Academic literature on the topic '621.361 6'

e16062 Background: Testicular cancer survivors may experience long-term psychological distress related to their diagnosis and treatment. Measurement of mental health service use (MHS) is an objective way to quantify the incurred burden of psychological distress. Here we describe patterns of MHS use among survivors of testicular cancer in a single-payer health system. Methods: The Ontario Cancer Registry was linked to electronic treatment records to identify all incident cases of testicular cancer treated with orchiectomy in the Canadian province of Ontario during 2004-2010. Mental health clinical visits were identified from records of hospital admission, emergency room visits and out-patient physician billing records. Results: The study cohort included 1877 patients; mean age was 35 and 61% had pure seminoma. Two thirds of patients (66%, 1230/1877) were initially treated with active surveillance. In the 2-year period prior to orchiectomy, 24% (443/1877) of patients had MHS use. Post-orchiectomy, the prevalence of MHS use was 18% (331/1877), 23% (431/1877) and 30% (572/1877) at 6, 12 and 24 months, respectively. The use of MHS was greatest in the peri-diagnostic/surgical period. Rates of MHS visits, 3 months before, 0-3 months after, 4-6 months after and 2 years after orchiectomy were 11%, 14%, 10%, and 6%, respectively. Post-orchiectomy MHS use was greatest among those with baseline MHS use. The prevalence of MHS use for patients with and without baseline MHS use was 40% (175/443) vs 11% (156/1434, p < 0.001) at 6 months; 51% (225/443) vs 14% (206/1434, p < 0.001) at 12 months; and 61% (271/443) vs 21% (301/1434, p < 0.001) at 24 months post-orchiectomy. Post-orchiectomy MHS use did not vary by initial treatment strategy (active surveillance vs upfront treatment, p = 0.435). Older patients were more likely to have MHS visits at all time periods than younger patients; MHS rates at 6 months were 15% (93/631) vs 18% (112/625) vs 20% (126/621) for ages 16-29, 30-39, and 40+ years respectively (p = 0.035). Conclusions: MHS use among survivors of testicular cancer is common, particularly in the peri-diagnostic and surgical period. The rate of MHS use is highest among those patients with a history of prior MHS use. Clinicians should screen for the presence of psychological distress among survivors of testicular cancer.

<p>The aim of the experiment was to determine suitable substrate type and optimal plant size for transfer of plantlets from in vitro to ex vitro under experimental outdoor conditions. Tests focused on the effect of substrate type (muddy and sandy) and starting size of plantlets gained through in vitro seed germination (0–3, 3.1–5,5.1–6, 6.1–10 cm) on plant growth. Three parameters (fresh weight, length, and the number of leaves) were compared to evaluate growth. Basic water parameters in experimental water tanks were regularly measured (pH, temperature, electrical conductivity, shadow intensity) and controlled to reach similar conditions to those in the natural habitat of this species. Overwintering was studied in a cellar with newly defined size categories (≤6, 6.1–8, 8.1–10, 10.1–12, 12.1–15 cm).</p><p>Both substrate type and starting size of plantlets significantly impacted growth. Plantlets grew better in the muddy substrate while a 100% success rate of rooting was gained with a starting size of 6.1–10 cm in both substrates. The biggest increase in fresh weight was observed with a starting size of 3.1–5 cm and 5.1–6 cm in both substrates. The greatest increase in fresh weight was observed in plants with a starting size of 3.1–5 cm in the muddy substrate (more than 95% increase). The best overwintering results were gained in the 6.1–8 cm size category.</p>

Abstract From 1984–94, testicular relapse (TR) was reported in 10–20% of boys with ALL. Addition of intermediate and higher dose methotrexate (MTX) in subsequent trials may have reduced this risk. Pediatric Oncology Group (POG) trials 9201, 9405, 9605, and 9406 for B-precursor ALL opened in 1994–6. Protocol 9201 enrolled 365 lesser risk, 9405: 158 standard risk, 9605: 601 standard risk, and 9406: 512 higher risk (total 1,636) boys with ALL. All studies used a common induction protocol of L-asparaginase, vincristine, and prednisone. Doxorubicin was added for higher risk (based on age, initial WBC, and CNS/testicular status). Overt testicular disease at diagnosis was present in only 7/512 (1.4%) boys, all on 9406; they later received radiation therapy to the testicles. After induction, patients were assigned to POG protocols based on NCI risk criteria. Patients on 9201 received 6 courses of IV MTX (1g/m2) during intensification and once or twice daily oral 6-MP during continuation. Patients on 9405 were randomized to 1 or 2.5 g/m2 IV MTX for 12 courses during consolidation and once or twice daily oral 6-MP during continuation. Patients on 9605 received 6 courses of 1g/m2 IV MTX in consolidation and were randomized to +/− 6 months of divided dose oral MTX during intensification and once or twice daily oral 6-MP during continuation. Study 9406 randomized to 6 courses of 1 or 2.5g/m2 IV MTX and to standard or high dose AraC during intensification. TR was overt (physical exam) or occult (biopsy). 99 boys had isolated or combined TR. 0/7 with testicular disease at diagnosis had TR. Of the boys with TR, only 3 did not receive a significant amount of the total therapy. Lesser risk patients had the lowest incidence of TR and lowest overall mortality rate of 1/11(9.1%). Higher risk patients had more relapses during therapy, 11/32(34%) and highest overall mortality rate of 13/32(40.6%). Isolated TR was more common than combined, except on 9406. Median time to TR off therapy was 7.5 months (range 1–52). Median age at relapse was 9.4 years (range 1.8–22). Mortality post any type of second relapse after TR was 60% compared to 25% for those without second relapse(p=0.0124). Table 1 9201 9405 9605 9406 # Pts. 365 158 601 512 # TR 11(3.0%) 13(8.2%) 43(7.1%) 32(6.3%) Isolated TR, ON Rx/OFF Tx 8(2.2%),1/7 7(4.5%),1/6 30(5.0%),4/26 16(3.1%),6/10 Combined TR, ON Rx/OFF Rx 3(0.8%),0/3 6(3.9%),2/4 13(2.2%),2/11 16(3.1%),5/11 Median(Range)# of mos. off Rx 5(2–46) 11(1–28) 7(1–52) 8(1–42) Median(Range)Age at Relapse (yrs.) 6(4.4–15.6) 8.1(1.8–22) 8.3(3.4–21) 12.4(3–20.4) Table 2 Type of TR Count(%) Second Relapse(%) Overall Mortality(%) *Other includes 6-TR+CNS and 1-TR+Subcutaneous mass in cheek. Isolated TR 61/99 (61.6) 18/61 (13.1) 18/61 (29.5) TR+Marrow 31/99 (31.3) 5/31 (16.1) 10/31 (32.3) TR+Other 7/99 (7.1) 2/7(28.6) 2/7 (28.6) Overall TR rate on these studies was approximately 6%. Risk stratification, augmentation of therapy and use of intermediate and high dose MTX may have contributed to this reduction.

