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Nursing students experience higher stress and burnout compared to students in other health professions, with a prevalence rate of as high as 20%. More recently, they have been affected by changes in nursing education due to the COVID-19 pandemic, such as requirements for social isolation and distance learning. Although there are existing studies on interventions that address academic burnout among nursing students, there is no synthesis of randomized trials on this topic.This study aimed to systematically synthesize studies of interventions for academic burnout among nursing students.A systematic search for randomized controlled trials was performed in PubMed, CINAHL, CENTRAL, Web of Science, and Scopus. Eligibility criteria were based on study directness in relation to the Patient, Intervention, Comparison, and Outcome (PICO) question. Two review authors independently screened articles for inclusion, collected data from the included studies, and performed risk of bias assessments using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis was performed. This review was registered a priori in PROSPERO (CRD42022350196).Six papers were included in this review. Various interventions were studied: Qigong exercises, progressive muscle relaxation, autogenic therapy and laughter therapy, didactic behavioral sessions focusing on personal and professional development, and coping skills enhancement. The effects of these interventions on academic burnout, depression, and stress among nursing students were short term and their benefits over time remain uncertain.Progressive muscle relaxation and cognitive behavioral interventions demonstrated short-term positive effects on academic burnout, depression, and stress among nursing students. These findings may support the development of individual-level and organizational-level initiatives for nursing students aimed to lessen or prevent academic burnout. Large-scale, high-quality studies on the effect of interventions on academic burden in various settings and cultures are needed.

Rejuvenation and memory, long considered the distinguishing features of spin glasses, have recently been proven to result from the growth of multiple length scales. This insight, enabled by simulations on the Janus~II supercomputer, has opened the door to a quantitative analysis. We combine numerical simulations with comparable experiments to introduce two coefficients that quantify memory. A third coefficient has been recently presented by Freedberg et al. We show that these coefficients are physically equivalent by studying their temperature and waiting-time dependence., 10 pages, 8 figures

We unveil the multifractal behavior of Ising spin glasses in their low-temperature phase. Using the Janus II custom-built supercomputer, the spin-glass correlation function is studied locally. Dramatic fluctuations are found when pairs of sites at the same distance are compared. The scaling of these fluctuations, as the spin-glass coherence length grows with time, is characterized through the computation of the singularity spectrum and its corresponding Legendre transform. A comparatively small number of site pairs controls the average correlation that governs the response to a magnetic field. We explain how this scenario of dramatic fluctuations (at length scales smaller than the coherence length) can be reconciled with the smooth, self-averaging behavior that has long been considered to describe spin-glass dynamics., 15 pages, 15 figures

Electroencephalography (EEG) is a tool that allows us to analyze brain activity with high temporal resolution. These measures, combined with deep learning and digital signal processing, are widely used in neurological disorder detection and emotion and mental activity recognition. In this paper, a new method for mental activity recognition is presented: instantaneous frequency, spectral entropy and Mel-frequency cepstral coefficients (MFCC) are used to classify EEG signals using bidirectional LSTM neural networks. It is shown that this method can be used for intra-subject or inter-subject analysis and has been applied to error detection in musician performance reaching compelling accuracy. This work has been funded by Junta de Andalucía in the framework of Proyectos I+D+I en el marco del Programa Operativo FEDER Andalucia 2014–2020 under Project No.: UMA18-FEDERJA-023, Proyectos de I+D+i en el ámbito del Plan Andaluz de Investigación, Desarrollo e Innovación (PAIDI 2020) under Project No.: PY20_00237 and Universidad de Málaga, Campus de Excelencia Internacional Andalucia Tech . Funding for open access charge: Universidad de Málaga/CBUA

In this paper we show the way to apply some and analytical and numerical techniques in order to solve the forced Van der Pol oscillator. We illustrate the obtained results with examples. A comparison with Runge–Kutta numerical method is made in order to see the accuracy of the approximated analytical solution.

The rise of antimicrobial-resistant phenotypes and the spread of the global pandemic of COVID-19 are worsening the outcomes of hospitalized patients for invasive fungal infections. Among them, candidiases are seriously worrying, especially since the currently available drug armamentarium is extremely limited. We recently reported a new class of macrocyclic amidinoureas bearing a guanidino tail as promising antifungal agents. Herein, we present the design and synthesis of a focused library of seven derivatives of macrocyclic amidinoureas, bearing a second phenyl ring fused with the core. Biological activity evaluation shows an interesting antifungal profile for some compounds, resulting to be active on a large panel of Candida spp. and C. neoformans. PAMPA experiments for representative compounds of the series revealed a low passive diffusion, suggesting a membrane-based mechanism of action or the involvement of active transport systems. Also, compounds were found not toxic at high concentrations, as assessed through MTT assays.

