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Es una investigación, desde la comunicación social, que busca reconstruir narrativas socioculturales, a partir de relatos de vida de las personas en situación de calle, en la ciudad de Valencia, observando cotidianidad e interpretando su contexto. Para la comprensión de estos relatos se tomaron dos teorías comunicacionales: la teoría del Interaccionismo Simbólico de Blumer (1968) y la de las Mediaciones Sociales de Serrano (1976), una para entender la forma como ocurren las interacciones y sus significados entre los indigentes y otra para producir, con la narración de sus relatos, la comunicación y la mediación social de la realidad sociocultural que les es propia. Esta investigación es de paradigma cualitativo, de tipo etnográfica, de diseño no experimental, de campo y emergente, la cual tiene un nivel descriptivo y cuyo método utilizado es el de los relatos de vida, los instrumentos aplicados fueron la entrevista etnográfica y el diario de campo del cual se obtuvieron los relatos de vida de diez personas en situación de calle, discriminadas por género, cinco femeninas y cinco masculinos, llevándose a cabo el cruce dialectico de estos relatos, y finalmente la triangulación con la observación del contexto y los fundamentos teóricos referidos a la exclusión y la cultura del descarte propuesta por el Papa Francisco, como principal aporte se realizó una narrativa donde se analiza el marco sociocultural de la ciudad de Valencia desde la perspectiva del descarte social, y a la persona del indigente como un ser humano socialmente limitado, emocionalmente herido y esencialmente valioso.

The Mexican states of Chiapas and Tabasco have for decades been linked to Central American migrations, largely through cross-border labor mobility. Today, however, the diversification of receiving areas in Mexico requires focusing attention on how the dynamics of mobility, settlement, and/or transit impact new contexts. The state of Veracruz, part of the so-called Gulf of Mexico corridor that connects the country’s southern and northern borders on the east, has emerged as an unplanned destination—a place of temporary or permanent residence—for Central American migrants, especially Hondurans. Examination of the types of violence experienced by in-transit undocumented migrants and temporary or permanent residents in the area shows how the coercive migration policies of the Mexican government contribute to maintaining a continuum of violence that affects people “trapped in mobility.” Los estados mexicanos de Chiapas y Tabasco han estado vinculados durante décadas a las migraciones centroamericanas, en gran parte a través de la movilidad laboral transfronteriza. Hoy, sin embargo, la diversificación de las áreas receptoras en México requiere que enfoquemos la atención en cómo la dinámica de movilidad, asentamiento y/o tránsito impacta en nuevos contextos. El estado de Veracruz, parte del llamado corredor del Golfo de México que conecta las fronteras sur y norte del país en el lado este, se ha convertido en un destino no planificado, un lugar de residencia temporal o permanente, para los migrantes centroamericanos, especialmente los hondureños. Un análisis de los tipos de violencia que experimentan los migrantes indocumentados en tránsito y los residentes temporales o permanentes en la zona muestra cómo las políticas migratorias coercitivas del gobierno mexicano contribuyen a mantener un ciclo de violencia que afecta a aquellos “atrapados en la movilidad”.

Background: Previous evidence supports that monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 50%-65%, regardless of baseline treatments. We tested possible sex differences in a multicentre registry of real-world patients treated with PCSK9 inhibitors. Methods: This is a multicentre and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 18 different hospitals. Before-treatment and on-treatment LDLc and medical treatments, clinical indication, and clinical features were recorded. Results: Women represented 24.69% of the cohort. The use of statins was similar in both sexes, but women were receiving most frequently ezetimibe. Before-treatment median LDLc was 135 (interquartile range 115-166) mg, and it was higher in women. The median on-treatment LDLc was 57 (interquartile range 38-84) mg/dL, which represented a mean 54.5% reduction. On-treatment LDLc was higher in women, and the mean LDLc reduction was lower in women (47.4% vs. 56.9%; P = 0.0002) receiving evolocumab or alirocumab. The percentage of patients who achieved >= 50% LDLc reduction was higher in men (71.36% vs. 57.62%; P = 0.002). According to LDLc before-treatment quartiles, LDLc reduction was statistically lower in women in the 2 highest and a significant interaction of women and baseline LDLc >135 mg/dL was observed. Women were negatively associated with lower rates of LDLc treatment target achievement (odds ratio: 0.31). Differences were also observed in women with body mas index >25 kg/m(2). Only 14 patients (2.14%) presented side effects. Conclusions: This multicentre and retrospective registry of real-world patients treated with PCSK9 inhibitors highlights significant gender differences in LDLc reduction.

