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INTRODUCTION: Data about the role of chemotherapy in sarcomatoid bladder cancer (SBC) are limited. We addressed the effect of chemotherapy in non-metastatic SBC patients treated with radical cystectomy (RC). METHODS: Using the Surveillance, Epidemiology, and End Results database (2001–2018), we identified 331 patients with non-metastatic muscle-invasive or higher SBC (T(2–4)N(0–3)M(0)). Kaplan-Meier plots and Cox regression models tested cancer-specific mortality (CSM ). Sample size and power analyses tested for power limitations. RESULTS: Of 331 SBC patients, 129 (38.9%) were exposed to chemotherapy. The rate of organ-confined stage (T(2)N(0)M(0)) was 33% in both chemotherapy-exposed and chemotherapy-naive patients. In the overall cohort, median CSM-free survival was 84 months (interquartile range [IQR] 21–NA) vs. 26 months (IQR 17–84) in chemotherapy exposed vs. chemotherapy-naive patients, respectively. In multivariable Cox regression models, chemotherapy was associated with lower CSM, without reaching statistical significance (hazard ratio [HR ] 0.72, confidence interval [CI] 0.51–1.01, p=0.054). In subgroup analyses, chemotherapy exposure in organ-confined (n=110) vs. non-organ-confined (n=221) patients resulted in a HR of 0.51 (p=0.12) vs. 0.77 (p=0.17), respectively. Power analyses, based on two-sided α=0.05, revealed values of 52%, 14%, and 43% in the entire population, organ-confined, and nonorgan-confined subgroups, respectively. CONCLUSIONS: In non-metastatic SBC treated with RC, the association between chemotherapy and lower CSM is particularly strong in organ-confined stage. A substantially larger cohort would be required to confirm the statistical significance of the recorded protective effect of chemotherapy.

Introduction Depression and antidepressants are among risk factors for osteoporosis. However, there are still inconsistencies in literature regarding bone consequences of antidepressant drugs and the role of age and the natural decline of bone health in patients with depression. Objective To investigate the relationship between antidepressant and bone mineral density (BMD). Methods We conducted a systematic review and metanalysis according to PRISMA guidelines searching on PubMed/Medline, Cochrane Database, and Scopus libraries and registered with PROSPERO (registration number CRD42021254006) using generic terms for antidepressants and BMD. Search was restricted to English language only and without time restriction from inception up to June 2021. Methodological quality was assessed with the Newcastle-Ottawa scale. Results Eighteen papers were included in the qualitative analysis and five in the quantitative analysis. A total of 42,656 participants affected by different subtypes of depression were identified. Among the included studies, 10 used serotonin reuptake inhibitors (SSRIs) only, 6 involved the use of SSRIs and tricyclic antidepressants, and 2 the combined use of more than two antidepressants. No significant studies meeting the inclusion criteria for other most recent categories of antidepressants, such as vortioxetine and esketamine. Overall, we observed a significant effect of SSRI on decrease of BMD with a mean effect of 0.28 (95% CI = 0.08, 0.39). Conclusion Our data suggest that SSRIs are associated with a decrease of BMD. We aim to raise clinicians’ awareness of the potential association between the use of antidepressants and bone fragility to increase monitoring of bone health.

RationaleThe Predicting Asthma Risk in Children (PARC) tool uses questionnaire-based respiratory symptoms collected from preschool children to predict their risk of asthma 5 years later. The tool was originally developed and externally validated in population-based settings and has not yet been validated in a clinical setting.ObjectiveTo externally validate the PARC tool in children seen in paediatric pulmonology clinics.MethodsThe Swiss Paediatric Airway Cohort (SPAC) is a prospective study of children seen in respiratory outpatient clinics across Switzerland. This analysis included children seen at ages 1-6 years for cough or wheeze at baseline and who completed the follow-up questionnaire 2 years later. The outcome was defined as current wheeze plus use of asthma medication. In sensitivity analyses, we explored effects of varied inclusion criteria and outcomes. We assessed performance by describing sensitivity, specificity, negative and positive predictive value (NPV, PPV), area under the curve (AUC), scaled Brier’s score and Nagelkerke’s R2 scores and compared performance in SPAC to that achieved in the original population, the Leicester Respiratory Cohort (LRC).ResultsAmong the 346 children included, 125 (36%) reported the outcome after 2 years. At a PARC score cut-off of 4, sensitivity was higher (95% vs 79%) but specificity lower (14% vs 57%) in SPAC compared to LRC. NPV was comparable (0.84 vs. 0.87) as was PPV (0.37 vs.0.42). Discrimination was lower in SPAC (AUC of 0.71 vs 0.78), as were Nagelkerke’s R2 (0.18 vs 0.28) and scaled Brier’s scores (0.13 vs 0.22). When the outcome was changed to moderately severe asthma (>4 attacks plus use of asthma medication), there were improvements in AUC (0.74), sensitivity (0.97), specificity (0.22) and NPV (0.99), but some deterioration in PPV (0.13), R2 (0.15) and scaled Brier score (0.09).ConclusionWhile the PARC tool performs well in a population-based setting and has some clinical utility, in particular for ruling out the development of asthma, this study highlights the need for new prognostic prediction tools to be developed specifically for the clinical setting.FundingSNSF:320030_182628, SLA2019-03_641670

