Background and objectives: The efficacy and safety of ustekinumab have been proved in clinical trials. In daily clinical practice, knowing the factors that determine survival differences of biological drugs allows psoriasis treatment to be optimized as a function of patient characteristics. The main objectives of this work are to understand ustekinumab drug survival in patients diagnosed with plaque psoriasis in the Hospital Universitario Central de Asturias  between 1 February 2009 and 30 November 2019, were collected. Survival curves were approximated through the Kaplan–Meier estimator and compared using the log-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. Results: The average duration of the treatment before discontinuation was 47.57 months . The retention rates were 82% (2 years), 66% (5 years), and 58% (8 years). Median survival was 80 months . The survival study revealed statistically significant differences between patients with arthritis  and those who had previously received biological treatment . The five-year prevalence in patients still under treatment was 80% (those without arthritis) and 54% (arthritis patients). In the multivariate analysis, only the patients with arthritis had a lower rate of drug survival. No statistically significant differences were observed for any of the other comorbidities studied. The first and second most frequent causes of discontinuation were secondary failure and arthritis inefficacy, respectively. Conclusion: Ustekinumab is a biological drug conferring high survival in plaque psoriasis patients. Ustekinumab survival is lower in patients with arthritis. Psoriasis  is a chrIt is characterized by a greater level of proliferation of keratinocytes and by the infiltration of immunocompetent cells in the epidermis and dermis. It affects approximately 2% of the world’s population. At present, it is considered a systemic disease with predominantly cutaneous manifestations and is associated with psoriatic arthritis in up to 30% of cases .Psoriasis exhibits variable morphology, distribution, extension and clinical course, and may be classified into one of several forms: plaque (vulgar), guttate, erythrodermic, generalized pustular psoriasis, and palmoplantar pustulosis. Plaque psoriasis is the most frequent clinical form, accounting for 90% of all patients with psoriasis . The diaThe etiology of psoriasis is not fully understood, but it is thought to be a product of the interaction between genetic, immune, and environmental factors. From 30 to 50% of patients with psoriasis report having affected first- or second-degree relatives . The mosPsors1 involves, among other genes, HLA-Cw6 * 0602, which is related to a more aggressive psoriasis course, earlier onset, greater extent of skin involvement, poorer response to treatments and a greater frequency of comorbidities [bidities ,8.Of the immunological factors currently studied, the interleukin (IL)-23/Th17 axis is considered to be crucial to the pathogenesis of psoriasis. Indeed, IL-23 is produced mainly by antigen-presenting cells, and induces the differentiation of Th17 and Th22 cells, which produce pro-inflammatory cytokines such as IL-17A, IL-17F, IL-22, and IL-26, which mediate the epidermal hyperplasia, keratinocyte activation, and tissue inflammation inherent to psoriasis ,10.Stress is the best-known influential environmental factor. Szepietowski reported 60% of patients with psoriasis as experiencing stressful circumstances. Infections, trauma, certain drugs, and even cold weather and seasonal changes are other frequent triggers .An epidemiological association of psoriasis has been reported with diseases whose shared chronic inflammation is a common pathogenic substrate. Associated comorbidities or diseases usually manifest years after the onset of the disease and appear more frequently in patients with severe psoriasis . It has It is also associated with a greater risk of mortality from cardiovascular events and a variety of other causes ,14.®) is a human IgG1k monoclonal antibody, approved by the FDA in 2009 for the treatment of moderate–severe plaque psoriasis. By binding to the p40 protein subunit of human IL-12 and IL-23 these cytokines are unable to bind to their receptor protein, IL-12Rβ1, which is expressed on the surface of immune cells [Psoriatic arthritis is present in 5 to 30% of these patients, being most prevalent in those with more severe cutaneous psoriasis. It is a chronic inflammatory disease of the musculoskeletal system that is also mediated by the immune system, and affects both sexes equally, usually occurring after skin involvement . Ustekinne cells . In thisne cells .The survival of a drug is defined as the duration of a specific therapy, the period over which a certain drug remains a suitable option for a specific patient .Some authors interpret drug survival as being a marker of therapeutic success, since it depends on efficacy, the presence of adverse reactions, and the patients’ satisfaction with the treatment .Another aspect to consider is the time that the patient has to continue without the drug for the treatment to be considered to have been suspended. This period varies from drug to drug, but, in the case of ustekinumab, it is considered to be 24 weeks without receiving the drug  .Analyzing the survival of biological therapy for psoriasis can inform us about the efficacy of drugs over time in real clinical practice, in which doses are adjusted depending on how the disease evolves and adjuvant treatments are administered, and patient satisfaction is a key factor influencing the introduction of therapeutic changes. None of these actions is allowed in clinical trials. In clinical practice, this type of analysis can be influenced by changes in the prices of biological treatments, the appearance of new drugs, and changes in prescription habits . For theThe objectives of this study were to determine survival of the drug ustekinumab and to study the factors that predict discontinuation in patients diagnosed with plaque psoriasis in the HUCA Dermatology Department.We designed a retrospective, hospital study, with an inclusion period between 1 February 2009 and 30 November 2019. The study was approved by the Ethics and Research Committee of the Principality of Asturias, Spain (Number 113-18).The study included 148 patients who received 45 or 90 mg ustekinumab (Stelara) for the treatment of plaque psoriasis from the HUCA Dermatology Department. We only included patients starting Ustekinumab due to dermatological indication.The records of all patients who received this treatment were reviewed. The following data were obtained from each patient’s clinical history: sex, age (years), weight (kilograms), height (centimeters), family history of psoriasis (a positive family history was considered if there was psoriasis in at least one first degree relative), age of onset of skin pathology, whether the patient had received previous treatments (“non-naive”) or not (“naive”), and presence of arthritis (diagnosed by a rheumatologist). Comorbidities such as high blood pressure, diabetes mellitus (DM), and dyslipidemia were identified. The medications taken were reviewed, coding the patients as having hypertension, DM, or dyslipidemia if they declared it, if it was evident from their clinical history, or if they were taking antihypertensive, antidiabetic, or lipid-lowering medication. Patients with a BP of >135/85 mm Hg, measured during their consultation, were also classified as hypertensive.The analytical determinations in the medical records were reviewed. Patients with hypertriglyceridemia (triglycerides > 150 mg/dL), hypercholesterolemia , or low-density hyperlipidemia (LDL > 160 mg/dL) were considered to have dyslipidemia.Body mass index (BMI) was calculated as weight (kg)/square of height (m). Following World Health Organization (WHO) guidelines, values of BMI ≥ 30 were taken to indicate obesity. Descriptive data of the patient cohort are summarized as total frequencies and percentages.Ustekinumab survival (retention rate) was retrospectively calculated as the time period until definitive treatment interruption after initiation treatment.Statistical analyses were performed with IBM SPSS version 24.0 . Data are presented as mean ± standard deviation for continuous variables, and number and percentage for categorical variables. The chi-square test was used for qualitative variables. Survival curves were approximated through the Kaplan-Meier estimator and compared using the long-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. 