Our experiment consists of analyzing a non-Newtonian fluid, testing it at different pressures and thus seeing its peculiar behaviour.A non-Newtonian fluid is a curious material whose viscosity changes with temperature and the stress applied to it at a given time. As a result, you will never be able to have a defined and constant viscosity value.That is, if we introduce an object at low speed, we will go through it without difficulty as if it were a liquid, since we do not exert enough pressure for its atoms to rearrange.In contrast, when a non-Newtonian fluid is struck, the incoming applied force causes it to temporarily behave like a solid.

Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Of the 3946 patients in the registry, 24 were aged 21 years or younger. The mean age of this group when they started treatment upon registration on Biobadaderm was 16.1 years and the mean Psoriasis Area and Severity Index was 9.4. In 67% the first treatment recorded was with a conventional systemic drug. Treatment was discontinued in 14 patients (58%) due to adverse events or a loss or lack of effectiveness. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs. (C) 2021 AEDV. Published by Elsevier Espana, S.L.U.

Families with rare diseases (RDs) have unmet needs that are often overlooked by health professionals. Describing these needs and the impact of the disease could improve their medical care. A total of 163 surveys were obtained from patients visiting primary care centres in the Valencian Region (Spain), during 2015-2017, with a confirmed or suspected diagnosis of RD. Of the 84.7% with a confirmed diagnosis, 50.4% had a diagnostic delay exceeding one year, and it was more prevalent among adults (62.2%). Families with paediatric patients were in a worse economic situation, with lower incomes and higher monthly disease-related expenses (euro300 on average). These expenses were incurred by 66.5% of families and were mainly for medication (40.3%). Among them, 58.5% reported not being able to afford adjuvant therapies. The disease had an impact on 73.1% of families, especially on their routine and emotional state. Expenses, needs, and impacts were more frequent among families of patients with a history of hospitalisation or deterioration. Patients with delayed diagnosis had a higher consumption of drugs prior to diagnosis. People affected by RDs in the Valencian Region need therapies to improve their autonomy and emotional state. Health professionals should be aware of these needs.

El objetivo del estudio fue evaluar el efecto de un anticoccidial natural a base de saponinas procedentes de Yucca schidigera y Trigonella foenum-graecumen en el control de coccidiosis en pollos de carne. Se utilizaron 75 pollos machos de la línea Cobb 500 de un día de edad, distribuidos al azar en tres tratamientos: DBSA (dieta base sin adición de anticoccidial), DBAN (dieta base con adición de anticoccidial natural), DBQI (dieta base con adición de anticoccidial químico - ionóforo) con cinco repeticiones y cinco aves por unidad experimental. Los pollos fueron inoculados en día 14 con 15 veces la dosis recomendada de la vacuna viva (Coccivac-D), que contiene Eimeria acervulina, E. maxima, E. mivati, E. tenella, E. necatrix, E. brunetti, E. hagani y E. praecox para inducir la enfermedad. Se evaluaron las variables recuento de ooquistes por gramo de heces (ROpgh), lesiones intestinales y diversos parámetros productivos. Los valores de ROpgh fueron similares para DBAN y DBQI llegando a su pico a la séptima semana (328.8 y 455.8 Opgh, respectivamente), para luego disminuir. Las lesiones intestinales los días 10, 20 y 28 pos-infección y los parámetros productivos al final del estudio fueron similares para ambos tratamientos, pero significativamente mejores que el control DBSA. Se concluye que las saponinas procedentes de Y. schidigera y T. foenum-graecum pueden remplazar eficientemente a los anticoccidiales químicos en la alimentación de las aves.