Background References from the Global Lung Function Initiative (GLI) are widely used to interpret children's spirometry results. We assessed fit for healthy schoolchildren. Methods LuftiBus in the School was a population-based cross-sectional study undertaken in 2013-2016 in the canton of Zurich, Switzerland. Parents and their children aged 6-17 years answered questionnaires about respiratory symptoms and lifestyle. Children underwent spirometry in a mobile lung function lab. We calculated GLI-based z-scores for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow for 25-75% of FVC (FEF25-75) for healthy White participants. We defined appropriate fit to GLI references by mean values between +0.5 and -0.5 z-scores. We assessed whether fit varied by age, body mass index, height and sex using linear regression models. Results We analysed data from 2036 children with valid FEV1 measurements, of whom 1762 also had valid FVC measurements. The median age was 12.2 years. Fit was appropriate for children aged 6-11 years for all indices. In adolescents aged 12-17 years, fit was appropriate for FEV1/FVC z-scores (mean±sd -0.09±1.02), but not for FEV1 (-0.62±0.98), FVC (-0.60±0.98) and FEF25-75 (-0.54±1.02). Mean FEV1, FVC and FEF25-75 z-scores fitted better in children considered overweight (-0.25, -0.13 and -0.38, respectively) than normal weight (-0.55, -0.50 and -0.55, respectively; p-trend

Additional file 2: Figure S2. Bootstrapped confidence intervals (#boots = 2000) for estimated edge-weights of BED patients.

Additional file 5: Table S12- Provincial disease burden and economic supplemental results; Table S13- Provincial discounted economic costs of Hib disease and vaccine program costs (2017 US$) for each vaccination strategy from the societal perspective.

Additional file 2: Supplementary Figure 1. A) DKC1 expression after transduction with a library of DKC1-specific shRNAs, n=3. Analyses were performed 5-8 days post-transduction. B) Analysis of the vector copy number per cell (VCN/cell) after transduction with shRNA-LVs. Analyses were performed at least after 15 days post-transduction. Supplementary Figure 2. Gating strategy and analysis of Annexin V-based apoptosis assay. Representative dot-plots of flow cytometry analyses in DKC1-interferred CD34+ cells are shown. Supplementary Figure 3. Levels of CD34+ cells after 10 days in culture (n=3). Supplementary Figure 4. Telomere length in human CD34+ samples transduced with DKC1-shRNAs and scrambled-shRNA LVs and cultured for 8 days as described in Materials and Methods section. For comparison, also human peripheral blood cells and fresh CD34+ cells were analyzed (n=1). Supplementary Figure 5. Analysis of the clonogenic potential, discriminating between GM-CFU (A) and E-BFU (B) colonies, of CD34+ cells transduced with DKC1-shRNA LVs and scrambled shRNA-LVs (n=8). Data are expressed as mean ± SEM. Asterisks indicate significant differences determined by Student’s t test (*p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001). Supplementary Figure 6. Gating strategy and analysis of the NSG mice repopulating potential of CD34+ cells transduced with iDKC1 and scrambled-shRNA LVs. Representative dot-plots of flow cytometry analyses performed in the bone marrow samples from two mice transplanted with scrambled-shRNA LVs are shown. Supplementary Figure 7. Analysis of the VCNs in the bone marrow of recipient NSG mice at 3 months post-transplantation. NSG mice were transplanted with scrambled transduced CD34+ cells (orange dots, n=14) or iDKC1 interfered CD34+ cells (blue dots, n=8)

Full list of participants interviewed and type of interview conducted

Additional file 1: Supplementary Table 1. Overview of the information about the shRNA sequences. Supplementary Table 2. Compilation of RT-qPCR data in CD34+ transduced with scrambled and DKC1-shRNA LVs. A) Results of DKC1 expression (n = 7). B) TERC expression data (n = 7). C) Expression of CDKN1A gene (n = 6). Triplicates were performed in every experiment and results are expressed as mean ± SEM

Additional file 7: Table S17- Incremental cost-effectiveness ratios (US$) for the different Hib vaccine schedules (4 doses vs. 3 doses in the NIP); Table S18- National incremental cost-effectiveness ratios (US$ per QALY gained) when varying the NIP Hib vaccine price; Table S19- Provincial incremental cost-effectiveness ratios (US$ per QALY gained) when reducing the NIP Hib vaccine price.