We study the interface representation of the contact process (CP) at its directed-percolation critical point, where the scaling properties of the interface can be related to those of the original particle model. Interestingly, such a behavior happens to be intrinsically anomalous and more complex than that described by the standard Family-Vicsek dynamic scaling Ansatz of surface kinetic roughening. We expand on a previous numerical study by Dickman and Mu\~noz [Phys. Rev. E 62, 7632 (2000)] to fully characterize the kinetic roughening universality class for interface dimensions $d=1, 2$, and 3. Beyond obtaining scaling exponent values, we characterize the interface fluctuations via their probability density function (PDF) and covariance, seen to display universal properties which are qualitatively similar to those recently assessed for the Kardar-Parisi-Zhang (KPZ) and other important universality classes of kinetic roughening. Quantitatively, while for $d=1$ the interface covariance seems to be well described by the KPZ, Airy$_1$ covariance, no such agreement occurs in terms of the fluctuation PDF nor the scaling exponents., Comment: 12 pages, 9 figures

Introduction Smoking produces significant health problems affecting millions of people globally. It is the largest single cause of preventable deaths. This study aims to describe the characteristics of Filipino adolescent smokers aged 13–15 years and determine the factors associated with the intention to continue to use tobacco in the next 12 months among current smokers. Methods This was a secondary analysis of the 2015 Global Youth Tobacco Survey (GYTS) in the Philippines to determine the association of the following factors with the intention to continue to use tobacco in the next 12 months among current smokers: 1) exposure to anti-tobacco media messages, 2) exposure to health warnings on cigarette packages, and 3) being taught about the dangers of tobacco in any class. Results The adjusted odds of continuing to use of any form of tobacco in the next 12 months was higher (AOR=1.24; 95% CI: 0.62–2.49) among those who have not seen health warnings on cigarette packages and higher (AOR=1.32; 95% CI: 0.71–2.45) when not taught about tobacco in any of their classes. Finally, those who have not seen or heard antitobacco messages on television, radio, internet, billboards, posters, newspapers, magazines, or movies, were more likely (AOR=2.19; 95% CI: 1.14–4.21) to report their intention to continue to use tobacco. Conclusions Understanding the relationship of different tobacco control strategies to adolescents’ intention to continue using tobacco can contribute to the improvement of tobacco policies and programs and achieve effective tobacco control among the youth. A targeted anti-tobacco campaign in both traditional and new media should be considered an essential part of a comprehensive tobacco control program. Health warnings on cigarette packs should be supported by a policy banning the sale of single stick cigarettes.

Bovine blood plasma (BBP), a waste stream from some slaughterhouses, represents an alternative feedstock to be used as a nitrogen source for microbial cultivation. The objective of this research was to evaluate the feasibility of producing Lactobacillus plantarum by submerged fermentation on a laboratory scale in different culture media based on protein BBP hydrolyzates. Six protein hydrolyzates from BBP were obtained using commercial alkaline protease to prepare liquid media with different contents of assimilable nitrogen in a 3-L glass reactor with a water recirculation jacket. L. plantarum ATCC 8014 was cultivated in those media with contents of assimilable nitrogen from 582 to 1097 mg/L, and sucrose from 20 to 80 g/L up to a time of 60 h. The response volume methodology and a numerical optimization method were used to find the optimal values of these variables. Optimal treatment maximizing the viable cell concentration of L. plantarum is associated with a sucrose concentration of 80 g/L, an amino nitrogen content of 825 mg/L, and a culture time of approximately 34 h. The obtained results are relevant for the future design of a biotechnological process for BBP valorization to obtain starter cultures for the meat industry.

Future scientific and technological evolution in many areas of applied mathematics and modern physics will necessarily depend on dealing with complex systems. Such systems are complex in both their composition and behavior, namely, dealing with complex dynamical systems using different types of Duffing equations, such as real Duffing equations and complex Duffing equations. In this paper, we derive an analytical solution to a complex Duffing equation. We extend the Krýlov–Bogoliúbov–Mitropólsky method for solving a coupled system of nonlinear oscillators and apply it to solve a generalized form of a complex Duffing equation.

The extended principle of superposition has been a touchstone of spin glass dynamics for almost thirty years. The Uppsala group has demonstrated its validity for the metallic spin glass, CuMn, for magnetic fields $H$ up to 10 Oe at the reduced temperature $T_\mathrm{r}=T/T_\mathrm{g} = 0.95$, where $T_\mathrm{g}$ is the spin glass condensation temperature. For $H > 10$ Oe, they observe a departure from linear response which they ascribe to the development of non-linear dynamics. The thrust of this paper is to develop a microscopic origin for this behavior by focusing on the time development of the spin glass correlation length, $\xi(t,t_\mathrm{w};H)$. Here, $t$ is the time after $H$ changes, and $t_\mathrm{w}$ is the time from the quench for $T>T_\mathrm{g}$ to the working temperature $T$ until $H$ changes. We connect the growth of $\xi(t,t_\mathrm{w};H)$ to the barrier heights $\Delta(t_\mathrm{w})$ that set the dynamics. The effect of $H$ on the magnitude of $\Delta(t_\mathrm{w})$ is responsible for affecting differently the two dynamical protocols associated with turning $H$ off (TRM, or thermoremanent magnetization) or on (ZFC, or zero field-cooled magnetization). In this paper, we display the difference between the zero-field cooled $\xi_{\text {ZFC}}(t,t_\mathrm{w};H)$ and the thermoremanent magnetization $\xi_{\text {TRM}}(t,t_\mathrm{w};H)$ correlation lengths as $H$ increases, both experimentally and through numerical simulations, corresponding to the violation of the extended principle of superposition in line with the finding of the Uppsala Group., Comment: 23 pages and 18 figures