RationaleOutcomes in patients with severe SARS-CoV-2 infection (COVID-19) are conditioned by virus clearance and regulation of inflammation. Variants in IFIH1, a gene coding the cytoplasmatic RNA sensor MDA5, regulate the response to viral infections.ObjectiveTo characterize the impact of IFIH1 rs199076 variants on host response and outcomes after severe COVID-19.MethodsPatients admitted to an intensive care unit (ICU) with confirmed COVID-19 were prospectively studied and rs1990760 variants determined. Peripheral blood gene expression, cell populations and immune mediators were measured. Peripheral blood mononuclear cells from healthy volunteers were exposed to an MDA5 agonist and dexamethasone ex-vivo, and changes in gene expression assessed. ICU discharge and hospital death were modelled using rs1990760 variants and dexamethasone as factors in this cohort and in-silico clinical trials.Measurements and Main Results227 patients were studied. Patients with the IFIH1 rs1990760 TT variant showed a lower expression of inflammation-related pathways, an anti-inflammatory cell profile and lower concentrations of pro-inflammatory mediators. Cells with TT variant exposed to a MDA5 agonist showed an increase in IL6 expression after dexamethasone treatment. All patients with the TT variant not treated with steroids (N=14) survived their ICU stay (HR 2.49, 95% confidence interval 1.29–4.79). Patients with a TT variant treated with dexamethasone (N=50) showed an increased hospital mortality (HR 2.19, 95% confidence interval 1.01–4.87) and serum IL-6. In-silico clinical trials supported these findings.ConclusionsCOVID-19 patients with the IFIH1 rs1990760 TT variant show an attenuated inflammatory response and better outcomes. Dexamethasone may reverse this anti-inflammatory phenotype.

X Congreso Geológico de España, 5-7 Julio 2021, Vitoria - Gasteiz, La difusión de contenidos científicos mediante audiovisuales alojados en plataformas online y redes sociales facilita el acceso público a información usualmente restringida a la comunidad científica. Este trabajo muestra la experiencia obtenida a partir de la creación de un audiovisual para divulgar los resultados de un proyecto de investigación. El proyecto, titulado ¿Caracterización geomorfológica y geocronológica de cavidades kársticas en el Parque Nacional de los Picos de Europa¿ (referencia 580/12, MAGRAMA-OAPN), incluía en su plan de difusión la realización de contribuciones científicas y diversas acciones de transferencia (Jiménez-Sánchez et al., 2019). Entre estas últimas destaca el audiovisual titulado ¿Las cuevas del Parque Nacional de los Picos de Europa: una historia por descubrir¿ (https://goo.gl/wNnQnG), que explica el origen de las cavidades de los Picos de Europa contextualizado en la evolución del relieve del parque. El audiovisual facilita el acceso público al conocimiento científico garantizando, además, el rigor y exactitud de la información divulgada., Dissemination of scientific results through videos shared via online platforms and social media enables public access to information usually restricted to the scientific community. Here we present the experience obtained with the creation of a video for disseminating the results of a research project. The project, entitled “Geomorphological and geochronological characterization of karstic cavities in the Picos de Europa National Park” (reference 580/12, MAGRAMA-OAPN), included in its dissemination plan the making of scientific contributions and several transfer actions (Jiménez-Sánchez et al., 2019), being the video “Las cuevas del Parque Nacional de los Picos de Europa: una historia por descubrir” (https://goo.gl/wNnQnG) one of these actions. The video explains the origin of Picos de Europa caves in the context of the evolution of the park’s relief. This video allows the lay public accessing to scientific knowledge, while ensuring rigorous and accurate information.