Additional file 6: Table S14- Incremental cost-effectiveness ratios of including Hib vaccine in the NIP in 2017 (RMB); Table S15- Incremental cost-effectiveness ratios of including Hib vaccine in the NIP in 2017 (US$); Table S16- Hib cases and deaths averted by province and region when including herd immunity effects.

Tracking Sheet

Additional file 3: Table S4- ICD-10 codes used for each syndrome; Table S5- Summary of individual-level cost data from 2013 to 2017 obtained from the China Healthcare Insurance Research Association (CHIRA); Table S6- Inputs for the calculations of indirect costs (US$); Table S7- Cost of illness and lifetime productivity estimates (US$).

BACKGROUND Asthma treatment should be modified according to symptom control and future risk, but there is scarce data on what drives treatment adjustments in routine tertiary care. OBJECTIVE We studied factors that drive asthma treatment adjustment in paediatric outpatient clinics. METHODS We did a cross-sectional analysis of the Swiss Paediatric Airway Cohort (SPAC), a clinical cohort of 0-16-year-old children seen by paediatric pulmonologists. We collected information on diagnosis, treatment, lung function and Fractional exhaled Nitric Oxide (FeNO) from hospital records; and on symptoms, sociodemographic and environmental factors from a parental questionnaire. We used reported symptoms to classify asthma control and categorised treatment following the 2020 GINA guidelines. We used multivariable logistic regression to study factors associated with treatment adjustment (step-up or down vs. no change). RESULTS We included 551 children diagnosed with asthma (mean age 10 years, 37% female). At the clinical visit, most children were prescribed GINA Step 3 (35%). Compared to pre-visit treatment, 252 (47%) children remained on the same step, 227 (42%) were stepped-up and 58 (11%) were stepped-down. Female sex (aOR 1.61, 95% CI 1.05-2.47), poor asthma control (3.08, 1.72-5.54), and a lower Forced Expiratory Volume in the first second (FEV1) Z-score (0.70, 0.56-0.86 per 1 Z-score increase) were independently associated with treatment step-up, and low FeNO (2.34, 1.23-4.45) with treatment step-down, with a marked heterogeneity between clinics. CONCLUSION In this tertiary care real-life study, we identified main drivers for asthma treatment adjustment. These findings may help improve both asthma management guidelines and clinical practice.

Additional file 1: Table S1- Model live birth cohort and mortality rate parameters by province

Additional file 4: Table S8- Summary of Hib vaccine products available in China; Table S9- Provincial vaccine coverage and weighted vaccine coverage in the private in 2017; Table S10- Regional dose-specific and weighted combined Hib vaccine coverage used for the NIP strategy; Table S11- Societal cost per dose of the National Immunization Program (NIP) in China in 2015 (2017 US$).

Additional file 2: Table S2- Province-specific disease burden model parameters and data sources; Table S3- Hib disease burden among children 1-59 months by province.

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IRISS Messages in Hausa

INTRODUCTION Diagnosing asthma in children remains a challenge because respiratory symptoms are not specific and vary over time. AIM In a real-life observational study, we assessed the diagnostic accuracy of respiratory symptoms, objective tests, and two paediatric diagnostic algorithms proposed by GINA and NICE to diagnose asthma in school-aged children. METHODS We studied children aged 5-17 years referred consecutively for evaluation of suspected asthma to pulmonary outpatient clinics. Symptoms were assessed by parental questionnaire. The investigations included specific IgE measurement or skin prick tests, measurement of fractional exhaled nitric oxide, spirometry, body plethysmography, and bronchodilator reversibility. Asthma was diagnosed by paediatric pulmonologists based on all available data. We assessed diagnostic accuracy of symptoms, tests, and diagnostic algorithms by calculating sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC). RESULTS Among 514 participants, 357(70%) were diagnosed with asthma. The combined sensitivity and specificity (sensitivity/specificity) was highest for any wheeze (0.75/0.65), dyspnoea (0.56/0.76), and wheeze triggered by colds (0.58/0.78) or by exercise (0.55/0.74). Of the diagnostic tests, the AUC was highest for specific total resistance (sRtot) (0.73) and lowest for the residual volume (RV) total lung capacity (TLC) ratio (0.56). The NICE algorithm had a sensitivity of 0.69 and specificity of 0.67, whereas the GINA algorithm had a sensitivity of 0.42 and specificity of 0.90. CONCLUSION This study confirms the limited usefulness of single tests as well as existing algorithms for the diagnosis of asthma. It highlights the need for new and more appropriate evidence-based guidance.