BackgroundThe interrater reliability of 2 new inpatient functional short-form measures, Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” basic mobility and daily activity scores, has yet to be established.ObjectiveThe purpose of this study was to examine the interrater reliability of AM-PAC “6-Clicks” measures.DesignA prospective observational study was conducted.MethodsFour pairs of physical therapists rated basic mobility and 4 pairs of occupational therapists rated daily activity of patients in 1 of 4 hospital services. One therapist in a pair was the primary therapist directing the assessment while the other therapist observed. Each therapist was unaware of the other's AM-PAC “6-Clicks” scores. Reliability was assessed with intraclass correlation coefficients (ICCs), Bland-Altman plots, and weighted kappa.ResultsThe ICCs for the overall reliability of basic mobility and daily activity were .849 (95% confidence interval [CI]=.784, .895) and .783 (95% CI=.696, .847), respectively. The ICCs for the reliability of each pair of raters ranged from .581 (95% CI=.260, .789) to .960 (95% CI=.897, .983) for basic mobility and .316 (95% CI=−.061, .611) to .907 (95% CI=.801, .958) for daily activity. The weighted kappa values for item agreement ranged from .492 (95% CI=.382, .601) to .712 (95% CI=.607, .816) for basic mobility and .251 (95% CI=.057, .445) to .751 (95% CI=.653, .848) for daily activity. Mean differences between raters' scores were near zero.LimitationsRaters were from one health system. Each pair of raters assessed different patients in different services.ConclusionsThe ICCs for AM-PAC “6-Clicks” total scores were very high. Levels of agreement varied across pairs of raters, from large to nearly perfect for physical therapists and from moderate to nearly perfect for occupational therapists. Levels of agreement for individual item scores ranged from small to very large.

Riittävä uni on tärkeää vasikan hyvinvoinnille. Erityisen tärkeää uni ja lepo ovat nuorille kasvaville eläimille, joiden aivot kehittyvät vielä. Uni ja leporytmin muutokset ovat uusimpia hyvinvointia kuvaavia mittareita.Tuotantotiloilla saattaa olla pikkuvasikan uneen merkittävä vaikutus, sillä epämiellyttävät ympäristöolosuhteet voivat heikentää unen laatua. Useat erilaiset ympäristötekijät vaikuttavat yksilön uneen, samoin kipu. Kivuliaan yksilön uni sirpaloituu ja kipu heikentää unen laatua, kun taas unen puute vahvistaa kipukokemusta. Tuotantoeläinten unesta ja kivusta ei ole tehty tieteellisiä tutkimuksia. Tähän asti vasikan unta on tuotantoympäristöissä voitu mitata vain kannettavalla EEG-laitteistolla tai tarkkailemalla eläinten käytöstä. EEG-laitteisto on kallis ja häiritsee eläintä. Käyttäytymistarkkailu puolestaan vie paljon aikaa. Tavoitteenamme oli kehittää langaton mittalaite, aktigrafi, vasikan unen mittaamiseen.Kiinnitimme kevyen, langattoman kiihtyvyysanturin 10 vasikan kaulapantaan. Vasikat olivat alle 6 viikon ikäisiä ja ne pidettiin tutkimuksen ajan olkikuivitetussa ryhmäkarsinassa. Laite kiihtyvyyden kolmen akselin suhteen 25 Hz taajuudella ja 2 g:n mittausalueella. Videoimme vasikoiden käytöstä yhtäjaksoisesti 24 tunnin ajan ja rekisteröimme keskimääräisen päivittäisen keston kokonaisuniajalle sekä, vilkeunelle (REM) ja hidasaaltounelle (NREM) vasikan lepoasennoista käyttäen CowLog-ohjelmaa.Alustavat tulokset ovat valmiina kuudelta vasikalta. Aluksi unta ennustava malli (SVM luokittelija) kehitettiin kolmella vasikalla ja mallin toimivuus testattiin kolmella muulla vasikalla. Lopulliset tulokset saadaan 10 vasikalta. Aktigrafidatasta unta ennustivat parhaiten mallissa keskimääräinen kiihtyvyys, kiihtyvyyden vaihtelu ja wavelet-varianssi. Mallin antamien ennusteiden ja käyttäytymistarkkailun tulosten eroavaisuutta verrattiin t-testillä.Malli ennusti kokonaisuniajan 93 ∓ 3 % tarkkuudella sekä päivittäisen NREM- ja REM-unen määrän 89 ∓ 9 % ja 83 ∓ 2 % tarkkuudella. Kokonaisuniajassa sekä NREM- ja REM-unen kokonaiskestoissa ei ollut tilastollisesti merkitseviä eroja käyttäytymistarkkailun ja unta ennustavan mallin välillä (621 vs. 602 min, 351 vs. 339 min, 316 vs. 351 min).Kehitimme aktigrafin, jolla mitata vasikoiden unikäyttäytymistä langattomasti yhtä tarkasti kuin käyttäytymistä tarkkaillen. Laite mahdollistaa vasikoilla jatkuvan unimittauksen tuotantoolosuhteissa häiritsemättä eläintä.