Aim: There is a paucity of data on Non-Alcoholic Fatty Liver Disease (NAFLD) and Metabolic Syndrome (MetS) among native Cubans. We aimed to assess the prevalence of MetS in Cubans with NAFLD and the outcomes and predictors for advanced fibrosis. Methods: A multicenter (outpatient clinics of nine hospitals in seven Cuban provinces) cross-sectional study of adults with NAFLD between September 2018 and May 2019. MetS was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP: ATPIII) criteria. Advanced fibrosis was defined using AST to Platelet Ratio Index (APRI) ≥1 and Fibrosis-4 score (FIB-4) ≥2.67. Results: 819 patients enrolled, 563 (68.7%) had MetS; mean age 54.9 years, 60.3% female, 65.8% white, 95.1% from urban residency, mean BMI 30.7 kg/m². Fibrosis was present in 114 (13.9%); 94 (82.5%) had APRI ≥1; 77 (67.5%) had FIB-4 ≥ 2.67; 57 (50%) both scores were elevated. MetS group had significantly more fibrosis than no MetS, [17% vs. 7% (p=0.0001)]. Patients with fibrosis were older (57.7 vs. 54.5, P=0.0015), of Mestizos ethnicity (36.8% vs. 16.9%, P0.05). Conclusion: Cuban NAFLD patients with MetS have substantial clinical impairment and a higher risk for fibrosis.

La azadiractina es un triterpenoide con propiedades insecticidas, que es producida por el árbol de margosa (Azadirachta indica A. Juss.). En este trabajo se determinó el contenido de este metabolito en frutos completos de diferentes estados de desarrollo y en diferentes tejidos del fruto (embrión, endospermo, cubierta seminal y cuerpo del fruto). En Córdoba, Veracruz, México, la concentración de azadiractina aumentó con el desarrollo del fruto, en la mayoría de ellos hasta alcanzar su máximo en la madurez fisiológica, a los 127 d después de floración (equivalentes a 1040 unidades calor), con valores de 2.8 mg g-1 materia seca en fruto completo y de 5.88 mg g-1 materia seca en embrión. El tejido del fruto con mayor contenido de azadiractina fue el embrión, con 83 % del total.

We present a three-dimensional restitution of the Buendía-Iguarán house from the detaileddescriptions of One Hundred Years of Solitude by applying constructive criteria to the narrativeuniverse. To do this, we generated a methodology that allowed to verify the narrative logics of literatureand the construction logics of architecture. Measurements were assigned based on a geometric modulethat integrated the concepts of space and the construction of the building. The research achieved thedetermination of the measurements of the lot, the number of rooms that could be built at the maximummoment of growth of the house and the arrangement of the spaces in the three stages of its development.The core of the paper is to provide a methodology for the three-dimensional restitution of other literaryworks that contain fictional architectural references. A partir de las descripciones detalladas de Cien años de soledad, se realizó la restitucióntridimensional de la casa de los Buendía-Iguarán, mediante la aplicación de criterios constructivos aluniverso narrativo. Para ello, se generó una metodología que permitiera verificar las lógicas narrativasde la literatura y las lógicas constructivas de la arquitectura. Se asignaron medidas a partir de un módulogeométrico que integrara las concepciones del espacio y la construcción de la edificación. Se logróla determinación de las medidas del lote, la cantidad de habitaciones que se pudieron construir en elmáximo momento de crecimiento de la vivienda y la disposición de los espacios en las tres etapas desu desarrollo. Se pretende, con ello, aportar una metodología para la restitución tridimensional de otrasobras literarias que contienen referentes arquitectónicos ficcionales.