Supplemental material, EULT_manuals_070220 for Evaluation of the enhanced upper limb therapy programme within the Robot-Assisted Training for the Upper Limb after Stroke trial: descriptive analysis of intervention fidelity, goal selection and goal achievement by Helen Bosomworth, Helen Rodgers, Lisa Shaw, Leanne Smith, Lydia Aird, Denise Howel, Nina Wilson, Natasha Alvarado, Sreeman Andole, David L Cohen, Jesse Dawson, Cristina Fernandez-Garcia, Tracy Finch, Gary A Ford, Richard Francis, Steven Hogg, Niall Hughes, Christopher I Price, Laura Ternent, Duncan L Turner, Luke Vale, Scott Wilkes, Hermano I Krebs and Frederike van Wijck in Clinical Rehabilitation

Las especies comensales del orden Enterobacterales pueden actuar como patógenos potenciales dando lugar a infecciones oportunistas, siendo uno de los principales agentes etiológicos en las infecciones tanto nosocomiales como comunitarias. La aparición de enterobacterias resistentes a carbapenems ha aumentado en los últimos años, debido no solo a la producción de carbapenemasas, sino también a otros mecanismos como la alteración de la permeabilidad de la membrana, como es el caso de la alteración en las porinas, que en combinación con la producción de otras beta-lactamasas conlleva a una resistencia a carbapenems, especialmente ertapenem. En Europa la propagación de enterobacterias productoras de carbapenemasa se ha visto incrementada en los últimos años. En nuestro país, destaca K. pneumoniae productora de OXA-48. En K. pneumoniae se han descrito ciertos clones epidémicos de alto riesgo, como ST11, ST15, ST340, ST258 y ST512, los cuales se asocian a cepas multirresistentes. En España, los clones más extendidos son ST405, ST11 y ST15.El primer objetivo de la tesis fue el estudio de enterobacterias con sensibilidad disminuida carbapenems en aislados de origen clínico recogidos entre 2012 y 2016 en el Servicio de Microbiología del Hospital Clínico Universitario Lozano Blesa de Zaragoza. Se estudiaron 40.557 cepas y se seleccionaron 51 con sensibilidad disminuida a carbapenems. Se detectó una baja prevalencia de enterobacterias productoras de carbapenemasas (0,02%). Estas cepas correspondían a las especies de C. freundii y K. aerogenes. A pesar de que en España la carbapenemasa más frecuentemente descrita es OXA-48, el único gen codificante de carbapenemasas detectado fue blaVIM. Este gen se encontró asociado a integrones de clase 1, lo que facilita su diseminación. Uno de los aislados fue productor de VIM-1. Esta variante es la más descrita en enterobacterias. El resto, presentaron el gen blaVIM-2 dentro de un nuevo integrón cuya estructura no había sido descrito hasta ahora (In1470).El segundo objetivo de esta tesis fue estudiar la prevalencia de pacientes ingresados en la UCI colonizados por enterobacterias con sensibilidad disminuida a carbapenems, así como el estudio de estas cepas. Para ello, durante 18 meses se obtuvieron frotis nasales, faríngeos y perineales, y se seleccionaron los aislados crecidos en un medio cromogénico para enterobacterias productoras de carbapenemasas. Hemos detectado una baja prevalencia (6,35%) de pacientes colonizados por enterobacterias con sensibilidad disminuida a carbapenems. La mayor parte de los aislados (78,94%) fueron cepas de K. pneumoniae multirresistentes, las cuales presentaron alta resistencia a beta-lactámicos, incluyendo ertapenem. Uno de esto aislados fue productor de VIM-2 y, además, todas ellas presentaron diferentes beta-lactamasas de espectro extendido y/o beta-lactamasas de tipo AmpC plasmídicas (CTX-M-15, SHV-2, SHV-76, DHA-1). La alteración de la estructura de las porinas OmpK35, OmpK36 y OmpK37 en combinación con las beta-lactamasas detectadas fue el principal mecanismo de resistencia a ertapenem detectado en nuestros aislados. La mayor parte de los aislados de K. pneumoniae multirresistentes pertenecieron al clon ST405, pero también encontramos clones de alto riesgo como ST340, ST15 y ST11. Además, también se aislaron cepas de C. freundii productoras de VIM-2 entre los aislados de portadores. Todos los aislados de C. freundii productores de carbapenemasas, tanto clínicos como de portadores, presentaron el mismo perfil de PFGE y, por tanto, asumimos que pertenecen al mismo clon, aunque no presentaron ninguna relación espacio- temporal ni originó brotes. Todos los aislados de enterobacterias productoras de VIM-2, presentaron este gen dentro del integrón no descrito hasta ahora In1470. Este integrón parece haber actuado como vehículo de transmisión de carbapenemasas entre enterobacterias en el entorno de nuestro hospital.