Purpose: To report the results of our sequential intravitreal (IV) tissue plasminogen activator (tPA), pneumatic displacement (PD), and IV anti-vascular endothelial growth factor (VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD)-related submacular hemorrhage (SMH). Methods: A total of 16 eyes of 16 patients with SMH of less than 15 days duration were included in this retrospective pilot study. The tPA was applied on the day of diagnosis, and PD was performed the following day. Patients received 3 consecutive monthly IV injections of ranibizumab starting from 15 days after PD. During the follow-ups, additional ranibizumab treatment was performed if persistent macular or recurrent subretinal or intraretinal fluid hemorrhage was observed. Results: The mean central retinal thickness was 489 ± 92 μm (311-621 μm) at the time of diagnosis, 324 ± 56 μm (209-409 μm) at the first month, 262 ± 48 μm (197-364 μm) at 3 months, 248 ± 40 μm (190-334 μm) at 6 months, and 253 ± 41 μm (192-356 μm) at the last control (p<0.01). The mean best-corrected visual acuity was 2.08 ± 0.79 logMAR (0.7-3.0 logMAR) at baseline, 1.41 ± 0.70 logMAR (0.56-2.50 logMAR) at the first month, 1.21 ± 0.66 logMAR (0.3-2.0 logMAR) at 3 months, 1.14 ± 0.77 logMAR (0.2-2.50 logMAR) at 6 months, and 1.09 ± 0.73 logMAR (0.3-2.50 logMAR) at the last follow-up (p<0.01). Conclusions: Sequential IV tPA, PD, and IV anti-VEGF treatments for SMH in patients with nAMD is effective. However, further studies are needed to establish the best treatment algorithm for SMH in patients with nAMD.

A total of 65 Przeworsk culture features were discovered in the Żelazna Nowa cemetery. This number included a rectangular groove feature, urned cremations (6), alleged/damaged urned cremations (14), unurned cremations (14), alleged/fully or partly damaged unurned cremations (27), pits containing no bone material (4), undtermined cremations (2), pits containing no archeological material (1). All of the explored burials are cremations. However, a more detailed analysis encounters problems due to the state of preservation of the graves. Features 3, 19A and 19B, 30, 33, 37, 39 have been confidently identified as urned cremations. In many other features fragments of ceramic vessels were found, which may be remains of damaged urns: 18, 21, 23, 25, 31, 35, 44, 46, 47, 48, 49, 56, 57, and 58. Certain unurned cremations are 4, 6, 7, 8, 11–13, 15–17, 22, 24, 32, and 34. The interpretation of the remaining features is uncertain. Among the features uncovered in the cemetery were pits containing no bones: 5, 60, 61, 62, as well as pits containing no archaeological material at all: 55. The majority of unurned cremations contained pyre debris, while no such remains were observed in the following damaged unurned cremations: 15, 40–42, 45, 61, 62. There were a few cases of double burials identified. Three unurned cremations (6, 13, 15) and one urned cremation (39) contained bones of Infans I and an undetermined individual, while feature 19 contained two urns with individual burials: Infans II and an undetermined individual. Urned cremations, and one alleged unurned cremation (56), are distinguished by a higher standard of furnishing and a considerably larger amount of bone remains. This can be given two interpretations: a higher status of those buried there, or different rituals used for urned and unurned cremations. In two graves the urn was covered with an upturned vessel (features 33 and 37). In one case, an apotropaic behaviour characteristic of the Przeworsk culture was recorded, involving driving sharp objects into the pit’s bottom: in grave 41 these were two spearheads.

As mobile technology sustains exponential growth and spread to all aspects of our everyday life and smartphone computational power increases, new promises arise for cultural institutions and citizens to use these tools for promoting cultural heritage. This survey proposes to review available smartphone applications (apps) relating to cultural heritage in three different contexts: cities, street art, and museums. Apps were identified by searching two app stores: Apple's App Store and Google Play (Android). A data search was undertaken using keywords and phrases relating to cities, street art, and museums. A total of 101 apps were identified (Google Play only= 7, Apple App Store only = 26, both Google Play and Apple App Store = 61, Apple Web Store and Web App = 6). Apps were categorized into the following categories: museums (39), street art (30), and cities (32). The most popular features are photos (96%) and maps (79%), and the most uncommon the 360 (4% – only in museums apps), games (6%), and video (15%).

Adopting international standards within health research communities can elevate data FAIRness and widen analysis possibilities. The purpose of this study was to evaluate the mapping feasibility against HL7® Fast Healthcare Interoperability Resources® (FHIR)® of a generic metadata schema (MDS) created for a central search hub gathering COVID-19 health research (studies, questionnaires, documents = MDS resource types). Mapping results were rated by calculating the percentage of FHIR coverage. Among 86 items to map, total mapping coverage was 94%: 50 (58%) of the items were available as standard resources in FHIR and 31 (36%) could be mapped using extensions. Five items (6%) could not be mapped to FHIR. Analyzing each MDS resource type, there was a total mapping coverage of 93% for studies and 95% for questionnaires and documents, with 61% of the MDS items available as standard resources in FHIR for studies, 57% for questionnaires and 52% for documents. Extensions in studies, questionnaires and documents were used in 32%, 38% and 43% of items, respectively. This work shows that FHIR can be used as a standardized format in registries for clinical, epidemiological and public health research. However, further adjustments to the initial MDS are recommended – and two additional items even needed when implementing FHIR. Developing a MDS based on the FHIR standard could be a future approach to reduce data ambiguity and foster interoperability.

This chapter examined limestone performance as a roughing media for pollutant removal from leachate using a filtration column. Limestone with a density of 2554 kg/m3 was crushed and graded between 4-6, 8-12 and 12-18 mm as filter media. The length of run for each experiment of the various individual media sizes and combination sizes was 10 days. Test analysis was performed at intervals of 24 hours to ascertain the percentage removal efficiency for the parameters desired. The observed best removal occurred when a combination of 4 – 8mm, 8 – 12mm and 12 – 18mm, media top to bottom was used. This obtained a BOD removal in the range of 22 to 81%, COD was 22 to 75%, and turbidity was 32 to 86% while the colour was 36 to 62%, respectively. A general decline in removal efficiency was observed after the sixth day showing maximum adsorption and breakthrough had been achieved. The study indicates that limestone is an effective adsorbent that can be used for short-term treatment of leachate.

