of visible blood contamination and containing mature oocyte-corona-cumulus complexes, obtained from 12 women undergoing in vitro fertilization. Follicular development was induced by clomiphene citrate and human menopausal gonadotrophin, and follicular aspiration was performed 35 h after an ovulatory dose of human chorionic gonadotrophin. Concentrations of IGF-I were significantly higher in follicular fluids associated with mature oocytes that fertilized and cleaved, than in follicular fluid associated with mature oocytes that did not fertilize (P < 0.001). There was no difference in the concentration of insulin between follicular fluids from which fertilized oocytes were obtained and those with oocytes that remained unfertilized. No significant correlations were found between rates of embryo cleavage, concentrations of insulin and IGF-I. Multiple linear regression analysis demonstrated that the concentrations of IGF-I in follicular fluid were predicted statistically by a negative regression coefficient for the concentration of testosterone, and by a positive regression coefficient for the concentration of progesterone in follicular fluid. No candidate variable was included in the model to predict concentrations of insulin. These data suggest an important role for IGF-I in the mature follicle.

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