95% confidence intervals (95% CI) are also provided. The proportionality of the risks was previously checked through the Schoenfeld residual.p < 0.05. We selected the following variables as possible predictors: sex, age of onset of psoriasis, family history, obesity, arthritis, previous use of biologics, arterial hypertension, and dyslipidemia. Group differences were considered to be statistically significant for values of Final sample size allows to declare significative (Type I error of 0.05), with a probability of 0.2 (Type II error), those hazard ratios above 1.75, difference in proportions above 25% and standardized differences of means above 0.5.The study included 148 patients, all of whom were of white ethnicity. Their characteristics are summarized in The survival of the drug is shown in p = 0.296), arterial hypertension (p = 0.578), dyslipidemia (p = 0.258), family history of member with psoriasis (p = 0.175), age of onset of psoriasis after 40 years of age (p = 0.501), obesity (p = 0.110), or sex (p = 0.453).In our cohort, the retention rates were 82% (2 years), 66% (5 years), and 58% (8 years), and the median survival was 80 months . Log-rank tests revealed no significant differences in drug survival in relation to the presence of diabetes (p < 0.001) (p = 0.026) (p < 0.001)  b and hav= 0.026) c. The pr< 0.001) .Univariate analyses showed statistically significant differences between groups with respect to the presence of arthritis and the previous use of a biologic . The proIn the multivariate model, only arthritis retained its statistical significance. Previous use of biologics was not independently significant in the model.At the end of the study, 104 of the 148 patients in the study (70.27%) were still pursuing their treatment. There were a variety of reasons why the other 44 (29.73%) patients did not continue: primary failure  , secondary failure  , infections , women wishing to become pregnant , paradoxical pustular reaction , death , hepatocarcinoma , lost to follow-up , headache and edema , dizziness  and psoriatic arthritis inefficacy  . Exitus We present a retrospective study in which we assess the overall survival of the drug ustekinumab, based on data collected over 10 years and 10 months in the HUCA Dermatology Department.Several studies of the survival of ustekinumab in the treatment of psoriasis have been published: the PSOLAR , BADBIR The demographic characteristics of our patient cohort are comparable to those of the BIOBADADERM , PSOLAR Regarding the overall survival of the drug, retention rates of 92% (first year), 82% (second year), 66% (fifth year), and 58% (eighth year) were noted. Subsequently, the rate was stable until 12 years. One-year survival in our study was towards the higher end of the range of the other studies, being surpassed only by that of the PSOLAR registry , and simKnowing the factors that influence survival can be key for choosing the most appropriate treatment with the available biological drugs. Our current knowledge indicates that obesity, being female, and having previous had a biologic treatment are factors that reduce the survival of biological drugs ,30,31.In our series, we did not find that obesity or female sex influenced survival with ustekinumab. This is consistent with the findings of the BADBIR  and ORBIOur multivariate analysis suggests that the most influential factor is the presence of arthritis, and it can be deduced that these patients receive more treatments with biologics, similar to the conclusions of other studies .Our series features more patients with DM, arterial hypertension, dyslipidemia, and psoriatic arthritis than those of the BIOBADADERM , BADBIR These comorbidities have not been found to be related to higher or lower rates of survival of biological therapy in any of the series , except 42.8% of our patients had arthritis, a lower figure than reported in our review of patients treated with secukinumab (53.1%)  and withUnlike the present study, in which we found worse survival in patients with arthritis than in those without , survival was independent of whether patients had arthritis in the DERMBIO , BIOCAPTIn the BADBIR study , the preThe main cause of drug discontinuation is secondary failure (38.64% of cases of discontinuation), followed by arthritis inefficacy (22.73%), and adverse effects 11.36%). Except for our findings on arthritis inefficacy, which is barely mentioned in the literature, our results are similar to those of the series that considered causes of discontinuation ,23,30,311.36%. ExRegarding the differences noted between the pivotal studies and those carried out under clinical conditions, it is important to point out that different strategies were employed for 27 patients in our series before suspending treatment that are not permissible in clinical trials and that may have helped increase the median survival of the drug. With this drug we were able to deintensify only two patients due to good disease control, increasing the interval between doses from 12 to 16 weeks. This contrasts with adalimumab, with which we were able to deintensify 63.5% of patients, producing a good response .Our study has several limitations. First, it is observational in nature, and so is prone to the effects of biases inherent to this type of study. Second, the selection of treatments for each patient is not randomized in routine clinical practice. Third, new active psoriasis treatments have been introduced that are able to modify drug survival. Fourth, the published studies, two theoretical meta-analyses of national registries  and hospital studies similar to ours, used different statistical approaches and examined different variables, which makes it impossible to compare those results directly with ours.Ustekinumab drug survival in our sample was towards the highest end of the range of all the equivalent published series .Of the variables studied, sex, age, early onset of psoriasis, family history of psoriasis, dyslipidemia, diabetes mellitus, arterial hypertension, and previous use of biologics were unrelated to survival; only the presence of arthritis was associated with significantly lower survival of ustekinumab, bestowing a relative risk of 34% of suspending treatment for affected patients compared with those who did not suffer from arthritis. This information will help patients make an informed decision when starting a biologic therapy, based on drug survival outcome.


Integrative research on water resources requires a wide range of socio-environmental datasets to better understand human-water interactions and inform decision-making. However, in transboundary watersheds, integrating cross-disciplinary and multinational datasets is a daunting task due to the disparity of data sources and the inconsistencies in data format, content, resolution, and language. This paper introduces a socio-environmental geodatabase that transcends political and disciplinary boundaries in the Rio Grande/Río Bravo basin (RGB). The geodatabase aggregates 145 GIS data layers on five main themes: (i) Water & Land Governance, (ii) Hydrology, (iii) Water Use & Hydraulic Infrastructures, (iv) Socio-Economics, and (v) Biophysical Environment. Datasets were primarily collected from public open-access data sources, processed with ArcGIS, and documented through the FGCD metadata standard. By synthesizing a broad array of datasets and mapping public and private water governance, we expect to advance interdisciplinary research in the RGB, provide a replicable approach to dataset compilation for transboundary watersheds, and ultimately foster transboundary collaboration for sustainable resource management. Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11807424 In 2015, the United Nations (UN) adopted 17 Sustainable Development Goals (SDG), including “Ensuring access to water and sanitation for all” (SDG6)5. However, increasing pressure on water resources, due to population growth and climate change, may be an obstacle to reaching this goal and may lead to increased competition and political tensions. This especially applies to transboundary river systems6, which represent 60% of freshwater supply basins and almost 50% of the total land area on Earth7.Finding solutions to manage scarce water resources to meet human water needs while sustaining ecosystems has become a priority for research7. Synthesizing a broad range of environmental and social datasets is further critical for in-depth understanding of watershed dynamics8 and for assessing the sustainability of water allocation9. In large areas, spatial datasets are also valuable to capture the spatial heterogeneity of local conditions and for better understanding of different development trends across a region10. However, integrating scattered cross-disciplinary and multinational datasets is challenged by the disparity of data sources, transboundary discontinuity11 and the inconsistencies in format, content, spatial and temporal resolution, languages12, and institutional norms. This can limit the study of transboundary socio-environmental systems, and calls for the development of a harmonized, transboundary, open-access database.In transboundary basins, data- and information-sharing provide a mechanism to foster cooperation among countries and, ultimately, achieve more sustainable water management and maintain peace and security13 and transboundary cooperation issues14. Covering 552,382 km2, the basin is shared by two countries (United States and Mexico) and eight states, three in the U.S.  and five in Mexico . Distribution of water resources is governed by distinct national and state water rights regimes, as well as bi-national and inter-state agreements14. The river is highly engineered via extensive damming and channelization15, which significantly disturb the natural flow regime16. Classified as one of the most endangered in the world17, the river hosts several endangered and threatened species, such as the Rio Grande Silvery Minnow, and the Southwestern Willow Flycatcher. Despite chronically severe water scarcity, human water demand has grown along with an increase in population (current population is estimated at 10.5 million people18). Furthermore, irrigated agriculture makes up approximately 83.5% of the total surface and groundwater withdrawals20 while cultivated areas cover only 3.5% of the basin21. Projected climate change and population growth are likely to lead to a growing imbalance between water supply and demand, potentially impacting the sustainability of the basin22 and resulting in a cascade of negative impacts 23.The Rio Grande/Río Bravo basin (RGB) epitomizes the challenges of managing water resources under conditions of scarcity24. Examples of topics include population, land-cover, irrigation, rainfall, and dams (http://gis.nacse.org/tfdd/index.php). In the RGB, a basin level database synthesizing hydrologic, administrative, land-use/cover, and water management datasets, was also developed at a finer resolution26. However, we are not aware of a similar approach to capture the social heterogeneity and complexity across the basin27. Hence, we compiled a comprehensive socio-environmental geodatabase for the RGB, encompassing geospatial data sets related to Water & Land Governance, Hydrology, Water Use & Hydraulic Infrastructures, Socio-Economics, and Biophysical Environment. An innovative contribution of our geodatabase is to provide open-access to a thorough collection of reliable and well documented, basin-wide geospatial data sets, as well as, to our knowledge, the most extensive spatial