Soils become flooded occasionally by intense rainfall or by runoff, and a significant portion of soils globally underlies highly productive wetlands ecosystems that are inundated intermittently or permanently. Peat-producing wetlands (bogs and fens) account for about half the inundated soils, with swamps and rice fields each accounting for about one-sixth. Wetlands soils hold about one-third of the total nonfossil fuel organic C stored below the land surface, which is about the same amount of C as found in the atmosphere or in the terrestrial biosphere. This C storage is all the more impressive given that wetlands cover less than 6% of the global land area. On the other hand, wetlands ecosystems are also significant locales for greenhouse gas production. They constitute the largest single source of CH4 entering the atmosphere, emitting about one-third the global total, with half this amount plus more than half the global N2O emissions coming from just three rice-producing countries. A soil inundated by water cannot exchange O2 readily with the atmosphere. Therefore, consumption of O2 and the accumulation of CO2 ensue as a result of soil respiration. If sufficient humus metabolized readily by the soil microbiome (“labile humus”) is available, O2 disappearance after inundation is followed by a characteristic sequence of additional chemical transformations. This sequence is illustrated in Fig. 6.1 for two agricultural soils: a German Inceptisol under cereal cultivation and a Philippines Vertisol under paddy rice cultivation. In the German soil, which was always well aerated prior to its sudden inundation, NO3- is observed to disappear from the soil solution, after which soluble Mn(II) and Fe(II) begin to appear, whereas soluble SO42- is depleted (left side of Fig. 6.1). The appearance of the two soluble metals results from the dissolution of oxyhydroxide minerals (Section 2.4). Despite no previous history of inundation, CH4 accumulation in the soil occurs and increases rapidly after SO42- becomes undetectable and soluble Mn(II) and Fe(II) levels have become stabilized. During the incubation time of about 40 days, the pH value in the soil solution increased from 6.3 to 7.5, whereas acetic acid (Section 3.1) as well as H2 gas were produced.

An innovative manufacturing method, BACM (Bladder Assisted Composite Manufacturing), to fabricate geometrically complex, hollow parts made of polymeric composite materials is presented. BACM uses an internally heated bladder to provide the consolidation pressure at the required cure temperature, and thus produces high quality components. The feasibility of this manufacturing method is demonstrated by fabricating laminated composite cylinders using multiple cure pressures and wall thicknesses. The mechanical properties, energy consumed during the curing, and void content of the composite cylinders, are investigated in detail. The curing of composite cylinders was carried out by circulating heated air inside the bladder. Using the described heating method a number of 2-, 4-, and 6-ply composite cylinders made of E-glass/epoxy prepreg (Newport 321/7781) were prepared as test samples. Cylinders were cured at 121°C (250°F) for 2 hours using bladder pressures of 207 kPa (30 psi), 345 kPa (50 psi), 483 kPa (70 psi), and 621 kPa (90 psi). The mechanical behavior of the cylinders were characterized by compressing sample rings and loading ring segments in three-point bending. The fiber volume fraction and the void content of the cylinders were determined from resin burn-off experiments and density measurements. The cylinders produced using the BACM process were found to exhibit excellent surface quality. The elastic moduli, failure strength, and void contents of the cylinders were comparable to the values obtained from flat laminates produced by hot plate molding. Compared to conventional bladder manufacturing methods, the BACM process reduced the energy required to cure the cylinder by more than 50%.

Wear of materials is a serious problem facing industry especially in mechanical applications where moving parts are continuously subjected to friction. Hard coatings prepared by a variety of processes are nowadays considered as effective solutions to protect components against wear. Examples of such processes are: thermal spray coating, vacuum-based coating and hardfacing. In this paper, we study the mechanical, tribological and corrosion properties of two hard coating systems: CoCr Stellite 6 (ST6) hardfacing on 316 stainless steel and NiWCrB Colmonoy 88 (C88) thermal spray coating on Inconel 718. The effect of gas nitriding on the microstructure and wear performance of these coating systems is investigated. X-ray diffraction, energy dispersive spectroscopy and scanning electron microscopy were used for microstructural analysis. Micro-indentation technique was utilized to measure the surface and cross-sectional hardness of the coatings. Rockwell indentation technique was used to evaluate coating adhesion in accordance with CEN/TS 1071-8. Pin-on-disk tests were conducted to assess the tribological performance of the coatings. Microstructural analysis showed that ST6 has a cobalt matrix in the form of dendrites reinforced with metal carbide particles whereas C88 has a Nickel matrix reinforced mainly with metal boride particles. ST6 and C88 improved significantly the wear resistance of their corresponding substrates. This is mainly due to good adhesion and high hardness of the coatings; HR15N values of ST6 and C88 were almost 85 as compared to 61 and 80 for 316 and INC substrates, respectively. ST6 was found to improve significantly the corrosion resistance of 316 whereas C88 decreased the corrosion performance of INC. Moreover, nitriding treatment was found to improve significantly the wear resistance of 316 and INC, however, in the case of ST6, nitriding was beneficial in terms of wear resistance only at relatively low load.

Background: Obesity contributes to numerous and varied comorbid disease. Obesity is one of a constellation of markers for coronary heart disease and type 2 diabetes. This meta-analysis study aimed to assess the effect of obesity on hypertension in elderly. Subjects and Method: Meta-analysis and systematic review were conducted by collecting articles from Google Scholar, PubMed, Springer Link, and Science Direct databases. Keywords used “obesity” AND “hypertension” OR “high blood pressure” AND “elderly” OR “older people” AND “cross sectional”. The inclusion criteria were full text, using English or Indonesian language, using cross-sectional study design, and reporting adjusted odds ratio. The data were analyzed using Revman 5.3 program. Results: 6 studies from Netherland, Ethiopia, Singapura, Cina, Jerman, and Canada were selected for this study. Current meta-analysis study showed that obesity increased the risk of hypertension in elderly (aOR = 3.01; 95% CI= 2.44 to 3.72; p<0.01) with I2 = 61%. Conclusion: obesity increased the risk of hypertension in elderly. Keywords: obesity, hypertension, elderly Correspondence: Maria Imakulata Berek. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: imma123433@gmail.com. Mobile: 085311622368.