Background Saprochaete clavata, an ascomycetous yeast intrinsically resistant to echinocandins, is a rare yet emerging pathogen associated with invasive infections in immunosuppressed patients, particularly those with haematological malignancies. It is commonly misidentified as the closely-related S. capitata. Outbreaks have been associated with a high mortality rate of >50%, due in part to delayed diagnosis and resistance to commonly-used antifungals. Environmental source identification is challenging, although dishwashers and milk flasks have been implicated in previous hospital clusters. Methods We describe a cluster of five haematology-oncology patients with disseminated S. clavata infections between April 2020 and April 2021 following current or recent admissions to the same ward. Results All had prolonged (median=24 days, range=9-210) and profound immunosuppression from chemotherapy and/or stem cell transplantation for acute myeloid leukaemia (n=3) or lymphoma (n=2) at the time of culture positivity. Four were severely neutropaenic (median=0.08/mm3, range=0.01-0.26). Median patient age was 62 years (range=58-73). S. clavata was isolated from blood (n=3), urine (n=2), and liver tissue (n=1) samples. Whole genome sequencing of these isolates was performed to confirm the presence of an outbreak. All patients received empirical treatment with intravenous caspofungin before culture-guided therapy with intravenous liposomal amphotericin B +/- oral flucytosine. Two of the five patients died although both had advanced refractory malignancy. Detailed environmental sampling of fridges/freezers, drains, and vents in patient rooms and clean areas for handling or storage of food and medication failed to identify a clear point source despite isolation of multiple environmental organisms. No further cases have emerged after intensification of the cleaning regimen in these areas. Conclusion Our experience highlights the emerging threat of drug-resistant yeasts particularly in the immunocompromised. Management of such outbreaks requires a multidisciplinary approach incorporating antifungal stewardship, infection control, and environmental microbiology, alongside close clinical liaison between haemato-oncologists and infection specialists. Disclosures All Authors: No reported disclosures

INTRODUCTION During recent years, microgels have emerged as an effective type of drug delivery system (DDS), showing advantages such as tuneable size, increased surface area and injectability1. Collagen has been extensively studied as a scaffold for regenerative medicine and drug delivery due to its biocompatibility, non-immunogenicity and degradability2,3. The current study focuses on the use of microfluidic techniques for the automated generation of monodisperse type-I collagen (col-I) microgels crosslinked with PEG-4S, encapsulating hollow collagen spheres with glial-derived neurotrophic factor (GDNF) and bone morphogenetic protein 2 (BMP-2) for regenerative therapies in Parkinson’s Disease and bone repair, respectively. MATERIALS AND METHODS Col-1 (Collagen Solutions, UK) stock was characterized in a rotational viscometer and UV-Vis spectrophotometer to determine the fibrillogenesis conditions. Collagen was crosslinked with 4S-Star-PEG succinimide glutarate (Jenkem, USA) to form hydrogels. Crosslinking occurred after merging col-I with PEG-4S crosslinker in the nozzle of a double-chamber capillary within an oil flow. A coiled tube was placed at the outlet for microgels to gelify inside the device. Microgel size was controlled varying the nozzle diameter and flow speeds, and the mechanical properties modulated through pH and concentration of collagen/crosslinker. Microgels were characterized with TNBS assay and their cytotoxicity with LIVE-DEAD® assay (Neu-7 astrocytes, n=3). Hollow spheres were prepared by covalently attaching collagen to silica templates that are later dissolved with hydrofluoric acid. They were characterized morphologically and chemically, namely: scanning electron microscopy, dynamic light scattering and Fourier-Transform Infrared (FTIR). Hollow spheres were loaded with GDNF and BMP-2 by diffusion, seeded with different cell-types and encapsulated in the microgels within the microfluidic device. RESULTS AND DISCUSSION Microgels with different size and stiffness were successfully synthetized in a glass microfluidic device. The microgels are non-cytotoxic to cells (fig.1C) and foster cell growth at different crosslinker concentrations. In the synthesis of hollow spheres, no harmful by-products appeared (fig.1D), and their size ranged around 200 nm (fig.1E). Microfluidic-generated hydrogels encapsulating hollow spheres can therefore be used for sustained delivery of GDNF and BMP-2. CONCLUSIONS We demonstrate that microfluidics is an adequate technique for automatically generating monodisperse collagen microgels and provides a simple and useful tool for the posterior encapsulation of nanospheres and cells. The combination of microgels encapsulating hollow spheres is expected to provide a controlled and sustained delivery system of different therapeutic factors. AKNOWLEDGEMENTS The authors would like to thank European Union H2020 Programme (H2020-MSCA-ITN-2015) and Grant No. 676408 for providing financial support to this project.