picture of multi-scale water governance in the RGB. The geodatabase expands the availability of information detailing the social and environmental characteristics of the basin and enables an integrated and cross-disciplinary approach to the watershed. Many outputs can be derived from the geodatabase, including maps, spatially explicit integrated models, and statistical analyses . The data synthesis approach presented here is transferable to other transboundary basins, and the geodatabase will help the research, management, and policy-making communities to foster transboundary collaboration.To overcome the challenges of data- and information sharing in transboundary basins, several initiatives were launched in recent years. The Transboundary Freshwater Dispute Database gathers global and regional information for the world’s 310 international river basins, including the RGBThe development of the socio-environmental geodatabase followed four steps: 1) data identification; (2) collection of raw data; (3) assembling, harmonizing, and geoprocessing of datasets; and (4) organization of the final geospatial data sets into the geodatabase  and their spatial scale of action , followed by state agencies (13%), global agencies (2%) and binational agencies (7%). We also collected datasets from joint research projects (5%) and private institutions (6%). Most of the input datasets were available open-access online. We also contacted public or private institutions to access unpublished information and were granted permission to publish the synthesized data. The original formatting of the raw datasets varied greatly. 62% were vector data , 19% were raster files, and 19% were only available in tabulated format (comma-delimited text or Microsoft Excel files). In terms of language, 73% of the raw datasets were in English and 27% in Spanish. The detailed list of raw datasets used to produce the geospatial output datasets is available in Supplementary Information et al.27. For all political jurisdictional boundary information , given the spatial mismatch with the catchment boundary, we prioritized the use of administrative boundaries over catchment boundaries in locations where they overlap.Third, we assembled, harmonized, and geoprocessed the datasets using ESRI’s ArcGIS 10.6 and, where appropriate, the Python programming language (version 2.7) and the arcpy package for automating the geoprocessing workflow. Geoprocessing operations varied according to the type of raw dataset, and a detailed description of these operations is available in the metadata for each geographic layer. In general, we tried to synthesize scattered state and national raw data into one data layer. Where necessary, we harmonized the information in the datasets  and translated Spanish information to English. Geospatial operations included the projection of the final datasets to the most appropriate projected coordinate system that minimized areal distortion for the whole RGB , and clipping datasets to the RGB boundary. Instead of using the hydrological basin boundary, we used the spatial boundaries of the Rio Grande/Río Bravo socio-environmental system as delineated by Koch Water & Land Governance, Hydrology, Water Use & Hydraulic Infrastructures, Socio-Economics, and Biophysical Environment.Fourth, we stored the resulting 145 geographic layers, including 125 vector data and 20 raster data (GRID), in a geodatabase with a total size of 1.40 GB. We organized the datasets into five main themes: For each individual data layer, we produced a standardized metadata record, following the Federal Geographic Data Committee Content Standard for Digital Geospatial Metadata (FGDC CSDGM). The standard includes seven types of information: Identification Information , Data Quality Information, Spatial Data Organization Information, Spatial Reference Information (Geographic Coordinate System Definition), Entity and Attribute Information, Distribution Information, and the Metadata Reference Information. The metadata records have been created through the ArcMap graphical user interface and are automatically included with the hosted layer item. The user can export the metadata in XML format through the ArcMap graphical user interface if needed.28. The collection of datasets can be downloaded as a single file (.gdb) or as individual geospatial output layers (shapefiles or raster files). Here, we describe the geospatial datasets available for the five themes Water & Land Governance, Hydrology, Water Use & Hydraulic Infrastructures, Socio-Economics, and Biophysical Environment. Online-only Table The socio-environmental geodatabase is freely and publicly available on the OSF repositoryThe Water & Land Governance category is divided into 12 sub-categories, representing political jurisdiction boundaries, surface water management agencies , state and interstate multi-stakeholder platforms, groundwater-focused institutions, irrigation and conservation organizations, land management, and border control. A description of each entity with their missions is provided in Supplementary Information municipio, and places . The geodatabase also provides a point dataset of the most populated places in both countries, which includes the main U.S.-MX sister cities along the border.The geodatabase provides the boundaries of four political jurisdiction divisions: nation, state, county/The geodatabase gathers 13 vector datasets of binational infrastructure that spatializes the joint operations of the U.S. International Boundary and Water Commission (IBWC) and its Mexican counterpart the Comisión Internacional de Límites y Aguas (CILA), regarding national allocation of water, dam and reservoir operations, river course management , water quality, sanitation, and flood control in the border region.This sub-category includes two datasets of federal dams. One gathers all federal dams operated by the Comisión Nacional del Agua (CONAGUA) in Mexico. The other maps all dams owned by a federal agency in the U.S., including the U.S. Army Corps of Engineers (USACE), the Bureau of Indian Affairs (BIA), the Bureau of Land Management (BLM), the Bureau of Reclamation (USBR), the U.S. Fish and Wildlife Service (USFWS) and the U.S. Forest Service (USFS).Junta Central de Agua y Saneamiento (JCAS); in Coahuila, the Comisión Estatal de Aguas y Saneamiento (CEAS); in Durango, the Comisión de Agua del Estado de Durango (CAED); in Nuevo León, the Servicios de Agua y Drenaje de Monterrey (SADM); and in Tamaulipas, the Comisión Estatal del Agua en Tamaulipas (CEAT).This sub-category depicts the boundaries of the Offices of the State Engineer (OSE) and their regional offices (divisions and districts) in charge of the administration of water rights and interstate compacts in the U.S. For Mexico, we generated spatial layers representing state-level offices of the federal agency CONAGUA. We also included entities that engage in planning, coordination, and oversight of domestic water supply and wastewater treatment state-wide: in Chihuahua, the The Rio Grande Compact Commission — U.S. inter-state platform — monitors water flows and administers water-sharing among the states of Colorado, New Mexico, and Texas. We mapped its domain through three spatial layers: one representing the spatial scope of the Interstate Compacts (including the Rio Grande Compact), one identifying the gauges used to monitor and account for states’ water delivery obligations to each other, and one identifying the “post-Compact” reservoirs used to manage states’ water delivery obligations.The San Juan Chama Project (SJCP) — U.S. inter-state platform — moves water through a trans-mountain diversion from the Colorado River basin in the state of Colorado (San Juan River) to municipal and irrigation users in the upper and middle Rio Grande valley of New Mexico. We mapped this project with three vector datasets: one for the trans-mountain diversion, one for the reservoirs where imported water is stored and transferred, and one displaying the users of that water .The Rio Grande Project — binational and inter-state platform — supplies water for irrigation from the Elephant Butte Reservoir to several U.S. and Mexican irrigation districts. Its domain is represented through two vector datasets: one representing the dams used for storage  plus the diversion dams for distributing water in the U.S. and Mexico ; and one representing the irrigation districts supplied by the Rio Grande Project .Consejo de Cuenca del Río Bravo (Rio Bravo Watershed Council) — Mexican inter-state platform — is a multi-state entity that develops and implements a basin management plan for the CONAGUA Hydrological-Administrative region VI in Mexico. We mapped its domain using its administrative boundary.The 29. The geodatabase maps the boundary of its domain of action.The Rio Grande Basin Roundtable in southern Colorado — intra-state platform — regroups various stakeholders such as counties, municipalities, and conservancy districts to identify consensual strategies that meet competing needs in the region, and to provide support and funding for basin projectsThe geodatabase includes five platforms:In Colorado, we mapped three levels of groundwater management: the Rio Grande Water Conservation District (RGWCD) that manages groundwater at the regional level ; the Groundwater Management Subdistricts that manage groundwater at the local level (subdistrict); and the high capacity wells with augmentation/replacement plans. For the regional level, we provided the spatial domain of the RGWCD, the location of unconfined and confined wells that the RGWCD monitors, and the boundaries of the Closed Basin, an unconfined groundwater salvage project maintained by RGWCD that transfers water from the aquifer to the surface water basin.The state of New Mexico is divided into 39 declared groundwater basins where the OSE assumes jurisdiction over the appropriation and use of groundwater. We mapped the 18 basins overlapping the RGB.In Texas, we mapped the domains of the Groundwater Management Areas (GMA), the Groundwater Conservation Districts (GCD) in charge of the implementation of groundwater management plans within the GMA, and the Priority Groundwater Management Areas (PGMA) located in areas with critical groundwater problems.This dataset maps the local entities and related infrastructures associated with the administration, management, monitoring and conservation of groundwater in the U.S. states of Colorado, New Mexico, and Texas.In Mexico, except for the groundwater permits  available in the section Water Use & Hydraulic Infrastructures > Water Rights/Permits, we did not find any comparable administrative or governance mechanism explicitly set up on a spatial basis to manage groundwater per se.30. Two of the four transboundary priority aquifers underlay the RGB: Mesilla/Conejos-Médanos and Hueco Bolson.At the transboundary level, the U.S. and Mexico also established a binational agreement, the Transboundary Aquifer Assessment Program (TAAP), to strengthen collaborations among Mexican and U.S. institutions to jointly assess priority shared aquifers along the U.S.