Factor XIIIa catalysis the formation of isopeptide bonds Between γ-carbamoyl groups of peptide-bound glutamines and ε-amino groups of lysines or lysine analogues. During fibrin crosslinking two such bonds are rapidly formed between the C-termini of two γ-chains in adjacent molecules and then several bonds are more slowly formed between several α-chains. The crosslinking sites in the γ-chain were identified already 15 years ago, those in the α-chain are still only tentatively or partially identified,, However, by determining the incorporation of lysine analogues in the α-chain it could be shown that the glutamines in positions 328, 366 and possibly also 237 may participate in crosslinking reactions. Analyses of cyanogen bromide fragments isolated from crosslinked fibrin indicated the segments 271-776 and 518-587 to contain the primary crosslinking sites.In the present study factor XHI-containing fibrinogen was incubated over night with thrombin in presence of calcium ions and cysteine or, as a control, in presence of EDTA. The fibrin material was cleaved with cyanogen bromide, mercaptolysed, pyri-dylethylated and then subjected to Sephacryl S-300 chromatography. The early protein fractions were tested by reversed-phase high-performance liquid chromatography (HPLC) using fibrinogen fragments as reference. In the control sample Aa-chain fragment 271-776 eluted first but in the crosslinked sample it was missing and instead a heterogeneous mixture of higher-molecular weight components was observed. N-Terminal sequence analysis showed the mixture to contain not only the expected fragments 241-476 and 518-584,but in fact all glutamine- or lysine-containing Aα-chain fragments between positions 208 and 611. In the corresponding 6 fragments a total of 6 glutamines and 21 lysines as potential crosslinking sites are present. Two fragments contain only one each of these residues which therefore must be true crosslinking sites. Remaining sites and the actual linkages were identified after reversed-phase HPLC of the tryptic peptide mixture by N-terminal sequence and total amino acid analyses.The linkage pattern will provide information about the localisation and conformation of the C-terminal part of the α-chain and its contribution to the fibrin polymer structure.

ABSTRACT Background: Complementary feeding practice is needed to be optimized to maximize children’s potential for growth and development. However, there are still many obstacles in provide complementary feeding practice. This study aimed to examine the determinants of complementary feeding practice. Subjects and Method: A cross sectional study was conducted in Gunungkidul, Yogyakarta, Indonesia, from October to November 2019. A sample of 200 mothers who had infants aged 6-24 months was selected by probability sampling. The dependent variable was complementary feeding practice. The independent variables were birthweight, child nutritional status, maternal knowledge toward complementary feeding, maternal education, and family income. The data were collected by infant weight scale, infantometer, and questionnaire. The data were analyzed by a multiple logistic regression run on Stata 13. Results: Complementary feeding practice increased with birthweight ≥2500 g (b= 2.67; 95% CI=0.59 to.89; p= 0.008), child nutritional status (WHZ) -2.0 to 2.0 SD (b= 2.72; 95% CI=o.75 to 4.61; p= 0.006), high maternal knowledge toward complementary feeding (b= 2.27; 95% CI= 0.27 to 3.79; p= 0.023), maternal education ≥Senior high school (b= 2.19; 95% CI= 0.23 to 4.25; p= 0.028), and family income ≥Rp 1,571,000 (b= 2.42; 95% CI= 0.39 to 3.77; p= 0.015). Conclusion: Complementary feeding practice increases with birthweight ≥2500 g, good child nutritional status, high maternal knowledge toward complementary feeding, high maternal education, and high family income. Keywords: complementary feeding, path analysis Correspondence: Renidya Asyura Muttabi’ Deya Fa’ni. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: renidyamdf@gmail.com. Mobile: +62 815 3934 0421. DOI: https://doi.org/10.26911/the7thicph.03.103

Abstract Serpentine inlet is widely used in military and civil aircraft due to its good stealth performance. However, it generates a high total pressure loss and swirl distortion which significantly affects the performance and the stability of the compressor. In order to improve the quality of the flow field at the aerodynamic interface plane (AIP), a flow control is required inside the serpentine inlet. The objective of this paper was to study the effectiveness of the blowing active flow control on reducing the swirl distortion and on improving the total pressure recovery at the AIP, by reducing the low-momentum flow in the serpentine inlet. The mechanism of the blowing control and the effect of the design parameters (i.e. blowing angle, blowing position and blowing flow rate) on the aerodynamic performance at the AIP were studied. The optimal solution was applied to the full flow path of the serpentine inlet and the fan-stage. The numerical results showed that the quality of the flow field at the AIP were effectively improved by blowing high-energy airflow into the boundary layer of the serpentine inlet. The blowing position had a high influence on the blowing effect, and upper wall blowing scheme obtained greater benefits than lower wall blowing scheme and combination blowing scheme. In addition, the blowing angle should be selected to avoid the high-energy air from pipes mixing with mainstream in the serpentine inlet which will result in an additional total pressure loss. When the ratio of the blowing mass flow rate to the designed mass flow rate of the serpentine inlet was about 1.5%, the swirl distortion on the AIP reached a minimum value, which then did not show a significant difference in performance with blowing ratio increased. When the upper wall blowing scheme was adopted with a blowing angle of 6 degrees and a blowing ratio of 1.5%, the AIP aerodynamic performance achieved the highest improvement, with an increase of the total pressure recovery factor by about 1%, and a decrease of the circumferential total pressure distortion and the swirling distortion by 60% and 61%, respectively. With the optimal control scheme, the area of the low-pressure region near the upper wall was remarkably reduced, and the performance of fan-stage was improved, with an increase of the pressure ratio by about 1.5%, and the efficiency of the single-stage compressor by about 3.1%, respectively.