Objective: To evaluate the sources of information used by the Regional Population-based Registries of Rare Diseases (RRD) for Wilson's Disease identification in Spain; to calculate its prevalence and mortality; and to describe the sociodemographic characteristics of those affected. Method: Cross-sectional epidemiological study, period 2010-2015. Possible cases were identified by codes 275.1 (ICD-9-CM), E83.0 (ICD-10) and 905 (ORPHAcode) in: 15 participating RRD and the Rare Disease Patients Registry of the Carlos III Health Institute. The diagnoses were confirmed through a clinical documentation review. The positive predictive value (PPV) of the sources of information used by RRD and their combinations were obtained. The prevalence, mortality and the distribution of sociodemographic characteristics were calculated. Results: The Hospital Discharge Database (HDD) was the most used source by the RRD (PPV = 39.4%), followed by the Orphan Drugs Registry (ODR) (PPV = 81.9%). The Clinical History of Primary Care (PC) obtains PPV = 55.9%. The combinations with highest PPV were the ODR with HDD (PPV = 95.8%) and the ODR with PC (PPV = 92.9%). 514 cases were confirmed, 57.2% men, with a median age of diagnosis of 21.3 years. The prevalence was 1.64/100,000 inhabitants in 2015 and mortality rate was 3.0%, being both higher in men. Conclusions: Incorporation of ODR and PC into the RRD is recommended, as its combination and ODR with HDD could be used as an automatic validation criterion for Wilson's disease. The prevalence obtained was similar to that of countries close to Spain. (c) 2020 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

237th Meeting Online Planner of the American Astronomical Society, 12-15 January 2021, virtually anywhere, NASA Ultraviolet & visible light (UV-Vis) SIG and Technology Interest Group (TIG)

X Congreso Geológico de España, 5-7 Julio 2021, Vitoria - Gasteiz, Se ha desarrollado una base de datos en un sistema de información geográfica (SIG) para la gestión del Geoparque Mundial de la UNESCO Montañas do Courel (NO de España). El SIG incluye 66 capas de información topográfica, geológica, minera, biológica, arqueológica y etnográfica, que pueden ser combinadas entre sí para elaborar mapas temáticos adaptados a la finalidad y al usuario. Los mapas generados son empleados en actividades de divulgación, en el diseño de cartografías técnicas de apoyo a los gestores del Geoparque, en el desarrollo de estudios científicos y en acciones de geoconservación

Background Consistency of results between different readers is an important issue in medical imaging, as it affects portability of results between institutions and may affect patient care. The International Atomic Energy Agency (IAEA) in pursuing its mission of fostering peaceful applications of nuclear technologies has supported several training activities in the field of nuclear cardiology (NC) and SPECT myocardial perfusion imaging (MPI) in particular. The aim of this study was to verify the outcome of those activities through an international clinical audit on MPI where participants were requested to report on studies distributed from a core lab. Methods The study was run in two phases: in phase 1, SPECT MPI studies were distributed as raw data and full processing was requested as per local practice. In phase 2, images from studies pre-processed at the core lab were distributed. Data to be reported included summed stress score (SSS); summed rest score (SRS); summed difference score (SDS); left ventricular (LV) ejection fraction (EF) and end- diastolic volume (EDV). Qualitative appraisals included the assessment of perfusion and presence of ischemia, scar or mixed patterns, presence of transient ischemic dilation (TID), and risk for cardiac events (CE). Twenty-four previous trainees from low- and middle-income countries participated (core participants group) and their results were assessed for inter-observer variability in each of the two phases, and for changes between phases. The same evaluations were performed for a group of eleven international experts (experts group). Results were also compared between the groups. Results Expert readers showed an excellent level of agreement for all parameters in both phase 1 and 2. For core participants, the concordance of all parameters in phase 1 was rated as good to excellent. Two parameters which were re-evaluated in phase 2, namely SSS and SRS, showed an increased level of concordance, up to excellent in both cases. Reporting of categorical variables by expert readers remained almost unchanged between the two phases, while core participants showed an increase in phase 2. Finally, pooled LVEF values did not show a significant difference between core participants and experts. However, significant differences were found between LVEF values obtained using different software packages for cardiac analysis. Conclusions In this study, inter-observer agreement was moderate-to-good for core group readers and good-to-excellent for expert readers. The quality of reporting is affected by the quality of processing. These results confirm the important role of the IAEA training activities in improving imaging in low- and middle-income countries. Electronic supplementary material The online version of this article (10.1007/s12350-018-1407-4) contains supplementary material, which is available to authorized users.