-Mexico borderDistritos de Riego in Mexico), ditch companies, and community ditch associations, an umbrella term under which we include the acequia systems of Colorado and New Mexico, and Unidades de Riego (Irrigation Units) across the states of Mexico. However, spatial datasets of ditch companies and community ditch associations were unavailable for New Mexico and Mexico.This sub-category maps the boundaries of the organizations that divert and coordinate surface water delivery to irrigators, and ensure maintenance of the irrigation conveyance systems, in both the U.S. and Mexico. Our dataset provides the name and the area managed by the organizations, in addition to other specific information for each state and country. We sought to gather the spatial boundaries of three organizations: the irrigation districts  that maps ejido and comunidad  lands in Mexico. When compiling the datasets, we labelled all areas that were neither classified by the BLM nor the RAN as “Private/Not reported”.This dataset maps four types of land management: Certified Ejido & Communal Land, Public, Native American/Tribal, and Private/Not Reported. The dataset results from the compilation of two national datasets: the National Surface Management Agency Area Polygons released by the Bureau of Land Management (BLM) that maps state and federally owned lands as well as Native American tribal lands in the U.S., and the This dataset maps the areas designated as protected by the International Union for Conservation of Nature (IUCN).This sub-category maps three key components of border control along the international reach of the Rio Grande/Río Bravo: the U.S. Southwest Border Patrol Sectors associated with the migration apprehension statistics; the border crossing ports of entry; and vehicle and pedestrian fences/barriers. U.S. border control is very active and has important implications for the management of riverbank and riparian areas. However, this research to-date has not covered policies or practices by Mexican border-related agencies that affect water management or flow.The vector dataset provided in this sub-category map the outlines of the Soil and Water Conservation Districts (SCWDs) in Colorado, New Mexico, and Texas. SCWDs foster voluntary conservation practices among private and public landowners, helping to manage and protect soil, water, forests, and wildlife at the local level. The SWCDs are a specific kind of district, with a mandate that is particular to the legal and institutional history of land and water management in the U.S. Our research to-date has not found anything equivalent to this formation in Mexico, and even less so, any spatial datasets for it.This sub-category includes conservation projects where members of multiple sectors and/or institutions actively work in collaboration to identify, protect, manage, monitor, and/or develop policy for the conservation of specific sites. Our research to-date has not extended to documentation of all such projects in either the U.S. or Mexico, and did not uncover spatial data sets that document their location. Our datasets map three collaborative conservation projects. Two of them, the Landscape Conservation Cooperatives (LCCs) and the North America Bird Conservation Joint Ventures (BJVs), are transboundary. For both, we mapped the boundaries of the four LCCs and the five BJVs that span the RGB. While the U.S. Fish and Wildlife Service recently discontinued its funding for the LCCs network, we decided to include these cooperatives in our dataset since the LCCs generated highly relevant information for the RGB in the past. The third project refers to the Instream Flow Program in Colorado. For this project, we mapped the streams and lakes affected by the Instream Flow Program.The Hydrology category includes five surface water and groundwater related sub-categories.The geodatabase provides the outlines of the Rio Grande/Río Bravo basin and of its sub-basins. The watershed boundary dataset is derived from the World Wildlife Fund’s (WWF) HydroSHEDS product, created from NASA’s Shuttle Radar Topographic Mission (SRTM) 15-second Digital Elevation Model (DEM) and released by the Food and Agriculture Organization (FAO) geoportal.This dataset of vectorized river reaches, derived from the WWF HydroSHEDS products, was also accessed from the FAO geoportal.We mapped the aquifer boundaries by assembling two national geospatial datasets compiled by the National System of Water Information of CONAGUA and the USGS.The geodatabase provides datasets for the location of discharge monitoring stations operated by USGS (above Elephant Butte Dam), IBWC/CILA , and CONAGUA (tributaries of the Rio Grande/Río Bravo coming from Mexico). Each dataset provides a URL to the historical time series of the stream flow.This dataset provides the location of water quality stations monitored by IBWC and TCEQ for the U.S. portion of the RGB.Water Use & Hydraulic Infrastructures datasets provide information related to consumption and diversion of water.municipio level. For both countries, estimates are available by type of source (surface or groundwater) and by sector of use . For the U.S., the data set also breaks down estimates by fresh water and saline water.This dataset provides estimates in million cubic meters per year of water used at the U.S. county and MX municipio basis the irrigated area estimated in hectares and the spatial coverage of different systems of irrigation , estimated in hectares for U.S. and in number of farms for Mexico. For the U.S., we used the original classes  and for Mexico, we clustered as follows: lined and earthen canals in surface; sprinkler and micro-sprinkler in sprinkler; and drip in micro-irrigation.We provide two datasets (one per country), which reports on a county/This sub-category displays the allocation of surface water rights and groundwater rights at the state level for U.S. and Mexico. A water right is a property right that conveys the right to use a certain amount of water. These are administered by the Offices of the State Engineer in the U.S. and by CONAGUA in Mexico. The datasets report the geographic coordinates of the water right holder, and when available, the amount of water right authorized (in acre feet in the U.S. and in cubic meters in Mexico), the name of the water right holder, the adjudication date, the rank of priority , or the type of use.We provide two vector datasets. The first one, derived from the National Inventory of Dams, maps all dams in the U.S. exceeding a certain height and capacity of storage. The second one maps all dams recorded by the CENAPRED in Mexico.The geodatabase provides three vector datasets of water diversion structures . The first one covers the five MX states and is derived from a Mexican national data source. The second one covers the three U.S. states and is derived from a U.S. national data source. The third one covers Colorado with more details and is derived from a state data source.We compiled four datasets of well locations. One is derived from the National Hydrography Dataset (NHD) for the whole U.S. portion of the RGB; the three other ones were compiled by the OSE for each U.S. state and provides more details. Our research to-date has not uncovered data for wells in Mexico.This category includes five datasets related to demography, economics, and transportation networks.municipio basis. We assembled national demographic census information distributed by the U.S. Census Bureau and INEGI.This vector dataset reports the total population for the years 1990, 2000, and 2010 on a county/This raster dataset depicts population density (number of persons per square kilometre) at 30 arc-second resolution (approximately 1 km at the Equator) for the years 2000, 2005, 2010, 2015, and 2020.municipios.Due to the lack of consistent data for both countries, the spatial database includes two heterogeneous datasets: the personal income for the U.S. counties from 1969 to 2015 and the income distribution  in 1990, 2000, and 2010 for the Mexican municipio-based statistics about the number of farms, the total farmed area, and the average farm size (in 2007 and 2012 for the U.S. and in 2007 for Mexico).This sub-category provides county/This sub-category contains two datasets: the roads derived from the Global Roads Open Access Data Set, Version 1 (gROADSv1) and the railroads derived from the North American Environmental Atlas.The biophysical environment category provides ecological, pedological, topographical, and land-use/land-cover datasets.Ecoregions are areas with similar patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. Ecoregions can be mapped for different nested levels. For North America , data are available for three levels (Level I being the coarsest and Level III the finest). Ecoregions level IV have also been delineated for the U.S. but not yet for Mexico. Each of those datasets are included in the geodatabase, although ecoregion Level IV is missing for Mexico.We compiled six national datasets due to a lack of transboundary