Harlequin ducks (Histrionicus histrionicus) are sea ducks that migrate inland each spring to nest along fast-flowing mountain streams. They are considered one of the most imperiled duck species in North America and occur in two distinct populations on the Atlantic and Pacific coasts. The Pacific coast population includes Washington State, where harlequin ducks breed in the Olympic, Cascade, and Selkirk Mountains. This species is designated as a Management Priority Species by the National Park Service within North Cascades National Park Service Complex (NOCA). This report summarizes harlequin duck surveys conducted during 15 years across a 27-year period (1990 and 2017) on major streams within NOCA, and incidental observations collected from 1968–2021. The primary objectives of these surveys were to 1) document the distribution and abundance of harlequin duck observations within NOCA boundaries, 2) describe productivity (number of broods and brood size), 3) describe breeding chronology of harlequin ducks, and 4) describe habitat characteristics of breeding streams. Sixty-eight stream surveys over 15 years resulted in observations of 623 individual harlequin ducks comprising various demographics, including single adults, pairs, and broods. In addition, we collected 184 incidental observations of harlequin ducks from visitors and staff between 1968–2021. Harlequin ducks were observed on 22 separate second- to sixth-order streams throughout NOCA across the entire 53-year span of data, both incidentally and during harlequin duck surveys by Park staff. Harlequin ducks were detected on 8 of the 13 streams that were actively surveyed. Excluding recounts, 88.7% (n = 330) of individual harlequin duck observations during surveys occurred in the Stehekin River drainage. Between all surveys and incidental observations, 135 unpaired females without broods were sighted across all NOCA waterways. Thirty-nine broods were recorded between NOCA surveys and incidental observations, with a mean brood size of 3.61 (± 1.44 SD; range = 2–10). Breeding pairs were recorded as early as April 5 and were seen on streams until June 15, a period of less than seven weeks (median: May 2), but most pairs were observed within a 3-week span, between April 26 and May 17. Single females (unpaired with a male, with (an)other female(s), or with a brood) were observed on streams between April 26 and August 25 (median: July 3), though most observations were made within a 5-week period between June 12 and July 19. Habitat data collected at adult harlequin duck observation sites indicate that the birds often used stream reaches with features that are characteristic of high-energy running water. While adults occupied all instream habitat types identified, non-braided rapids and riffles were used most frequently, followed by pools and backwaters. Larger instream substrate sizes (cobbles and boulders) were present at most observation sites. Adult harlequin ducks were more often found at locations that lacked visible drifting or lodged woody debris, but drift debris was a slightly more abundant debris type. The presence of gravel bars and at least one loafing site was common. Adult harlequin ducks were more often observed in association with vegetation that offered some cover over the channel, but not where banks were undercut. The average channel width at adult observation sites was 34.0 m (range: 6-80 m; n = 114) and 27.6 m (± 15.7 m; range: 10-60 m; n = 12) at brood observation sites. Compared to adult harlequin duck sites, broods were observed more frequently in low velocity habitat (pools, backwaters), but rarely in rapids. Cobble and boulder substrates were still the most dominant substrate type. Contrary to adult ducks, broods were observed most often observed in meandering stream channels, a morphology indicative of low gradient, low velocity stream reaches. Most broods were observed in stream reaches with gravel bars, loafing sites, and...