We find a dynamic effect in the non-equilibrium dynamics of a spin glass that closely parallels equilibrium temperature chaos. This effect, that we name dynamic temperature chaos, is spatially heterogeneous to a large degree. The key controlling quantity is the time-growing spin-glass coherence length. Our detailed characterization of dynamic temperature chaos paves the way for the analysis of recent and forthcoming experiments. This work has been made possible thanks to the most massive simulation to date of non-equilibrium dynamics, carried out on the Janus~II custom-built supercomputer., Comment: Version accepted for publication in Communication Physics 10 pages, 9 figures

Aging is a carcinogen that markedly increases cancer risk, yet we have limited mechanistic understanding of cancer initiation in aged cells. Here, we demonstrate induction of the hallmark aging process cellular senescence, triggered by loss of Wnt inhibitor ZNRF3, remodels the tissue microenvironment and ultimately permits metastatic adrenal cancer. Detailed characterization reveals a striking sexual dimorphism. Males exhibit earlier senescence activation and a greater innate immune response. This results in high myeloid cell accumulation and lower incidence of malignancy. Conversely, females present a dampened immune response and are more prone to metastatic cancer. Senescence-recruited myeloid cells become increasingly depleted with advanced tumor progression, which is recapitulated in patients where a low myeloid signature is associated with worse outcome. Collectively, our study reveals a novel role for myeloid cells in restraining adrenal cancer progression with significant prognostic value, and provides a model for interrogating pleiotropic effects of cellular senescence in cancer.Graphical abstract created with BioRender.com

In this work we report the development and validation of a photoelectrochemical immunosensor on the basis of alkaline phosphatase (ALP)-linked immunoassay for the detection of human serum albumin as a model analyte. In this biosensor, oriented immobilization of capture antibodies on aminated polystyrene was achieved via physical adsorption. After the interaction with the analyte, ALP immobilised on the surface through the sandwich immunoassay catalyses the hydrolysis of sodium thiophosphate (TP) to hydrogen sulphide (H2S) which in the presence of cadmium ions yields CdS quantum dots (QDs). The electrical current is generated in the course of the photoelectrochemical process (PEC) during irradiation of the CdS QDs with a UV LED (365 nm) on home-made screen-printed carbon electrodes modified with a conductive polymer. Reaction time, steps and volumes were optimized for the miniaturization of the process in order to develop a lab-on-a-chip platform. The microfluidic system was designed with optimised parameters to fabricate the immunosensor combining the immunoassay with PEC detection. The final system presents a sensitivity comparable to that of the commercial kit thanks to the signal amplification enabled by the enzymatic growth of CdS QDs in situ. This photoelectrochemical immunosensing strategy potentially opens up a new avenue for the detection of a wide range of analytes of interest due to the universal and effective enzymatic signal amplification method. Moreover, the developed bioanalytical device allows for a great reduction of time and reagents compared to exiting commercial assays, making it suitable for point-of-care applications.

PETHEMA group., Treatment of acute myeloid leukemia (AML) evolving from myeloproliferative (MPN) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN) is challenging. We evaluated disease characteristics, treatment patterns and outcomes in 372 patients diagnosed with AML after MPN or MDS/MPN over a 27-year period. Frontline treatment was intensive chemotherapy (38%), hypomethylating agents [HMAs] (17%), non-intensive chemotherapy (14%), and supportive care (31%). Median overall survival was 4.8 months, with a 5-year survival rate of 4%. Median survival was 2.8, 3.9 and 8.3 months for the 1992-2010, 2011-2015 and 2016-2019 periods, respectively (test for trend p

Tobacco mosaic virus(TMV) has served as a model organism for pathbreaking work in plant pathology, virology, biochemistry and applied genetics for more than a century. We were intrigued by a photograph published inPhytopathologyin 1934 showing that Tabasco pepper plants responded to TMV infection with localized necrotic lesions, followed by abscission of the inoculated leaves. This dramatic outcome of a biological response to infection observed by Francis O. Holmes, a virologist at the Rockefeller Institute for Medical Research, was used to score plants for resistance to TMV infection. Our objective was to gain a better understanding of early to mid-twentieth century ideas of genetic resistance to viruses in crop plants. We investigated Holmes’ observation as a practical exercise in reworking an experiment, having been inspired by Pamela Smith’s innovative Making and Knowing Project. We had a great deal of difficulty replicating Holmes’ experiment, finding that biological materials and experimental customs change over time, in ways that ideas do not. Using complementary tools plus careful study and interpretation of the original text and figures, we were able to rework, yet only partially replicate, this experiment. Reading peer-reviewed manuscripts that cited Holmes’ 1934 report provided an additional level of insight into the interpretation and replication of this work in the decades that followed. From this, we touch on how experimental reworking can inform our strategies to address the reproducibility “crisis” in twenty-first century science.