coverage. In the U.S., we mapped wetlands and deepwater habitats , riparian areas, and critical habitat for endangered and threatened species. In Mexico, we mapped Ramsar wetlands sites , priority sites for restoration , and priority focus sites for biodiversity conservation (conserved habitats that host endangered and threatened species and are adjacent to the protected areas).This vector dataset displays different soil units based on the FAO taxonomy at 1:5,000,000 scale.This raster data, derived from the Harmonized World Soil Database (version 1.1), provides the median elevation aggregated to 30 arc-second grid cells. It is derived from the NASA Shuttle Radar Topographic Mission Digital Elevation Model and the USGS GTOPO30.Spatial Analyst tool Slope in ArcGIS.We calculated the median slope in percent and in degree at a 30 arc-second resolution from the elevation data described above, by using the This raster dataset, derived from the North American Land Change Monitoring System (NALCMS), depicts the land cover in the RGB, based on 2010 Landsat satellite imagery. NALCMS uses the level II of the Land Cover Classification System (LCCS) standard developed by FAO.vs irrigated crops). The second one, non-spatial, is derived from the 2007 Census and provides on a municipio basis planted area estimates (in hectares) of annual spring and winter crops and perennial crops.Due to a lack of consistent transboundary datasets, we gathered national datasets to map land-use in the RGB. For the U.S., we used the yearly USDA Cropland Data Layer, a high-resolution crop-specific land-use image, available from 2008 to 2018 at a 30-meter resolution. For Mexico, we derived our datasets from two governmental datasets. The first one is a spatial dataset of land uses for 2011 and 2014 at a 30-meter resolution, with a coarse classification of crops  resolution for the time period 1950–2013.Climate records are also critical for understanding hydrological processes in the basin. While not included in our geodatabase, Livneh and othersTo ensure the reliability of the spatial database, we draw on a critical assessment of three factors: the quality of the source of information, transboundary discontinuities, and geoprocessing.https://github.com/cirlabs/border_fence_map) who traced the fences along the border by using open-source mapping tools and by digitizing detailed PDF maps obtained through a Freedom of Information Act request32. The creators of the data set acknowledge slight differences with the official government agency numbers. However, this is the most detailed border fence map publicly available. We also gathered four datasets — that were not downloadable online — by email requests from three organizations. The RGWCD provided the boundaries of the RGWCD and the Groundwater Management Subdistricts #1, #2, #3, #4, #5, #6 in Colorado. The CSCB (Colorado State Conservation Board) and the TSSWCB (Texas State Soil and Water Conservation Board) shared the boundaries of the SWCDs of Colorado and Texas, respectively. Although these datasets were not gathered from governmental sources, we believe that these datasets are the best available and we rely on the accuracy of data collection of the three organizations.Regarding the sources of information, we sought to download most of the raw datasets from official sources such as intergovernmental organizations and governmental agencies  or from joint projects overseen by reputable universities, research institutes, and non-governmental organizations . We compiled a few datasets (around 6%) from private entities  as they were the only source of the desired information. For example, this is the case for the border fences. We downloaded the spatial data from Reveal from The Center for Investigative Reporting and OpenStreetMap contributors  or state-wide (18.5%), which could lead to some of the inconsistencies previously mentioned. All information gathered from Mexican sources was translated from Spanish to English and verified by a bilingual speaker.Regarding the geoprocessing operations, for all datasets, we used several tools and functions available on ArcGIS, such as Project, Clip, Dissolve, Slope, Join, Merge and we rely on the accuracy of this software to create the final outputs. A series of quality checks has been carried out to catch as many potential coding errors as possible. Attributes were checked by using visual inspection. For quality control, transparency, and reproducibility, processing steps are thoroughly detailed in the metadata of each dataset.municipio basis , as well as hydrologic and biophysical environment datasets , socio-economic (population), and water use and hydraulic infrastructures (dams).The geodatabase can support spatially explicit and integrated modelling for the RGBThe geodatabase can be used to conduct spatiotemporal and geostatistical analyses. Examples of interdisciplinary topics include: (i) evaluating whether water use correlates with environmental variables , socio-economic factors (population), or governance ; and (ii) assessing land-use change at multiple scales . For example, we are currently analysing the spatial patterns of land fallowing in the basin.This spatial database offers a wide range of applications for transboundary and interdisciplinary research. We provide three examples drawing from our own research.Users of the compiled datasets should cite this data paper following the recommended citation format of the journal. Furthermore, we encourage users to refer to the sections “Credits” and “Use limitations” in the metadata of each layer file, as additional data constraints and required credits of the original data sources may apply.33. Moreover, we were able to identify data gaps, especially for the Mexican side of the RGB, and therefore the need for further research to reduce data imbalance between the two sides of this transboundary basin. Even though our study is limited to the socio-environmental boundaries of the RGB system and the typology of actors is specific to the shared basins between U.S. and Mexico, we consider that our approach to assembling a wide range of data is transferable to other shared river basins to serve transboundary and cross-disciplinary collaboration and research.In conclusion, to achieve more sustainable transboundary water management, it is necessary to approach problems from a boundary-spanning and interdisciplinary perspective. By creating a basin-wide, socio-environmental geodatabase for the RGB, we address this issue and support further interdisciplinary research in the basin. The main novelty of our approach was to include geospatial datasets mapping public and private water governance, which contributes to better understanding of scale interactions and mismatches between ecological and social (decision-making) boundariesSupplementary Information 1Supplementary Information 2Supplementary Information 3


The MI group displayed an improved TUG (p = 0.031) and a reduced sFES-I (p = 0.044). The decreased MTC variability and fear of falling as well as the improved functional mobility may contribute to a reduced risk of falling. For the subsequent study, further kinematic and cognitive parameters should be analyzed, and the number of participants has to be increased.Chronic low-back pain is a major individual, social, and economic burden. The impairment ranges from deterioration of gait, limited mobility, to psychosocial distress. Due to this complexity, the demand for multimodal treatments is huge. Our purpose is to compare the effects of a multimodal movement intervention (MI) (coordinative–cognitive exercises and dancing program) with standard physical therapy (PT) on gait, physical function, and quality of life in patients with lumbar spinal stenosis (LSS). The study design is based on a 6-week intervention with a two (group: MI/PT) by two (measurement time points: pre-/post-test) parallel group design with random assignment. Twenty-four subjects  diagnosed with LSS were included and randomly allocated to the MI or PT group. The primary outcomes are minimum toe clearance (MTC) and double step length (DSL) variability and the Timed “Up & Go” test (TUG). Secondary outcomes are the Brief Pain Inventory, the short Fall Efficacy Scale–International (sFES-I), and the Oswestry Disability Index. Nine subjects for each group could be analyzed. The MTC variability revealed a significant between-group difference in the posttest . Over 500 million people worldwide suffer from low-back pain (LBP) and the associated health restrictions, regardless of gender, or economic status , 2. PatiDue to the described manifold biosocial effects and since most of the affected people cannot attribute the pain to a specific nociceptive event , a purelTherefore, a dance training consisting of complex sensorimotor, rhythmic, and physical activity integrating multiple cognitive and social elements –32 combiFor this reason, the objective of this study is to evaluate the beneficial effects of a multimodal intervention (MI) composed of a coordinative–cognitive training and a dancing program in contrast to standard physical therapy (PT) on the risk of falling in patients with chronic LBP, neurogenic claudication in LSS and/or degenerative spondylolisthesis. We expect that the gait variability, functional mobility, perceived pain, and fear of falling improve more by the MI than by PT.Thirty-two subjects  were recruited by a newsletter announcement distributed in two different clinical institutions in Magdeburg from January to March 2019. All subjects were at least 60 years old, had LSS (decompression laminectomy), and showed clinical relevant evidence for chronic LBP and neurogenic claudication and/or degenerative spondylolisthesis diagnosed by medical professionals. The exclusion criteria were musculoskeletal disease, neurological disorders, congenital spinal malformations, and spinal surgical interventions (<2 years ago). Twenty-four subjects , on average, 70.8 ± 10.6 years old, could be included. Due to a probably higher dropout rate in the MI group, we have