1.1 Resumen macroeconómico En el segundo trimestre la economía enfrentó varios choques, principalmente de oferta y de costos, la mayoría de los cuales no fueron anticipados, o los previstos fueron más persistentes de lo esperado, y que en conjunto interrumpieron la recuperación de la actividad económica observada a comienzos de año y llevaron la inflación total a niveles superiores a la meta. La inflación básica (sin alimentos ni regulados: SAR) aumentó, pero se mantuvo baja y acorde con lo esperado por el equipo técnico. A comienzos de abril se inició una tercera ola de pandemia, más acentuada y prolongada que la anterior, con un elevado costo en vidas humanas y algún impacto negativo en la recuperación económica. Entre mayo y mediados de junio los bloqueos de las carreteras y los problemas de orden público tuvieron un fuerte efecto negativo sobre la actividad económica y la inflación. Se estima que la magnitud de estos dos choques combinados habría generado una caída en niveles en el producto interno bruto (PIB) con respecto al primer trimestre del año. Adicionalmente, los bloqueos causaron un aumento significativo de los precios de los alimentos. A estos choques se sumaron los efectos acumulados de la disrupción global en algunas cadenas de valor y el incremento en los fletes internacionales que desde finales de 2020 vienen generando restricciones de oferta y aumentos de costos. Todos estos factores, que afectaron principalmente el índice de precios al consumidor (IPC) de bienes y de alimentos, explicaron la mayor parte del error de pronóstico del equipo técnico y el aumento de la inflación total a niveles superiores a la meta del 3 %. El incremento en la inflación básica y de los precios de los regulados fue acorde con lo esperado por el equipo técnico, y se explica principalmente por la eliminación de varios alivios de precios otorgados un año atrás. A todo esto se suma la mayor percepción de riesgo soberano y las presiones al alza que esto implica sobre el costo de financiamiento externo y la tasa de cambio. A pesar de los fuertes choques negativos, el crecimiento económico esperado para la primera mitad del año (9,1%), es significativamente mayor que lo proyectado en el informe de abril (7,1%), signo de una economía más dinámica que se recuperaría más rápido de lo previsto. Desde finales de 2020 las diferentes cifras de actividad económica han mostrado un crecimiento mayor que el esperado. Esto sugiere que los efectos negativos sobre el producto de las recurrentes olas de contagio estarían siendo cada vez menos fuertes y duraderos. No obstante, la tercera ola de contagio del Covid-19, y en mayor medida los bloqueos a las vías y los problemas de orden público, habrían generado una caída del PIB durante el segundo trimestre, frente al primero. Pese a lo anterior, los datos del índice de seguimiento a la economía (ISE) de abril y mayo han resultado mayores que lo esperado, y las nuevas cifras de actividad económica sectoriales sugieren que el impacto negativo de la pandemia sobre el producto se sigue moderando, en un entorno de menores restricciones a la movilidad y de mayor avance en el ritmo de vacunación. Los registros de transporte de carga (junio) y la demanda de energía no regulada (julio), entre otros, indican una recuperación importante después de los bloqueos en mayo. Con todo lo anterior, el incremento anual del PIB del segundo trimestre se habría situado alrededor del 17,3 % (antes 15,8 %), explicado en gran parte por una base baja de comparación. Para todo 2021 el equipo técnico incrementó su proyección de crecimiento desde un 6 % hasta el 7,5 %. Este pronóstico, que está rodeado de una incertidumbre inusualmente elevada, supone que no se presentarán problemas de orden público y que posibles nuevas olas de contagio del Covid-19 no tendrán efectos negativos adicionales sobre la actividad económica. Frente al pronóstico del informe pasado, la recuperación de la demanda externa, los niveles de precios de algunos bienes básicos que exporta el país y la dinámica de las remesas de trabajadores han sido mejores que las esperadas y seguirían impulsando la recuperación del ingreso nacional en lo que resta del año. A esto se sumaría la aún amplia liquidez internacional, la aceleración en el proceso de vacunación y las bajas tasas de interés, factores que continuarían favoreciendo la actividad económica. La mejor dinámica del primer semestre, que llevó a una revisión al alza en el crecimiento de todos los componentes del gasto, continuaría hacia adelante y, antes de lo esperado en abril, la economía recuperaría los niveles de producción de 2019 a finales de 2021. El pronóstico continúa incluyendo efectos de corto plazo sobre la demanda agregada de una reforma tributaria de magnitud similar a la proyectada por el Gobierno. Con todo eso, en el escenario central de este informe, el pronóstico de crecimiento para 2021 es del 7,5 % y para 2022 del 3,1 %. A pesar de esto, el nivel de la actividad económica seguiría siendo inferior a su potencial. La mejora en estas proyecciones, sin embargo, está rodeada de una alta incertidumbre. En junio la inflación anual (3,63 %) aumentó más de lo esperado debido al comportamiento del grupo de alimentos, mientras que la inflación básica (1,87 %) fue similar a la proyectada. En lo que resta del año el mayor nivel del IPC de alimentos persistiría y contribuiría a mantener la inflación por encima de la meta. A finales de 2022 la inflación total y básica retornarían a tasas cercanas al 3 %, en un entorno de desaceleración del IPC de alimentos y de menores excesos de capacidad productiva. En los meses recientes el aumento en los precios internacionales de los fletes y de los bienes agrícolas, y las mayores exportaciones de carne y el ciclo ganadero han ejercido presiones al alza sobre el precio de los alimentos, principalmente de los procesados. A estas fuerzas persistentes se sumaron los bloqueos de las vías nacionales y los problemas de orden público en varias ciudades registrados en mayo y parte de junio, los cuales se reflejaron en una fuerte restricción en la oferta y en un aumento anual no esperado del IPC de alimentos (8,52 %). El grupo de regulados (5,93 %) también se aceleró, debido a la baja base de comparación en los precios de la gasolina y a la disolución de parte de los alivios a las tarifas de servicios públicos otorgados en 2020. Como se proyectaba, la inflación SAR repuntó al 1,87 %, debido a la reactivación de los impuestos indirectos de algunos bienes y servicios eliminados un año atrás, y por las presiones al alza que ejercieron los alimentos sobre las comidas fuera del hogar (CFH), entre otros. En lo que resta del año se espera que el aumento en los alimentos perecederos se revierta, siempre y cuando no se registren nuevos bloqueos duraderos a las vías nacionales. El mayor nivel de precios de los alimentos procesados persistiría y contribuiría a mantener la inflación por encima de la meta a finales de año. La inflación SAR continuaría con una tendencia creciente, en la medida en que los excesos de capacidad productiva se sigan cerrando y registraría un aumento transitorio en marzo de 2022, debido principalmente al restablecimiento del impuesto al consumo en las CFH. Con todo esto, para finales de 2021 y 2022 se estima una inflación total del 4,1 % y 3,1 %, y una inflación básica del 2,6 % y 3,2 %, respectivamente. El comportamiento conjunto de los precios del IPC SAR, junto con continuas sorpresas al alza en la actividad económica, son interpretados por el equipo técnico como señales de amplios excesos de capacidad productiva de la economía. Estos persistirían en los siguientes dos años, al final de los cuales la brecha del producto se cerraría. El mayor crecimiento económico sugiere una brecha del producto menos negativa que la estimada hace un trimestre. Sin embargo, el comportamiento de la inflación básica, especialmente en servicios, indica que el PIB potencial se ha recuperado de forma sorpresiva y que los excesos de capacidad siguen siendo amplios, con una demanda agregada afectada de forma persistente. Esta interpretación encuentra soporte en el mercado laboral, en donde persiste un desempleo alto y la recuperación de los empleos perdidos se