A growing body of evidence indicates that the sluggish low-temperature dynamics of glass formers (e.g. supercooled liquids, colloids or spin glasses) is due to a growing correlation length. Which is the effective field theory that describes these correlations? The natural field theory was drastically simplified by Bray and Roberts in 1980. More than forty years later, we confirm the tenets of Bray and Roberts theory by studying the Ising spin glass in an externally applied magnetic field, both in four spatial dimensions (data obtained from the Janus collaboration) and on the Bethe lattice., 8 pages, 4 figures, accepted in PRE

In this paper, we obtain the approximate value of 42.9815 arcsec/century for Mercury’s perihelion precession by solving both numerically and analytically the nonlinear ordinary differential equation derived from the geodesic equation in Einstein’s Theory of Relativity. We also compare our result with known results, and we illustrate graphically the way Mercury’s perihelion moves. The results we obtained are applicable to any body that moves around the Sun. We give predictions about the value of the Cosmological Constant. Simple algebraic formulas allow to estimate perihelion shifts with high accuracy.

Objective Radiotherapy is considered a risk factor for pharyngocutaneous fistula after a total laryngectomy. This study aimed to analyse the impact of exclusive radiotherapy versus chemoradiotherapy and the time interval between radiotherapy and surgery on the risk of pharyngocutaneous fistula. Method This study was a retrospective revision of 171 patients treated with a total laryngectomy after radiotherapy or chemoradiotherapy. Results Pharyngocutaneous fistula occurred in 33 patients (19.3 per cent). Patients previously treated with chemoradiotherapy showed a non-significant higher pharyngocutaneous fistula rate compared with patients treated with radiotherapy (25.0 per cent vs 18.0 per cent; p = 0.455). Patients with a pharyngocutaneous fistula after chemoradiotherapy treatment required a surgical repair more frequently than patients treated with radiotherapy (p = 0.005). There were no significant differences in the pharyngocutaneous fistula rate depending on the time interval between radiotherapy and surgery (p = 0.580). Conclusion There were no differences in the pharyngocutaneous fistula rate after total laryngectomy depending on the previous treatment with radiotherapy or chemoradiotherapy, or depending on the interval between radiotherapy treatment and surgery.

Memory and rejuvenation effects in the magnetic response of off-equilibrium spin glasses have been widely regarded as the doorway into the experimental exploration of ultrametricity and temperature chaos (maybe the most exotic features in glassy free-energy landscapes). Unfortunately, despite more than twenty years of theoretical efforts following the experimental discovery of memory and rejuvenation, these effects have thus far been impossible to simulate reliably. Yet, three recent developments convinced us to accept this challenge: first, the custom-built Janus II supercomputer makes it possible to carry out "numerical experiments" in which the very same quantities that can be measured in single crystals of CuMn are computed from the simulation, allowing for parallel analysis of the simulation/experiment data. Second, Janus II simulations have taught us how numerical and experimental length scales should be compared. Third, we have recently understood how temperature chaos materializes in aging dynamics. All three aspects have proved crucial for reliably reproducing rejuvenation and memory effects on the computer. Our analysis shows that (at least) three different length scales play a key role in aging dynamics, while essentially all theoretical analyses of the aging dynamics emphasize the presence and the crucial role of a single glassy correlation length., Comment: Main text:13 pages, 4 figures SM: 7 pages, 8 figures

Purpose Proviral integration site for Moloney murine leukemia virus (PIMs) are proto-oncogenes encoding serine/threonine kinases that phosphorylate a variety of substrates involved in the regulation of cellular processes. Elevated expression of PIM-1 has been associated with poor prognosis in several types of cancer. There are no studies that have analyzed the response to radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) according to the expression of PIM-1. The aim of our study was to analyze the relationship between the transcriptional expression of PIM-1 and local response to radiotherapy in HNSCC patients. Methods We determined the transcriptional expression of PIM-1 in 135 HNSCC patients treated with radiotherapy, including patients treated with chemoradiotherapy (n = 65) and bioradiotherapy (n = 15). Results During the follow-up, 48 patients (35.6%) had a local recurrence of the tumor. Patients with local recurrence had a higher level of PIM-1 expression than those who achieved local control of the disease (P = 0.017). Five-year local recurrence-free survival for patients with a high expression of PIM-1 (n = 43) was 44.6% (95% CI 29.2–60.0%), and for patients with low expression (n = 92) it was 71.9% (95% CI 62.5–81.3%) (P = 0.007). According to the results of multivariate analysis, patients with a high PIM-1 expression had a 2.2-fold increased risk of local recurrence (95% CI 1.22–4.10, P = 0.009). Conclusion Patients with elevated transcriptional expression levels of PIM-1 had a significantly higher risk of local recurrence after radiotherapy.