The objective was to identify immune alterations in patients with fibromyalgia syndrome (FMS) compared to healthy controls (HC) using meta-analysis and meta-regression. Six electronic databases were searched for suitable original articles investigating immune biomarkers in FMS in comparison to HC. We extracted outcomes and variables of interest, such as mean and SD of peripheral blood immune biomarkers, age or sex. A random-effects model with restricted maximum-likelihood estimator was used to compute effect sizes (standardized mean difference and 95% CI, Hedges' g) and meta-analysis, group meta-analysis and meta-regressions were conducted. Forty-three papers were included in this systematic review, of which 29 were suitable for meta-analysis. Interleukin (IL)-6 (g = 0.36 (0.09-0.63); I(2) = 85.94; p = 0.01), IL-4 (g = 0.50 (0.03-0.98); I(2) = 81.87; p = 0.04), and IL-17A (g = 0.53 (0.00-1.06); I(2) = 87.15; p = 0.05), were significantly higher in FMS compared to HC while also combinations of cytokines into relevant phenotypes were significantly upregulated including M1 macrophage (g = 0.23 (0.03-0.43); I(2) = 77.62; p = 0.02), and immune-regulatory (g = 0.40 (0.09-0.72); I(2) = 84.81; p = 0.01) phenotypes. Heterogeneity levels were very high and subgroup and meta-regression analyses showed that many covariates explained part of the heterogeneity including medication washout, sex, time of blood sampling and exclusion of patients with major depressive disorder. In conclusion, FMS is accompanied by a disbalance between upregulated pro-inflammatory (M1 and Th-17) and immune-regulatory cytokines although effect sizes are small-to-moderate. Based on our results we provide specific methodological suggestions for future research, which should assess Th-1, Th-17, chemokines, and Th-2 phenotypes while controlling for possible confounding variables specified in this study.

Fibromyalgia (FM) is a prevalent and highly disabling chronic pain syndrome. However, differences among patients regarding how pain impacts on daily life are remarkable. The main aim of this study was to identify clinical and pain-related cognitive variables characterizing patients reporting high adaptability despite experiencing severe chronic pain.

RESUMEN Objetivo: La estrategia farmacológica en el manejo de la diabetes tipo 2 incluye la insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida. El análisis costo efectividad aborda el aspecto económico y el epidemiológico en el proceso de elección entre dos o más alternativas. El objetivo fue determinar el costo efectividad de la insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida. Métodos: Estudio de costo efectividad en pacientes con diabetes tipo 2. Alternativa 1, usuarios de insulina lispro protamina (NPL), y 2, usuarios de insulina NPH + insulina rápida. Tamaño de muestra de 62 por grupo, técnica muestral aleatoria simple. El costo incluyó, costo unitario, intensidad de uso del servicio, costo promedio por insumo, costo promedio por servicio, y costo por tipo de alternativa (incluyó medicina familiar, laboratorio y medicamentos). La efectividad se determinó con el promedio de los resultados de glucosa realizados durante todo el año. El plan de análisis incluyó análisis costo efectividad y análisis costo efectividad incremental. Resultados: Costo promedio (estimado en pesos mexicanos) de la alternativa lispro protamina (NPL) $6,146.30 y NPH + insulina rápida $2,671.02. La NPH + insulina rápida tiene menor costo y mayor efectividad. El costo efectividad incremental identifica que con la alternativa NPH + insulina rápida existe ahorro de $158.98 por cada miligramo de glucosa por decilitro en relación a la alternativa lispro protamina (NPL). Conclusion: El resultado, bajo nuestras limitantes, sugiere mejor relación costo efectividad en insulina NPH + insulina rápida.