RESUMEN: La necesidad de que los contenidos matemáticos sean entendidos por los alumnos como útiles y entretenidos, nos lleva a plantear actividades basadas en el interés y en su vida cotidiana. A través del enfoque de la divulgación matemática se consigue dotar de significado a los aprendizajes y de que los niños sean autores de su propio aprendizaje. Por ello, a continuación, se presenta una propuesta de actividades basadas en este enfoque cuyo objetivo es que aumente la motivación de los niños y el interés por aprender matemáticas, a través del juego. ABSTRACT: The need for mathematical content to be perceived by students as useful and entertaining, leads us to raise activities based on interest and their daily lives. Through the approach of the mathematical dissemination, it is possible to provide meaning to the learning and that the children are the authors of their own learning. Therefore, a proposal of activities based on this approach is presented, which aims to increase children's motivation and interest in learning mathematics through play Grado en Magisterio en Educación Primaria

Background Asthma is a public health problem in Latin America, where asthmatic children are mainly treated at emergency rooms during acute attacks. These attacks result in loss of lung function and quality of life for the asthmatic child and family, risk of death and high direct and indirect economic costs. In order to improve paediatric asthma management in Esmeraldas, Ecuador, we aimed to identify predictors of recurrent asthma attacks requiring emergency care and to explore the caregivers’ (CGs) and health care workers’ (HCWs) perceptions of barriers and facilitators to asthma health and home care access. Methods First, a systematic review and meta-analysis of published studies analysing predictors for emergency department (ED) re-attendance or hospital readmission for acute asthma in children was performed. Second, a prospective cohort study of children treated for an asthma attack at an emergency room in Esmeraldas, Ecuador, was undertaken to define the characteristics of these children, determine the rate of ED re-attendance for acute asthma and identify the predictors for this to occur. Third, a qualitative study to explore acute asthma significance and perceived barriers and facilitators for health and home care access from the asthmatic children’s CGs’ and HCWs’ perspective was performed. Results In both the meta-analysis and prospective cohort study, children of a younger age and a history of severe asthma attacks during the previous year were at a greater risk of ED re-attendance for acute asthma. Forty six percent of the children recruited during the prospective cohort suffered a subsequent asthma attack requiring emergency care in the following 6 months. Other identified predictors of ED re-attendance for acute asthma were: existing asthma diagnosis (AOR: 2.17, 95% CI: 1.19-3.94; AHR: 1.66, 95% CI: 1.15-2.39); food triggers (AOR: 1.99, 95% CI: 1.11-3.55); existing eczema diagnosis (AOR: 4.22, 95% CI 1.02-17.54); and urban residence as protective (AHR: 0.69, 95% CI: 0.50-0.95). Twelve HCWs and 20 CGs participated in the in-depth interviews and focus group discussions, expressing a differing significance of asthma attacks. This difference was also observed between experienced and inexperienced HCWs. Multiple barriers and several facilitators were identified by HCWs and CGs that affect health and home care access for asthmatic children. When shown the predictors of ED-reattendance for acute asthma combined in a risk-assessment tool, both HCWs and CGs reported finding the tool easy to use and understand, as well as a useful aid in the decision-making process concerning asthma treatment and follow-up. Conclusion A combination of several question-based predictors may result in an effective and simple risk-assessment tool to be used at the ED to identify asthmatic children at a higher risk of recurrent severe asthma attacks. Increasing CGs’ and HCWs’ asthma knowledge as well as HCWs’ communication skills, to establish a patient centred approach with a shared decision-making process could mean a difference in the quality of the asthma care in this setting. The use of the described recurrent risk assessment tool could prove useful in this process, as reported by the participants in this study.

La Limitación del Esfuerzo Terapéutico (LET) consiste en la no aplicación de medidas desproporcionadas para la finalidad terapéutica en pacientes con mal pronóstico vital y/o mala calidad de vida consiguiendo bienestar cuando se conoce que la no implantación o la retirada de terapéuticas no conllevarán beneficios. Las situaciones en las que se prolonga la vida con tratamientos no inocuos que producen daños mayores al beneficio, producen conflictos éticos para los profesionales sanitarios. Conocer los criterios determinantes de pacientes susceptibles de LET y las variables influyentes en la toma de decisiones tendrá aplicabilidad asistencial repercutiendo en la calidad de los cuidados. The limitation of therapeutic effort (LTE) consist in the no application of disproportionate measures for therapeutic purposes in patients with bad life prognosis and/or low life quality getting well-being when to no initiate or to withdraw therapeutics will bring no benefits is known.Those situations where life is sustained with not safe treatments that cause damages bigger than benefits, provided ethical conflicts to the health professionals. To know the determining factors of patients susceptible of LTE and the most influential variables in the decision making process will have assistance applicability with care quality impact.