Use of dedicated computers in spin glass simulations allows one to equilibrate very large samples (of size as large as $L=32$) and to carry out "computer experiments" that can be compared to (and analyzed in combination with) laboratory experiments on spin-glass samples. In the absence of a magnetic field, the most economic conclusion of the combined analysis of equilibrium and non-equilibrium simulations is that an RSB spin glass phase is present in three spatial dimensions. However, in the presence of a field, the lower critical dimension for the de Almeida-Thouless transition seems to be larger than three., Comment: 28 pages and 11 figures. We have added an additional scenario in Sect. 4. To appear as a contribution to the edited volume "Spin Glass Theory & Far Beyond - Replica Symmetry Breaking after 40 Years", World Scientific

Twitter recently celebrated its 15th anniversary. During this period, the platform has gone through several phases, culminating in a record number of subscribers and profits in 2021. Twitter is a household name all over the world and people know what it can or cannot provide, independent of the future growth that it may experience with new investments and updates. This article aims to verify two interrelated hypotheses, namely: the Spanish press already knows how to optimise the social network Twitter, as three decades have elapsed since its launch; and, secondly, the algorithm modification implemented by Twitter in 2018 has triggered a change in the positioning of the headers studied in this social network. In order to demonstrate both, the object of analysis will be conducted by a mixed approach through quantitative statistical processes (which will study the number of impacts and retweets and likes obtained), and inductive qualitative methods such as semi-structured interviews. This multidisciplinary approach will provide a more complete and in-depth analysis of the phenomenon. The research focuses on the period between 2018 and 2020, and addresses the participation on Twitter of the four main traditional newspapers (El País, La Vanguardia, ABC and El Mundo) as well as four native digital newspapers (20 Minutos, El Español, elDiario.es and El Huffpost). The analysis comprises more than 1.5 million tweets among the eight chosen newspapers. Twitter acaba de celebrar su decimoquinto aniversario. Durante este periodo, la plataforma ha pasado varias fases que han culminado con un récord de suscriptores y beneficios en 2021. El mundo conoce Twitter y sabe qué es lo que puede o no proporcionar, aparte de las posibilidades de crecimiento que pueda experimentar en caso de potenciales inversiones. En el presente artículo se pretende comprobar dos hipótesis interrelacionadas, a saber: la prensa española en castellano ya sabe cómo optimizar la red social Twitter, por haber transcurrido tres lustros desde su puesta en marcha; y, en segundo lugar, el cambio de algoritmo implementado por Twitter en 2018 que ha desencadenado un cambio de posicionamiento de las cabeceras estudiadas en esta red social. Con el propósito de demostrar ambas, se abordará el objeto de análisis desde un enfoque mixto a través de procesos cuantitativos estadísticos (que estudiarán el número de impactos y de retuits y likes obtenidos), y métodos cualitativos inductivos como entrevistas semiestructuradas a los responsables de redes de los medios involucrados. Esta aproximación mixta proporcionará un análisis más completo y profundo sobre el fenómeno. La investigación se centra en el período comprendido entre 2018 y 2020, y aborda la participación en Twitter de cuatro periódicos tradicionales (El País, La Vanguardia, ABC y El Mundo), así como de cuatro periódicos nativos digitales (20 Minutos, El Español, elDiario.es y El Huffpost). El análisis comprende más de 1,5 millones de tuits entre los ocho periódicos elegidos.

BACKGROUND: Primary analyses of the phase 3 BrighTNess trial showed addition of carboplatin with/without veliparib to neoadjuvant chemotherapy significantly improved pathological complete response (pCR) rates with manageable acute toxicity in patients with triple-negative breast cancer (TNBC). Here, we report 4.5-year follow-up data from the trial. DESIGN: Women with untreated stage II-III TNBC were randomized (2:1:1) to paclitaxel (weekly for 12 doses) plus either: (a) carboplatin (every 3 weeks for four cycles) plus veliparib (twice daily); (b) carboplatin plus veliparib placebo; or (c) carboplatin placebo plus veliparib placebo. All patients then received doxorubicin and cyclophosphamide (AC) every 2?3 weeks for four cycles. The primary endpoint was pCR. Secondary endpoints included event-free survival (EFS), overall survival (OS), and safety. Since the co-primary endpoint of increased pCR with carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel was not met, secondary analyses are descriptive. RESULTS: Of 634 patients, 316 were randomized to carboplatin plus veliparib with paclitaxel, 160 to carboplatin with paclitaxel, and 158 to paclitaxel. With median follow-up of 4.5 years, the hazard ratio [HR] for EFS for carboplatin plus veliparib with paclitaxel versus paclitaxel was 0.63 (95% confidence interval [CI] 0.43?0.92, P=0.02), but 1.12 (95% CI 0.72?1.72, P=0.62) for carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel. In post hoc analysis, HR for EFS was 0.57 (95% CI 0.36?0.91, P=0.02) for carboplatin with paclitaxel versus paclitaxel. OS did not differ significantly between treatment arms, nor did rates of myelodysplastic syndromes, acute myeloid leukemia, or other secondary malignancies. CONCLUSION: Improvement in pCR with addition of carboplatin was associated with long-term EFS benefit with a manageable safety profile, and without increasing the risk of second malignancies, while adding veliparib did not impact EFS. These findings support the addition of carboplatin to weekly paclitaxel followed by AC neoadjuvant chemotherapy for early stage TNBC.