Genome-wide association studies (GWASs) have identified a number of genetic risk loci associated with systemic sclerosis (SSc) and Crohn’s disease (CD), some of which confer susceptibility to both diseases. In order to identify new risk loci shared between these two immune-mediated disorders, we performed a cross-disease meta-analysis including GWAS data from 5, 734 SSc patients, 4, 588 CD patients and 14, 568 controls of European origin. We identified 4 new loci shared between SSc and CD, IL12RB2, IRF1/SLC22A5, STAT3 and an intergenic locus at 6p21.31. Pleiotropic variants within these loci showed opposite allelic effects in the two analysed diseases and all of them showed a significant effect on gene expression. In addition, an enrichment in the IL-12 family and type I interferon signaling pathways was observed among the set of SSc-CD common genetic risk loci. In conclusion, through the first cross-disease meta-analysis of SSc and CD, we identified genetic variants with pleiotropic effects on two clinically distinct immune-mediated disorders. The fact that all these pleiotropic SNPs have opposite allelic effects in SSc and CD reveals the complexity of the molecular mechanisms by which polymorphisms affect diseases.

Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.

Different machine learning methods have been used to develop predictive models of high quality and precision [1]. Among them, Random Survival Forests (RSF) has been proposed as an alternative to traditional survival models [2], being able to overcome most of the limitation of traditional survival techniques, such as Cox proportional hazards models. Objectives Our objective was to develop and internally validate a predictive model for rheumatoid arthritis (RA) mortality using Random Survival Forests (RSF). Methods Retrospective longitudinal study involving 1,461 patients diagnosed with RA between January 1994 and August 2011, and followed at the outpatient clinic of the Rheumatology Department of the Hospital Clínico San Carlos (Madrid, Spain) until death or September 2013. Demographic and clinical-related variables collected during the first two years after disease diagnosis were used. RSF models were developed, based on 1,000 trees. 100 iterations of each model were performed to measure the mean and standard deviation (SD) of the predictive error and the integrated Brier score (IBS). Missing values were imputed using the function implemented by the randomForestSRC package [3]. The predictive capacity of the variables was assessed using the “variable importance” (VIMP). Two models were constructed using the log-rank (MLG) or log-rank score (MLGS) splitting rules. The model with the lowest prediction error was selected. Next, those variables with negative VIMP were excluded and a final model developed. Results 148 patients died (10.1%). MLG showed the lowest prediction error. All variables exhibited a positive VIMP. Final model showed a mean (SD) prediction error and IBS of 0.187 (0.002) and 0.150 (0.003) respectively. The most important predictor variables were age at diagnosis, median erythrocyte sedimentation rate and number of hospital admissions in the first 2 years after RA diagnosis. Conclusions We developed an accurate and precise model for RA mortality using RSF. Age and disease activity showed the highest influence in mortality.

Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, and physical and emotional symptoms. Although its pathophysiology is largely unknown, immune-inflammatory pathways may be involved. We examined serum interleukin (IL)-6, high sensitivity C-reactive protein (hs-CRP), CXCL-8, and IL-10 in 67 female FM patients and 35 healthy women while adjusting for age, body mass index (BMI), and comorbid disorders. We scored the Fibromyalgia Severity Score, Widespread Pain Index (WPI), Symptom Severity Scale (SSS), Hospital Anxiety (HADS-A), and Depression Scale and the Perceived Stress Scale (PSS-10). Clinical rating scales were significantly higher in FM patients than in controls. After adjusting for covariates, IL-6, IL-10, and CXCL-8 were lower in FM than in HC, whereas hs-CRP did not show any difference. Binary regression analyses showed that the diagnosis FM was associated with lowered IL-10, quality of sleep, aerobic activities, and increased HADS-A and comorbidities. Neural networks showed that WPI was best predicted by quality of sleep, PSS-10, HADS-A, and the cytokines, while SSS was best predicted by PSS-10, HADS-A, and IL-10. Lowered levels of cytokines are associated with FM independently from confounders. Lowered IL-6 and IL-10 signaling may play a role in the pathophysiology of FM.