A Villa de Milreu é um exemplo do modelo de ocupação romana da região da Iberia, centrada na exploração dos recursos agrícolas, marinhos e na produção de bens alimentares, que eram exportados por via marítima para os portos do Império. É já o terceiro ano que o Centro Ciência Viva do Algarve traz “bioexperiências” às ruínas de Milreu, um conceito que pretende proporcionar aos participantes a possibilidade de vivenciar de forma prática a cultura e costumes do Algarve Romano à luz de um enquadramento científico, mas informal e lúdico. Dado o sucesso dos anos anteriores, recuperamos e reformulamos algumas das atividades já realizadas, mas segundo um novo enquadramento. Assim, após viajarmos “Do saber ao sabor” e “do saber ao bem estar” na era romana, o mote para este ano é “Do saber ao fazer”. Dado que “fazer” foi algo que claramente caracterizou a sociedade romana, sentimos a necessidade de abordar a temática ao longo de dois dias, explorando o “fazer” no âmbito do “labor” no primeiro dia (24 de setembro) e do “ócio” no segundo (1 de outubro). Ambos os eventos “Do saber ao fazer”: bioexperiências romanas" são realizados no âmbito do programa DiVaM 2017 e das Jornadas Europeias do Património 2017. Esperamos que passe bons momentos connosco em Milreu!, Financiado pela Direcção Geral de Cultura do Algarve ao abrigo do Programa DiVaM

La apropiación cultural consolida el poder de la cultura occidental por encima de otras culturas, banalizándolas y representándolas de manera errónea ante el resto del mundo. Aunque empezó a causa del colonialismo, hoy en día sigue vigente en el neo-colonialismo de los medios de comunicación. Y más específicamente, en la industria del cine. Lo podemos ver en la representación de las culturas del Pacífico –simplificadas e ignoradas- y de las culturas nativo-americanas –caricaturizadas y estereotipadas- en los filmes analizados en el presente trabajo, realizados siempre desde una perspectiva occidental. Los resultados nos muestran que Hollywood trata las distintas culturas minoritarias como meros elementos exóticos, maquillando un racismo muy actual con prácticas de "whitewashing" y reinvenciones culturales que consolidan prejuicios y visiones incorrectas del mundo. Cultural appropriation consolidates the power of occidental culture over other cultures, trivializing them and wrongly representing them before the rest of the world. Even though it started due to colonialism, it is still legit today in the neo-colonialism in the media. And, more specifically, in the cinema industry. We can see that in the representation of the Pacific cultures –simplified and ignored- and the Native-American cultures –caricatured and stereotyped- in the analysed films in the present work, always made from an occidental perspective. The results show us that Hollywood treats different, minority cultures as mere exotic elements, concealing a very real racism with whitewashing practices and cultural reinventions that consolidate prejudices and wrong visions of the world.

Supplementary Figures and Tables for the article "Regulatory landscape fusion in rhabdomyosarcoma through interactions between the PAX3 promoter and FOXO1 regulatory elements" (Vicente-García et al., 2017; Genome Biology)

A iniciativa “Do saber ao bem estar: uma nova bio-experiência romana" é uma atividade desenvolvida no âmbito do programa DiVaM e enquadrada nas Jornadas Europeias do Património 2016 e dá continuidade à atividade já realizada no ano anterior, intitulada “Do saber ao sabor: uma bio-experiência romana.” A Villa de Milreu é um exemplo do modelo de ocupação romana da região da Iberia, centrada na exploração dos recursos agrícolas, marinhos e na produção de bens alimentares, que eram exportados por via marítima para os portos do Império. Com esta “nova bio-experiência” pretende-se proporcionar aos participantes a possibilidade de vivenciar a cultura e costumes do Algarve Romano à luz de um enquadramento científico, mas informal e lúdico, segundo uma abordagem alternativa à que foi explorada na edição do ano passado, focando este ano nas plantas., Financiado pela Direcção Geral de Cultura do Algarve ao abrigo do Programa DiVaM

Grado en Magisterio en Educación Primaria

El caso de Terri Schiavo ha provocado dilemas éticos en la toma de decisiones sobre ciertas actuaciones médicas en enfermos gravemente afectados. El trabajo analiza las distintas posturas que entraron en conflicto: de un lado, la petición de limitación del aporte de nutrición e hidratación, desproporcionados por acarrear sufrimiento a la enferma y una vida indigna; de otro lado, la consideración de acto deshumanizado el suspender medios básicos y proporcionados de soporte vital, y provocar la muerte de una persona que aparentemente no sufría. Se concluye con una síntesis, basada en la moral cristiana y una visión personalista. The case of Terri Schiavo has produced disagreements, mainly on ethical questions brought forward by decisions on medical actions with severely affected patients. This work analyzes the different views in conflict: on the one side, the restriction of nutrition and hydration, disproportionate for bringing suffering to the patient as well as an unworthy life; on the other side, the decision to stop the basic means providing life support, which eventually caused the death of a person who was apparently not suffering. As a conclusion, a synthesis has been carried out considering the Cristian moral as reference and a personalist perspective.