initially assigned 14 participants to the MI and 10 to the PT group.The present study was designed as a 6-week pilot intervention study with a two (group: MI/PT) by two (measurement time points: pre-/post-test) parallel group design with random assignment. The research protocol was in accordance with the principles of the Declaration of Helsinki and was approved by the ethics committee of the Otto von Guericke University (OvGU) Magdeburg (Germany) (registration number: 182/18). At both time points (pre-/post-test), the subjects were invited to the Department of Orthopedic Surgery at Klinikum Magdeburg . At the first meeting, the participants were informed in detail about the study purpose, and written informed consent was obtained. Thereafter, an interview was conducted to assess the course of the disease, comorbidities and the location as well as the current intensity of pain related to the chronic LBP. Additionally, the Timed “Up & Go” test (TUG)  was perfFollowing the medical interview, the acquisition of gait kinematics was also carried out at the MVZ in order to assess gait variability. The patients had to walk back and forth a distance of 12 m over 2 min at their preferred walking speed. The first and last 2.5 m of each walking-track were excluded from data analyses to deduct the deceleration and acceleration phases. The gait kinematics were captured with three inertial measurement units   fixed dorsally at each foot and one at the upper body (sternum). The gait protocol and the calculation procedure are based on the recommendations from Hamacher et al. . The parFor both groups, adequate and medically secured treatment of pain was ensured by the intake of oral pain medications in accordance with WHO standards  and was The MI was offered twice a week for 60 min over 6 weeks at the gym of the OvGU. The exercise sessions of the MI group consisted of three different parts: (1) 10 min coordinative–cognitive training, (2) 40 min dancing program, and (3) 10 min cool-down. The coordinative–cognitive training included exercises that refer to the performance of motor–cognitive dual-task while simultaneously processing external information. Motor–cognitive dual-task exercises are defined as exercises where both motor task  and cognitive task  are performed at the same time. Therefore, the focus of these exercises was to perform a cognitively demanding task in addition to motor activities dictated by external information . The degree of complexity of these exercises was continuously adjusted so that the participants could not master the task to perfection. The dancing program consisted of different dancing choreographies including single and couple dance. The subjects had to learn, memorize, and access new moving patterns and step sequences under various physical and coordinative demands . In addition, subjects were trained to couple body movements regarding different rhythms. In order to maintain a high level of coordinative demand, the complexity of the choreography was successively increased over the course of the intervention. The cool-down mainly consisted of relaxing and stretching exercises. The PT group received a standard prescription for standard physical therapy  three times a week for 30 min. Each exercise session was supervised by experienced instructors or professional therapists, respectively. This applies to both the MI and PT group.The primary endpoint consisted of the variability of the DSL  and the The secondary outcomes of the study consisted of pain intensity and interference with activities of daily living, fear of falling, and pain-related disabilities, as measured through BPI, sFES-I, and ODI scores, respectively.U-test. Changes between measurement time points within a group were verified using the Wilcoxon test (time effect). Outcome parameters are presented in median (25th/75th percentile). All statistical analyses were performed using SPSS Statistics 25  for Microsoft Windows. The level of significance was set to an alpha level of 5%.Due to the low number of subjects that could be included in the analysis, we used non-parametric tests for all statistical analyses. Group differences in age, height, weight, body mass index (BMI), and changes in the outcome parameters  were compared using the Mann–Whitney The data of five subjects had to be excluded from the MI group due to a low attendance rate (<80%). The lack of participation in the intervention was explained by the participants with personal commitments. Additionally, one subject from the PT group was removed based on an incomplete dataset. Finally, the data of nine subjects for each group (MI/PT) was analyzed . The between-group difference concerning the DSL was also not statistically significant in the posttest . The MTC variability revealed a significant between-group difference , indicating that subjects of the MI group had a lower MTC variability after the intervention compared to the PT group (see p > 0.050) could be observed for the MI group, suggesting that these subjects reduced their variability of DSL and MTC in the posttest . For the MI group, we observed a significant time effect  and 18.0 (12.0/44.5), Z = −1.016, p = 0.340 and Z = −0.354, p = 0.730, respectively; ODI: 15.0 (8.0/16.5) and 12.0 (7.8/15.8), respectively, Z = −0.246, p = 0.842 and Z = −0.357, p = 0.762, respectively]. Furthermore, no significant between-group differences could be observed after 6 weeks of intervention . Regarding the sFES-I, we could observe a significant time effect, demonstrating that the fear of falling is reduced after 6 weeks of intervention in the MI group [−3.0 (0.0/−3.5)]. In the PT group, however, the sFES-I remained unchanged over time [−1.0 (2.0/−3.5)]. Regarding BPI and ODI, we could not determine any time effects in either group  and 11.0 (10.0/13.0), roup see .This pilot study has revealed first tendencies that a multimodal approach consisting of a coordinative–cognitive training and dancing program reduces gait variability (not significant) and the fear of falling and improves the level of functional mobility more than the standard PT. These results are congruent with other equivalent studies. Cruz-Díaz et al.  comparedMoreover, we could observe a group effect, suggesting that the MTC variability was significantly lower in the MI compared to the PI group at the end of the intervention see . The DSLThe results of Lamoth et al. support the notion that gait is not merely an automated motor activity but required higher cognitive functions especially in the elderly . MoreoveOverall, the effects were too small to be considered clinically significant especially looking at the short study period of this pilot study. However, these results indicate that the applied MI has the potential to improve parameters relevant to the individual fall risk in a more sustainable way than standard PT in patients with LSS, chronic LBP, and neurogenic claudication and/or degenerative spondylolisthesis.In future studies, this multimodal approach should be applied to larger cohorts to consolidate the results. Furthermore, cognitive parameters such as central activation  during simple/dual-task walking should be involved in the procedure, and other kinematic gait parameters should be taken into consideration. This would allow even better estimations about the extent of gait automaticity and thus about the effect on risk of falling of such a multimodal intervention.The datasets generated for this study are available on request to the corresponding author.The studies involving human participants were reviewed and approved by Ethics committee of the Otto von Guericke University Magdeburg, Germany. The patients/participants provided their written informed consent to participate in this study.Over 500 million people worldwide suffer from chronic low-back pain and the associated health restrictions, regardless of gender or economic status. The effects of this impairment are not only physical loss of function, but are also perceived on a psychosocial level, resulting in reduced quality of life. The pain is often accompanied by insufficient muscular stabilization and poor posture. All these factors lead to a change in gait pattern, which may lead to an increased risk of falling. Nearly one third of people over 65 years of age fall every year and with advancing age the risk of falling increases significantly. People with chronic low-back pain have an even higher prevalence of falls. A purely biomedical addressing of the complaints is not suitable for many patients due to the manifold biosocial effects. Many patients seek relief from symptoms in alternative treatment strategies. Dance training integrating physical activity, multiple cognitive, and social elements in combination with additional coordinative-cognitive exercises as a multidisciplinary and multimodal approach aims exactly this complex problem. We expect reduced gait variability, improved mobility, and physical function leading to an increased quality of life and a decreased risk of falling in low-back pain patients.K-CB: study execution and writing manuscript. TB: study execution, statistics, writing assistance, and proof reading. DH: study execution and proof reading. SB, TG, CC, KM, and AN: study execution. CS: study design and execution. JF and LS: study design, execution, and proof reading. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Background: Although not a life-threatening condition, infertility does influence various aspects of life. Based on a meta-analysis of the relevant literature, the aim of this study is to identify the psychosocial consequences of infertility in Iranian women.Methods: Comprehensive Portal of Human Sciences, Magiran, Scientific Information Database, Noormags, MEDLIB, ScienceDirect, Google Scholar, Medline, and ProQuest were the databases searched from inception (1999) to 2018. To maximize the comprehensiveness of the search, the reference lists of all the relevant papers identified were manually examined. The evaluation of the content was based on PRISMA guidelines, and Comprehensive Meta-Analysis software was used for data analysis.Results: Based on the analysis of 124 quantitative papers, the psychosocial consequences of infertility in women in Iran can be classified into 14 categories: psychological well-being (effect size = 3.10), adaptation to infertility (effect size = 2.71), quality of life (effect size = 1.83), depression (effect size = 1.80), anxiety (effect size = 1.72), marital relationships (effect size = 1.37), personality disorders (effect size = 1.37), violence (effect size = 1.31), social support (effect size = 0.90), self-efficacy (effect size = 0.90), coping strategies (effect size = 0.84), irrational thoughts (effect size = 0.77), somatization disorders (effect size = 0.65), and sexual dysfunction (effect size = 0.55).Conclusion: Considering the wide-ranging psychosocial consequences of infertility in women, it is necessary for treatment to account for psychological factors. Infertility is characterized by the failure to achieve a clinical pregnancy despite 12 months of regular and unprotected sexual intercourse . AccordiAlthough infertility has an emotional impact on both partners, studies have shown that it imposes greater pressure on women, as demonstrated by the fact that 50% of infertile women considered this the biggest problem in their lives . In a prThe stress and anxiety in women with infertility arises from issues such as missing out on the experience of motherhood, negative self-concept, and inability to continue the family line. Moreover, societal pressures are responsible for the extensive psychological consequences in women with infertility . In manySince infertility is an unexpected stress in the lives of couples, they are usually not equipped with the necessary information and appropriate coping strategies. Therefore, it is of paramount importance that psychological factors be taken into account during the treatment of infertility. Accordingly, the aim of this meta-analysis of studies concerning the psychological consequences of infertility in women is to provide experts with the data required to design therapy programs to preclude and decrease the negative effects of infertility in women. In this regard, this study seeks to answer the following question: What does the literature reveal about the psychological consequences of infertility in Iranian women?This study was conducted according to PRISMA guidelines. To investigate the entirety of the body of published research concerning the psychological consequences of infertility in women in Iran, the databases searched included Comprehensive Portal of Human Sciences, Magiran, Scientific Information Database, Noormags, MEDLIB, ScienceDirect, Google Scholar, Medline, and ProQuest. To maximize the comprehensiveness of the search, the reference lists for all the relevant papers were manually examined.The search strategy was based on the PICOS model, as follows: P—infertile Iranian women, I—psychological interventions or assessment were done about psychosocial consequences of female's infertility, C—fertile Iranian people, O—psychosocial consequences of infertility, S—randomized control trial studies, pretest and posttest, quasi-experimental, and descriptive studies. To identify papers in the aforementioned electronic databases, the keywords used were “infertility,” “women's infertility,” “primary infertility,” “secondary infertility,” “quality of life,” “well-being,” “mood disorder,” “anxiety disorder,” “sexual dysfunction,” “psychological distress,” and combinations of these words.For studies to be included in this meta-analysis, they had to meet certain inclusion and exclusion criteria. The inclusion criteria were studies that  were pubIn this study, we employed Hedges' effect size to quantitatively evaluate the results. To elaborate, we first drew a funnel plot to identify publication bias. Following the sensitivity analysis and exclusion of studies with publication bias, we determined the effect size of every psychosocial consequence of infertility in women in Iran as well as the effect size using fixed and random models. Further, to investigate the heterogeneity of the effect sizes in the initial studies, that is, those that did not make it to the final analysis stage despite originally meeting certain criteria, we employed Cochran's Q and the chi-l index. Comprehensive Meta-Analysis software  was used for data analysis.Out of the 474 papers initially identified in the electronic databases, 73 and 121 were excluded in the first stage owing to the incongruity of their topics and duplication. As a result, a total of 346 papers were selected for the next stage. In this stage, the authors investigated the texts of the papers. A total of 156 papers that had a low quality based on PRISMA principles were excluded from the list. At this point, 124 papers were selected for the meta-analytic process . DetailsA total of 292 effect sizes from the studies that initially entered the meta-analysis were measured. The reason for the number of effect sizes being greater than the number of included studies was the fact that every study contained numerous variables related to the psychosocial consequences of infertility. Since one of the main assumptions of our meta-analysis was the absence of publication bias, we first employed a graphic method (funnel plot) to identify publication bias and eliminate those studies.By observing the funnel plot , it can P ≤ 0.00).P ≤ 0.00) and indicated an actual difference between the effect sizes of the initial studies. Furthermore, the Chi-I results indicated that 91.28% of the variance present in the initial study results was real and could be obtained using moderating variables. Based on the criteria laid down by Bornstein, Hedges, Higgins, and Rothstein . The value obtained for the Q index (for 243 effect sizes) was 2,777.90, with a 242 degree of freedom, which was statistically significant , duration of infertility, success/failure of previous treatments, and the cause of infertility  . In thisThe fifth psychological consequence of infertility in women is anxiety, with 33 significant effect sizes and a Hedges' effect size of 1.72. The psychological, social, and financial challenges of infertility and its treatment can intensely influence the lives of couples. In the ranking of the worst possible events in a woman's life, infertility was positioned fourth, following death of parents and betrayal by the partner . A studyMarital satisfaction is the sixth psychological consequence of infertility in women, with 41 significant effect sizes and a Hedges' effect size of 1.37. The stress of infertility affects marital adaptation, marital quality, and marriage stability. Marital quality and satisfaction in couples with infertility is significant, since it facilitates the continuation of infertility treatments and increases their chances of success. It is worth mentioning that the quality of a marital relationship is a major predictor of psychological health in women with infertility, and plays a crucial role in reducing their anxiety and depression levels .The seventh psychological consequence of infertility in women relates to personality disorders, with seven significant effect sizes and a Hedges' effect size of 1.37. An individual's personality is influenced by infertility and its consequences, because people face problems differently and according to their personality traits. One of the factors that influence infertility and its consequences is the personality of individuals, because people with different personality traits face problem differently. Several studies have reported a high prevalence of personality disorders in women with infertility .The eighth psychological consequence of infertility is violence, with 14 significant effect sizes and a Hedges' effect size of 1.31. According to the United Nations' Declaration on the Elimination of Violence Against Women in 1993, violence against women is defined as “any act of gender-based violence that results in physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or private life” . InfertiSocial support is the ninth most influential psychocognitive consequence of infertility in women, with 18 significant effect sizes and a Hedges' effect size of 0.90. Social support is defined as a person's receipt of information, financial aid, health recommendations, and emotional support from individuals in their social network, including partners, relatives, and friends. The results of a qualitative study indicated that the four most necessary support categories in couples with infertility are social, financial, spiritual, and informational .Self-efficacy ranks 10th in the list of psychological consequences of infertility in women, with five significant effect sizes and a Hedges' effect size of 0.90. Self-efficacy stems from the difference between how an individual perceives him/herself (self-concept) and the ideal-self. A small difference between these two leads to high self-efficacy, while larger differences result in low self-efficacy . StudiesThe use of inefficient coping strategies ranks 11th among the psychocognitive consequences of infertility in women, with eight significant effect sizes and a Hedges' effect size of 0.84. Coping strategies refer to mindful behaviors and cognitive attempts to manage current or expected stressors and negative events. These strategies are often categorized into two main groups, namely, problem-focused and emotion-focused. While problem-focused strategies employ behaviors such as acting and planning, emotion-focused strategies include expressing emotions and changing expectations . The resIrrational thoughts regarding either having or not having children are the 12th most important psychological consequence of infertility, with five significant effect sizes and a Hedges' effect size of 0.77. Irrational thoughts are the beliefs that individuals learn in life. However, they are not fundamentally realistic and usual. Studies have shown that irrational cognitions regarding childbearing being the essence of a happy life are the main predictors of