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with PEX and immunosuppression. The objective of this study is to analyze and compare the safety and efficacy of caplacizumab versus the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 iTTP patients (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5% p

We prove that for some manifolds $M$ the set of robustly transitive partially hyperbolic diffeomorphisms of $M$ with one-dimensional nonhyperbolic centre direction contains a $C^1$-open and dense subset of diffeomorphisms with nonhyperbolic measures which are ergodic, fully supported and have positive entropy. To do so, we formulate abstract conditions sufficient for the construction of an ergodic, fully supported measure $\mu$ which has positive entropy and is such that for a continuous function $\phi\colon X\to\mathbb{R}$ the integral $\int\phi\,d\mu$ vanishes. The criterion is an extended version of the control at any scale with a long and sparse tail technique coming from the previous works., Comment: 23 pages, 0 figures

Dentro de las neoplasias vulvares malignas, los sarcomas representan solo del 1 % al 3 % de estas. El leiomiosarcoma es un tumor maligno raro de la vulva, es el más frecuente dentro de los sarcomas, que puede confundirse con un tumor benigno, como quistes o abscesos de la glándula de Bartholin, lo que puede dar lugar a un diagnóstico erróneo.

We consider $C^r$ ($r\geqslant 1$) diffeomorphisms $f$ defined on manifolds of dimension $\geqslant 3$ with homoclinic tangencies associated to saddles. Under generic properties, we show that if the saddle is homoclinically related to a blender then the diffeomorphism $f$ can be {$C^r$} approximated by diffeomorphisms with {$C^1$} robust heterodimensional cycles. As an application, we show that the classic Simon-Asaoka's examples of diffeomorphisms with $C^1$ robust homoclinic tangencies also display {$C^1$} robust heterodimensional cycles. In a second application, we consider homoclinic tangencies associated to hyperbolic sets. When the entropy of these sets is large enough we obtain $C^1$ robust cycles after $C^1$ perturbations., 4 figures

Brain responses are often studied under strictly experimental conditions in which electroencephalograms (EEGs) are recorded to reflect reactions to short and repetitive stimuli. However, in real life, aural stimuli are continuously mixed and cannot be found isolated, such as when listening to music. In this audio context, the acoustic features in music related to brightness, loudness, noise, and spectral flux, among others, change continuously, thus, significant values of these features can occur nearly simultaneously. Such situations are expected to give rise to increased brain reaction with respect to a case in which they would appear in isolation. In order to assert this, EEG signals recorded while listening to a tango piece were considered. The focus was on the amplitude and time of the negative deflation (N100) and positive deflation (P200) after the stimuli, which was defined on the basis of the selected music feature saliences, in order to perform a statistical analysis intended to test the initial hypothesis. Differences in brain reactions can be identified depending on the concurrence (or not) of such significant values of different features, proving that coterminous increments in several qualities of music influence and modulate the strength of brain responses.

El tratamiento estándar en el cáncer de ovario avanzado es la cirugía citorreductora en combinación con quimioterapia a base de platinos, siendo el objetivo principal de la cirugía, resecar toda enfermedad macroscópica visible, lo que se traduce a un aumento de la supervivencia global en comparación con la citorreducción subóptima (enfermedad visible).

El Programa de Especialización en Ginecología Oncológica (GO), de la Universidad Central de Venezuela (UCV), con sede en el Servicio de Ginecología Oncológica (SGO), del Servicio Oncológico Hospitalario (SOH) (Padre Machado) del IVSS, fue creada e iniciada en esta Institución, y está dirigido a Ginecólogos Obstetras, con el fin de formar recursos humanos en esta área de la Oncología, especializados en el despistaje, diagnóstico, tratamiento, reconstrucción, rehabilitación y seguimiento, de las pacientes con cáncer ginecológico. Esta especialidad, se viene ejerciendo desde hace 50 años en EE.UU, basado en el trabajo de famosos cirujanos ginecólogos como Meigs, Munell y Brunswick, y en Europa, por Ginecólogos Obstetras entrenados para este fin, concluyendo que una buena formación oncológica con entrenamiento quirúrgico especial podía ser enseñada durante un programa adicional dirigido.

El carcinoma de glándula de Bartholin, es una forma poco común de cáncer de vulva, representando aproximadamente el 5 % de la patología maligna vulvar. Se describe el caso de una paciente de 50 años, quien consulta por presentar tumoración vulvar no dolorosa en labio mayor derecho, cuyo resultado de biopsia reportó: carcinoma adenoescamoso moderadamente diferenciado de glándula de Bartholin. Luego de realizar los estudios de extensión, es llevada a mesa operatoria, realizándose escisión local radical de la lesión, más linfadenectomía inguinofemoral bilateral, con evolución posoperatoria favorable, e indicándose tratamiento adyuvante con radioterapia externa.