estancó. Adicionalmente, los aumentos en la inflación en buena medida están explicados por choques de oferta y de costos y por la disolución de algunos alivios de precios otorgados un año atrás. Los pronósticos de crecimiento y de inflación descritos son coherentes con una brecha del producto que se cierra más rápido y es menos negativa en todo el horizonte de pronóstico con respecto al informe de abril. No obstante, la incertidumbre sobre los excesos de capacidad es muy alta y es un riesgo sobre el pronóstico. Las perspectivas de las cuentas fiscales de Colombia se deterioraron, Standard & Poor’s Global Ratings (S&P) y Fitch Ratings (Fitch) redujeron su calificación crediticia, los bloqueos y problemas de orden público afectaron el producto y el país enfrentó una nueva ola de contagios de Covid-19 más acentuada y prolongada que las pasadas. Todo lo anterior se ha reflejado en un aumento de las primas de riesgo y en una depreciación del peso frente al dólar. Esto ha ocurrido en un entorno favorable de ingresos externos. Los precios internacionales del petróleo, del café y de otros bienes básicos que exporta el país aumentaron y han contribuido a la recuperación de los términos de intercambio y del ingreso nacional, y han mitigado las presiones al alza sobre las primas de riesgo y la tasa de cambio. En el presente informe se incrementó el precio esperado del petróleo para 2021 a USD 68 por barril (antes USD 61 bl) y para 2022 a USD 66 bl (antes USD 60 bl). Esta mayor senda presenta una convergencia hacia precios menores que los observados recientemente, como resultado de una mayor oferta mundial esperada de petróleo, la cual más que compensaría el incremento en la demanda de este bien básico. Por ende, se supone que el aumento reciente de los precios tiene un carácter transitorio. En el escenario macroeconómico actual se espera que las condiciones financieras internacionales sean algo menos favorables, a pesar de la mejora en los ingresos externos por cuenta de una mayor demanda y unos precios del petróleo y de otros productos de exportación más altos. Frente al informe de abril el crecimiento de la demanda externa fue mejor que el esperado, y las proyecciones para 2021 y 2022 aumentaron del 5,2 % al 6,0 % y del 3,4 % al 3,5 %, respectivamente. En lo corrido del año las cifras de actividad económica muestran una demanda externa más dinámica de la esperada. En los Estados Unidos y China la recuperación del producto ha sido más rápida que la registrada en los países de la región. En estos últimos la reactivación económica ha estado limitada por los rebrotes del Covid-19, las limitaciones en la oferta de vacunas y el poco espacio fiscal para enfrentar la pandemia, entre otros factores. La buena dinámica en el comercio externo de bienes se ha dado en un entorno de deterioro en las cadenas de valor y de un aumento importante en los precios de las materias primas y en el costo de los fletes. En los Estados Unidos la inflación sorprendió al alza y su valor observado y esperado se mantiene por encima de la meta, al tiempo que se incrementó la proyección de crecimiento económico. Con esto, el inicio de la normalización de la política monetaria en ese país se daría antes de lo proyectado. En este informe se estima que el primer incremento en la tasa de interés de la Reserva Federal de los Estados Unidos se dé a finales de 2022 (antes del primer trimestre de 2023). Para Colombia se supone una mayor prima de riesgo frente al informe de abril y se sigue esperando que presente una tendencia creciente, dada la acumulación de deuda pública y externa del país. Todo esto contribuiría a un incremento en el costo del financiamiento externo en el horizonte de pronóstico. La postura expansiva de la política monetaria sigue soportando unas condiciones financieras internas favorables. En el segundo trimestre la tasa de interés interbancaria y el índice bancario de referencia (IBR) se han mantenido acordes con la tasa de interés de política. Las tasas de interés promedio de captación y crédito continuaron históricamente bajas, a pesar de algunos incrementos observados a finales de junio. La cartera en moneda nacional detuvo su desaceleración anual y, entre marzo y junio, el crédito a los hogares se aceleró, principalmente para compra de vivienda. La recuperación de la cartera comercial y de los desembolsos a ese sector fue importante, y se alcanzó de nuevo el elevado saldo observado un año atrás, cuando las empresas requirieron niveles significativos de liquidez para enfrentar los efectos económicos de la pandemia. El riesgo de crédito aumentó, las provisiones se mantienes altas y algunos bancos han retirado de su balance una parte de su cartera vencida. No obstante, las utilidades del sistema financiero se han recuperado y sus niveles de liquidez y solvencia se mantienen por encima del mínimo regulatorio. A partir de este informe se implementará una nueva metodología para cuantificar y comunicar la incertidumbre que rodea los pronósticos del escenario macroeconómico central, en un entorno de política monetaria activa. Esta metodología se conoce como densidades predictivas (DP) y se explica en detalle en el Recuadro 1. Partiendo del balance de riesgos que contiene los principales factores que, de acuerdo con el juicio del equipo técnico, podrían afectar a la economía en el horizonte de pronóstico, la metodología DP produce distribuciones de probabilidad sobre el pronóstico de las principales variables (v. g.: crecimiento, inflación). Estas distribuciones reflejan el resultado de los posibles choques (a variables externas, precios y actividad económica) que podría recibir la economía y su transmisión, considerando la estructura económica y la respuesta de política monetaria en el futuro. En este sentido, permiten cuantificar la incertidumbre alrededor del pronóstico y su sesgo. El ejercicio DP muestra un sesgo a la baja en el crecimiento económico y en la brecha del producto, y al alza en la inflación. El balance de riesgos indica que las disyuntivas para la política monetaria serán potencialmente más complejas que lo contemplado en el pasado. Por el lado de las condiciones de financiamiento externo, se considera que el mayor riesgo es que se tornen un poco menos favorables, en un escenario en el cual la Reserva Federal de los Estados Unidos incremente con mayor prontitud su tasa de interés. Esto último, ante un crecimiento económico y del empleo mayor que el esperado en los Estados Unidos que genere presiones significativas sobre la inflación de ese país. A esto se suma la incertidumbre sobre el panorama fiscal en Colombia y sus efectos sobre la prima de riesgo y el costo del financiamiento externo. En el caso del crecimiento, la mayoría de los riesgos son a la baja, destacándose los efectos de la incertidumbre política y fiscal sobre las decisiones de consumo e inversión, la aparición de nuevas olas de contagio de la pandemia del Covid-19 y sus impactos sobre la actividad económica. En el caso de la inflación, se incorporó el riesgo de una mayor persistencia de los choques asociados con la disrupción de las cadenas de valor, mayores precios internacionales de las materias primas y de los alimentos, y una recuperación más lenta que la esperada de la cadena agrícola nacional afectada por los pasados bloqueos a las vías. Estos riesgos presionarían al alza principalmente los precios de los alimentos y de los bienes. Como principal riesgo a la baja se incluyó un alza de los arriendos menor que el esperado en el escenario central, explicada por una demanda débil y por una mayor oferta en 2022 dadas las altas ventas de vivienda observadas en el presente año. Con todo, el crecimiento económico presenta un sesgo a la baja y, con el 90 % de confianza, se encontraría entre un 6,1 % y 9,1 % para 2021 y entre el 0,5 % y 4,1 % para 2022. La brecha del producto tendría un sesgo a la baja, principalmente en 2022. El sesgo de la inflación es al alza, y se encontraría entre el 3,7 % y 4,9 % en 2021, y el 2,2 % y 4,7 % en 2022, con un 90 % de probabilidad. 1.2 Decisión de política monetaria En las reuniones de junio y julio la JDBR decidió mantener la tasa de política monetaria inalterada en 1,75 %.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.