El objetivo de este artículo es mostrar los beneficios de crear un huerto escolar en un centro de Infantil y Primaria. A través del Proyecto del Huerto escolar, los alumnos adquieren habilidades necesarias para la vida y aprenden contenidos de una manera contextualizada y significativa. El huerto se convierte en un excelente recurso didáctico que nos proporciona beneficios en diferentes áreas: educación medioambiental, éxito académico, hábitos saludables, servicio a la comunidad, habilidades sociales, educación en valores y desarrollo personal. This article’s main purpose is to show the benefits of creating a school garden in an Elementary School. Through the implementation of a school garden students achieve the necessary skills for life and they learn meaningful contents within a real context. The school garden becomes an excellent educational resource with benefits in multiple areas: environmental education, academic achievement, healthy habits, community service, social skills, citizenship education, values and personal development.

Leap Motion está diseñado para el reconocimiento 3D gestual de nuestras manos. Por lo tanto, la versatilidad de esta tecnología es muy grande, ya que hay muchas aplicaciones de campos muy diferentes en los cuales el uso de gestos puede facilitar la interacción persona-máquina. La motivación principal de este proyecto fue poder ver todas las posibilidades del dispositivo para manipular entornos 3D. Se trabajó con objetos 3D en la Asignatura "Visualització Gràfica Interactiva", creando un aplicativo Visual C++ que hace uso de la librería gráfica OpenGL. Los dispositivos de entrada utilizados en este aplicativo eran ratón y teclado, mediante los cuales se podía manipular el objeto 3D. Por ello, la idea de este proyecto es aprender el funcionamiento del dispositivo Leap Motion para crear y probar un lenguaje gestual que permita interaccionar con objetos 3D. De esta manera, se añaden nuevas funcionalidades al aplicativo y aquellas que se hacían mediante ratón y teclado se podrán hacer con el uso de gestos mediante Leap Motion. Leap Motion is designed to recognize 3D gestures of our hands. There are so many fields where Leap Motion could make a difference, as the use of gestures could change the way people interact with machines. Learning all the possibilities Leap Motion can bring to 3D object manipulation was the main motivation of this project. We had worked with 3D objects at "Visualització Gràfica Interactiva " lectures. We did a Visual C++ application, using OpenGL graphics library. This application had mouse and keyboard as input devices. 3D objects were manipulated by these devices. This project is based on this idea, learning how Leap Motion works in order to create and test a gesture language that let us interact with 3D objects. Thus, new functionalities are added to this application, and others (which were previously activated by mouse or keyboard) will use Leap Motion as an input device. Leap Motion està dissenyat pel reconeixement 3D gestual de les nostres mans. Per tant, la versatilitat d'aquesta tecnologia es molt amplia, ja que hi ha moltes aplicacions de camps molt diferents en les que l'ús de gestos pot facilitar la interacció persona-màquina. La motivació principal d'aquest projecte ha sigut poder veure totes les possibilitats del dispositiu per a manipular entorns 3D. Es va treballar amb objectes 3D a l'Assignatura "Visualització Gràfica Interactiva", creant una aplicació Visual C++ que feia ús de la llibreria gràfica OpenGL. Els dispositius d'entrada en aquesta aplicació eren mouse i teclat, mitjançant els quals es podia manipular l'objecte 3D. Per tant, la idea d'aquest projecte és aprendre el funcionament del dispositiu Leap Motion per a crear i provar un llenguatge gestual que permeti interaccionar amb objectes 3D. Així, s'afegeixen noves funcionalitats a l'aplicació i aquelles que es feien mitjançant mouse i teclat es faran amb l'ús de gestos mitjançant Leap Motion.

Corporate social responsibility (CSR) and total quality management (TQM) are considered potential sources in order to obtain a sustainable competitive advantage. This paper examines how the implementation of both TQM and CSR influences the results of hotels’ stakeholders as an antecedent of business performance. An empirical study of Spanish hotels from the Andalusian region shows that the adoption of such approaches improves the capacity of hotels to create benefits for their stakeholders, and these results have a positive effect on hotel performance. The study also provides evidence of the complementarity of both management philosophies as TQM can enhance the development of CSR. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.