La infección por el virus del papiloma humano (VPH), se ha relacionado como uno de los principales factores en el desarrollo de los cánceres del tracto genital femenino. En la actualidad, se entiende que el VPH de alto riesgo (VPH-AR), es necesario, pero no suficiente para el desarrollo del cáncer de cuello uterino. Casi el 80 % de la población sexualmente activa ha estado en contacto con algún genotipo de VPH. La principal causa de progresión de las lesiones preinvasivas a cáncer de cuello uterino, parece ser la persistencia de la infección durante varios años y está depende de otros factores como el estado inmunológico (inmunosuprimido), uso de anticonceptivos orales

We provide examples of transitive partially hyperbolic dynamics (specific but paradigmatic examples of homoclinic classes) which blend different types of hyperbolicity in the one-dimensional center direction. These homoclinic classes have two disjoint parts: an "exposed" piece which is poorly homoclinically related with the rest and a "core" with rich homoclinic relations. There is an associated natural division of the space of ergodic measures which are either supported on the exposed piece or on the core. We describe the topology of these two parts and show that they glue along nonhyperbolic measures. Measures of maximal entropy are discussed in more detail. We present examples where the measure of maximal entropy is nonhyperbolic. We also present examples where the measure of maximal entropy is unique and nonhyperbolic, however in this case the dynamics is nontransitive.

We study $C^1$-robustly transitive and nonhyperbolic diffeomorphisms having a partially hyperbolic splitting with one-dimensional central bundle whose strong un-/stable foliations are both minimal. {In dimension $3$, an important class of examples of such systems is given by those with a simple closed periodic curve tangent to the central bundle.} We prove that there is a $C^1$-open and dense subset of such diffeomorphisms such that every nonhyperbolic ergodic measure (i.e. with zero central exponent) can be approximated in the weak$\ast$ topology and in entropy by measures supported in basic sets with positive (negative) central Lyapunov exponent. Our method also allows to show how entropy changes across measures with central Lyapunov exponent close to zero. We also prove that any nonhyperbolic ergodic measure is in the intersection of the convex hulls of the measures with positive central exponent and with negative central exponent., Final version. Will appear in Mathematical Proceedings of the Cambridge Philosophical Society

Five copper complexes supported by terpyridine ligands were prepared and characterized, viz. [Cu3Cl4(naphtpy)2][CuCl2] (1), [Cu2Cl2(naphtpy)2](ClO4)2 (2), [CuCl2(naphtpy)]2(MeOH)3(H2O) (3), [CuCl2(Cltpy)] (4) and [Cu(Cltpy)2](ClO4)2 (5); (where naphtpy stands for 4’-((naphthalen-2-yl)methoxy)-2, 2':6', 2''-terpyridine and Cltpy for 4'-chloro-2, 2':6', 2''-terpyridine). Their ability to interact with DNA was investigated, and their cytotoxic behaviour was examined with three cells lines, namely human ovarian carcinoma cells (A2780), their derived cisplatin-resistant line (A2780cis), and human cervix adenocarcinoma cells (HeLa). All compounds show good cytotoxic properties (especially after 72 h of incubation). Remarkably, two compounds, 4 and 5, are still almost inactive after 24 h (particularly 4), but are highly active after 72 h, with IC50 values in the low-micromolar to sub-micromolar range. Compounds 1 and 2 induce necrosis, whereas late apoptosis is observed with 3–5, 4 exhibiting a behaviour close to that of cisplatin.

Objectives. The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses’ perception of their practice environment. Methods. The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses’ practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing. Results. Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related. Conclusion. Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).

Background: Outpatient laparoscopic cholecystectomy has proven to be a safe and cost-effective technique; however, it is not yet a universally widespread procedure. The aim of the study was to determine the predictive factors of outpatient laparoscopic cholecystectomy failure. Method: A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology. MEDLINE, Cochrane Library, Ovid, and ISRCTN Registry were searched. The main variables were demographic (age, sex), clinical (weight, American Society of Anesthesiologists classification, previous complicated biliary pathology, history of abdominal surgery in supramesocolic compartment, gallbladder wall thickness), and surgical factors (operative time, afternoon surgery). The secondary variables were the prevalence rates of outpatient laparoscopic cholecystectomy failure due to pain or postoperative nausea and vomiting. Results: Fourteen studies (4,194 patients) were included, with a mean outpatient laparoscopic cholecystectomy failure rate of 23.4%. The predictors of outpatient laparoscopic cholecystectomy failure were: age >65 years (odds ratio: 2.34; 95% confidence interval, 1.42-3.86; P = .0009), body mass index >30 (odds ratio: 1.6; 95% confidence interval, 1.05-2.45; P = .03), American Society of Anesthesiologists score >III (odds ratio: 2.89; 95% confidence interval, 1.72-4.87; P < .0001), previous complicated biliary pathology (odds ratio: 2.39; 95% confidence interval, 1.40-4.06; P = .001), gallbladder wall thickening (odds ratio: 2.33; 95% confidence interval, 1.34-4.04; P = .003), surgical time exceeding 60 minutes (mean difference: -16.03; 95% confidence interval,-21.25 to -10.81; P < .00001), and the beginning of surgery after 1:00 PM (odds ratio: 4.20; 95% confidence interval, 1.97-11.96; P = .007). Sex (odds ratio: 1.07; 95% confidence interval, 0.73-1.57, P = .73) and history of abdominal surgery in the supramesocolic compartment (odds ratio: 2.32; 95 confidence interval, 0.92-5.82, P = .07) were not associated with outpatient laparoscopic cholecystectomy failure. Conclusion: Our meta-analysis allowed us to identify the predictors of outpatient laparoscopic cholecystectomy failure. The knowledge of these factors could help surgeons in their decision-making process for the selection of patients who are suitable for outpatient laparoscopic cholecystectomy. (c) 2020 Elsevier Inc. All rights reserved.