quality of life in couples with infertility .Physical complaints are the 13th most significant psychocognitive consequence of infertility in women, with 10 significant effect sizes and a Hedges' effect size of 0.65. Overall, women with infertility have poorer psychological health compared to those who can bear children. A study showed that among the subscales of the Symptom Checklist-90-Revised, the highest mean score among women with infertility was for somatization . StressfFinally, sexual dysfunction is the 14th psychological consequence of infertility, with 17 significant effect sizes and a Hedges' effect size of 0.55. Negative psychological and physiological consequences of the diagnosis and treatment of infertility can influence sexual functioning and lead to sexual dysfunction. Pregnancy, in the minds of many individuals, is the result solely of sexual intercourse and an indication of intimacy. Therefore, when pregnancy does not occur, it can discourage individuals from having sexual intercourse. On the contrary, in the process of infertility treatment, physicians generally prescribe a certain schedule for couples to have sexual intercourse. When physicians recommend a strict regimen regarding the timing of sexual intercourse and dictate details, it changes from an enjoyable act to a mechanical one . As repoThe act of fertilization and delivering a healthy child is considered the main event in the life of every couple. However, there is a significant factor that obstructs such joy: infertility. Although both men and women can experience infertility, social  pressures imposed on women often result in them carrying the burden of infertility, in turn experiencing psychological and physical problems. Further, therapeutic protocols must be adjusted to decrease, if not eliminate, these consequences.All datasets generated for this study are included in the article/supplementary material.HZ, HA, and HK contributed conception and design of the study. HZ and HA organized the database. HZ and HK performed the statistical analysis. HZ wrote the first draft of the manuscript. HZ and HA wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Focal cortical dysplasia (FCD) is a type of malformations of cortical development and one of the leading causes of drug-resistant epilepsy. Postoperative results improve the diagnosis of lesions on structural MRIs. Advances in quantitative algorithms have increased the identification of FCD lesions. However, due to significant differences in size, shape, and location of the lesion in different patients and a big deal of time for the objective diagnosis of lesion as well as the dependence of individual interpretation, sensitive approaches are required to address the challenge of lesion diagnosis. In this research, a FCD computer-aided diagnostic system to improve existing methods is presented.Magnetic resonance imaging (MRI) data were collected from 58 participants . Morphological and intensity-based features were calculated for each cortical surface and inserted into an artificial neural network. Statistical examinations evaluated classifier efficiency.Neural network evaluation metrics—sensitivity, specificity, and accuracy—were 96.7, 100, and 98.6%, respectively. Furthermore, the accuracy of the classifier for the detection of the lobe and hemisphere of the brain, where the FCD lesion is located, was 84.2 and 77.3%, respectively.Analyzing surface-based features by automated machine learning can give a quantitative and objective diagnosis of FCD lesions in presurgical assessment and improve postsurgical outcomes. Focal cortical dysplasia (FCD) is inherently epileptogenic and can be an essential reason behind refractory epilepsy . FCD, deThis study involving human participants were reviewed and approved by the Research Ethics Committee of the School of Medicine, Mashhad University of Medical Sciences. Since we used pre-prepared data, there is no need for consent statement (Ethics code: IR.MUMS.fm.REC.1396.506).adni.loni.ucla.edu) database. All individuals were right-handed. The patients and control demographics and lesion characteristics are summarized in Thirty individuals with verified FCD type II were involved in the present research. To determine specificity, we also included a control group of 28 adults without a record of any neurological prognosis from the ADNI : 3D volume fast field echo (FFE) T1-weighted sequence  and 3D T2-FLAIR .The patients’ MRI datasets have been obtained with AchievaK-folds, and in each K, the machine trained 30 times, and the average results were considered. For the artificial neural network method, the classifier was trained 30 times, and the average of evaluations was obtained. Finally, we report the best results in this article. The evaluation results of the other methods are awaiting acceptance in another article.In this study, which is an extract from a dissertation , we usedThe FreeSurfer software   was usedTwo experienced neurologists segmented FCD lesions using the ITK-SNAP software . Thus, lesion tissue was labeled as 1 and healthy tissue as 0. We extracted morphological and intensity-based features. According to the Desikan–Killiany atlas, the cerebral cortex was parcellated into 34 regions (ROIs) per hemisphere. In general, for each ROI, the average cortical thickness, Gaussian curvature, mean curvature, intrinsic curvature index, and folding index; statistical indices including mean, min, max, range, and standard deviation; and SNR for intensity contrast were extracted. k1 and k2 are the principal curvatures at points 1 and 2 on the cortical surface): mean curvature = k1.k2, intrinsic curvature index is computed as |k1k2|, and folding index = |k1| (|k1|−| k2|)  to the nearest possible point over the pial surface (GM–CSF boundary) . The Gau|−| k2|) .z-score  the lesional lobe of the brain and (ii) the lesional hemisphere of the brain.Automatic FCD lesion diagnosis was performed utilizing an artificial neural network classifier carried out in MATLAB R2014 . The ANN classifier was trained with extracted features. We used the feedforward neural network to train information. It had input, hidden, and output layers. In this network, the information move only from one direction to the next. The flow of information is done by input nodes (neurons), and if there are hidden layers, they pass through and enter the output nodes . Each noWe decided to determine the location of the lesion in two steps: first, the lesional hemisphere in two classes—right hemisphere (RH) and left hemispheres (LH); and second, the lesional lobe in four classes: frontal, temporal, parietal, and occipital.The classification performance was assessed using statistical parameters of sensitivity, specificity, and accuracy to identify the patients from the control. The accuracy and sensitivity parameters were also used to evaluate the location of the lesion. The overall procedure is shown in n = 11), temporal lobe (n = 6), parietal lobe (n = 6), occipital lobe (n = 2), and multilobar (n = 5). The multilobar lesions are all located in the right hemisphere.Thirty clients with a radiological sign of FCD type II  and 28 healthy controls were involved. Due to radiological reports, lesion focus was present on the left hemisphere in 10 patients and on the right hemisphere in 20 other patients. The lesion location was labeled by an experienced neurologist: frontal lobe . In addition to MRI-positive patients, in the study of In evaluating the lesion’s location, the accuracy of the classifier for the detection of the lesional hemisphere and lesional lobe was 84.2 and 77.3%, respectively. In past works related to the localization of the lesion, For the automatic identification of FCD lesions and brain regions involved, using surface features including the morphology and intensity-based features as well as quantitative methods of machine learning, a computer-aided diagnostic system for FCD lesions was presented. In MRI-positive cases, our methods showed a high sensitivity of 96.7% in patients with FCD type II and also had excellent specificity (100%) and reliable accuracy (98.6%). This method had also high accuracy to detect lesion location in the brain (84.2% in hemisphere diagnosis and 77.3% in lobe diagnosis), but similar studies have not been performed for comparison. Also, in MRI-negative cases, the results showed 91.3% accuracy.Various classification methods were proposed in studies to detect FCD lesions. The results obtained from similar studies and the results of this research are shown in In general, our results suggest that a completely automated machine learning method can provide a major FCD diagnosis outcome in presurgical assessment for pharmacoresistant patients. The clinical application of these results can be found in the fact that the main goal of neurologists is accurate surgery of FCD lesions, and as has been mentioned, the visual detection of epileptogenic focal is a difficult and time-consuming task. In an automatic lesion detection system using MR images, noninvasive methods can be used to assist neuroradiologists, and the costs incurred for using other methods by many patients, such as PET imaging, can be reduced.We tried to prove the importance of surface-based MRI morphometry by machine learning using a group of patients with type II FCD. This technique can be a valuable tool to boost patients’ preoperative analysis with drug-resistant epilepsy. The limitation of our study was insufficient data. As a suggestion for future studies by the increasing amount of data, the results will be improved to detect the lesion area, and other methods may also be used to identify the lesion area involved.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.This study involving human participants were reviewed and approved by Research Ethics Committee of School of Medicine-Mashhad University of Medical Sciences. Written informed consent from the participants’ legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.All authors listed have made substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.