In this work, we give approximate expressions for Jacobian and elliptic Weierstrass functions and their inverses by means of the elementary trigonometric functions, sine and cosine. Results are reasonably accurate. We show the way the obtained results may be applied to solve nonlinear ODEs and other problems arising in nonlinear physics. The importance of the results in this work consists on giving easy and accurate way to evaluate the main elliptic functions cn, sn, and dn, as well as the Weierstrass elliptic function and their inverses. A general principle for solving some nonlinear problems through elementary functions is stated. No similar approach has been found in the existing literature.

There are many studies on the polymorphism of the HLA system in healthy donor populations, such as registries of unrelated bone marrow donors. Investigations on the characterization of the HLA complex in hematopoietic stem cell transplant (HSCT) patients, however, are scarce, at least in the Spanish population. This study presents a large-scale analysis of allelic diversity and HLA distribution at a high-resolution level in 2886 patients undergoing HSCT in Spanish Centres of the "Grupo Espanol de Trasplante Hematopoyetico y Terapia Celular" during a period of 11years. Allelic diversity analysis identified 67 HLA-A, 133 HLA-B, 60 HLA-C, 63 HLA-DRB1, 23 HLA-DQB1 and 27 HLA-DPB1 different alleles. Rare alleles were detected among which 31 alleles had not been reported in the European catalogue of common and well-documented HLA alleles. Regarding the distribution of five genes-haplotypes, it was observed that the five most frequent extended haplotypes found in our population were between the most common in other Spanish populations, both in patients and in healthy subjects. However, some particular haplotypes were also detected. Bilocus associations HLA-C~B and -DRB1~DQB1 were analysed in order to predict the probability of finding 10/10 matched donors in registries. We found HLA-B alleles showing a great diversity of combinations with HLA-C alleles and unusual associations involving a negative predicting factor. In the field of adoptive therapies, our work supports the necessity to expand further research of TCR-engineered cells, adoptive transfer of virus-specific T-cells and vaccines to target HLA alleles other than A*02:01. HLA alleles such as A*01:01, A*03:01, A*24:02, B*44:03, B*07:02 or B*51:01, might be considered new targets due to its high frequency in our population. This article is protected by copyright. All rights reserved.

En este artículo analizamos textualmente al-gunas secuencias claves de Trono de sangre (Ku-monosu-jō, Kurosawa, 1957) centrándonos en cómo emerge paulatinamente lo siniestro en el relato. En cuanto al concepto de lo sinies-tro, seguimos tanto la teorización que Freud propuso en su célebre artículo de 1919 “Lo ominoso”, como la lectura posterior que rea-lizó Trías proponiendo unos motivos de los si-niestro -que iremos localizando en la película-, así como la de González Requena en torno al mismo tema. La pregunta que guiará nuestro análisis es si lo siniestro surge o retorna de lo familiar como algo reprimido, como apunta Freud (y Trías), o si, como afirma González Requena, lo siniestro es más bien algo recha-zado o recusado. ¿Hay en Trono de sangre un secreto que requería permanecer oculto en el alma del protagonista y que sería revelado por la influencia de la araña femenina? O ¿es el propio héroe el que, extraviado por su ambición, cae en la tela de araña? In this article we textually analyse some key scenes of Throne of Blood (Kumonosu-jō, Kurosawa, 1957) focusing on how the sin-ister gradually emerges in the story. As for the concept of the sinister, we follow both the theorization that Freud proposed in his famous 1919 article “The Ominous”, as well as the subsequent reading made by Trías proposing some motives for the sinister,which we will be locating in the film, as well as that of González Requena around the same subject. The question that will guide our analysis is whether the sinis-ter arises or returns from the familiar as something repressed, as Freud (and Trías) oints out, or whether, as González Requena claims, the sinister is rather something reject-ed or challenged. Is there a secret on The Throne of Blood that required remaining hidden in the soul of the protagonist and would be revealed by the influences of the female spider? Or is it the hero himself who, lost by his ambition, falls into the spider web?