Fibromyalgia (FM) is a disabling syndrome characterized by chronic pain associated with fatigue. Its pathogenesis is unknown, but alterations in central sensitization, involving an imbalance of brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers, appear to be implicated. The aim of this study was to evaluate the impact of attachment-based compassion therapy (ABCT) on levels of BDNF, the inflammatory markers TNF-a, IL-6, IL-10, and the C-reactive protein (CRP), analysing whether biomarkers play a mediating/moderating role in improvements in FM functional status. Thirty-four female patients with FM participated in a RCT and were assigned to ABCT or relaxation therapy. Blood extractions were conducted at baseline and post-intervention, with self-report assessments of functional status (FIQ) at baseline, post-intervention and 3-month follow-up. A pro-inflammatory composite was obtained by summing up IL-6, TNF-a and CRP normalized values. Non-parametric tests, analysis of variance and regression models were used to evaluate treatment and mediation/moderation. Compared to relaxation therapy, ABCT showed significant improvements in FIQ and decreases in BDNF, CRP, and pro-inflammatory composite. Changes in BDNF had a mediating role in FIQ. ABCT seems to reduce BDNF and appears to have anti-inflammatory effects in FM patients. Reductions in BDNF could be a mechanism of FM functional status improvement.Clinical Trial Registration: http://ClinicalTrials.gov , identifier NCT02454244. Date: May 27th, 2015.

Recent publications have reported high prevalence of C. parapsilosis sensu stricto in oral cavity niches. Our research group performed a pilot study in 2017 which showed that of the psilosis complex, C. parapsilosis sensu stricto is the species most frequently isolated from oral cavity niches. Under inflammatory conditions, the probability of recovering it is almost four times higher, and it displays higher biofilm-forming capacity in-vitro, differing significantly from isolates of the same species obtained in conditions of eubiosis. This led us to hypothesize that an oral environment in dysbiosis overregulates virulent genes, promoting a more pathogenic phenotype. Accordingly, we decided to reevaluate the in-vitro biofilm formation assay using a larger sample, under two nutritional conditions, using colorimetric methods for quantification. In addition, the results obtained were validated by imaging techniques. For both clinical conditions (eubiosis and dysbiosis), high biofilm forming phenotype predominated with both reading methods, and for both nutritional conditions tested. XTT showed significant difference between absorbance values for isolates from buccal dysbiosis and eubiosis (p=0.0025). C. parapsilosis sensu stricto cells that colonize oral cavity niches are basically strong biofilm formers, regardless of in vitro growing conditions. However, the oral cavity in dysbiosis probably promotes virulence in this species due to inheritable epigenetic modifications.

We study spectral and transport properties of one-dimensional tight-binding $\mathcal{PT}$-symmetric chains with alternating couplings. Based on the transfer matrix method, we have analytically developed the expressions for the transmission and reflection coefficients for any values of control parameters. These expressions are obtained in a very compact form which separately imbed the generic energy dependence valid for any periodic structure, as well as specific properties of a unit cell composing the scattering setup. Out main interest is in specific properties of the left/right reflections that are due to the $\mathcal{PT}$ symmetric structure of the model. We have found that for the case of asymmetric couplings between dimers, a new type of specific points emerge in the spectrum, which are responsible for quite specific properties of the unidirectional reflectivity.

Fibromyalgia (FM) syndrome represents a great challenge for clinicians and researchers because the efficacy of currently available treatments is limited. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for reducing functional impairment as well as the role of mindfulness-related constructs as mediators of treatment outcomes for people with FM. Two hundred twenty-five participants with FM were randomized into 3 study arms: MBSR plus treatment-as-usual (TAU), FibroQoL (multicomponent intervention for FM) plus TAU, and TAU alone. The primary endpoint was functional impact (measured with the Fibromyalgia Impact Questionnaire Revised), and secondary outcomes included "fibromyalginess," anxiety and depression, pain catastrophising, perceived stress, and cognitive dysfunction. The differences in outcomes between groups at post-treatment assessment (primary endpoint) and 12-month follow-up were analyzed using linear mixed-effects models and mediational models through path analyses. Mindfulness-based stress reduction was superior to TAU both at post-treatment (large effect sizes) and at follow-up (medium to large effect sizes), and MBSR was also superior to FibroQoL post-treatment (medium to large effect sizes), but in the long term, it was only modestly better (significant differences only in pain catastrophising and fibromyalginess). Immediately post-treatment, the number needed to treat for 20% improvement in MBSR vs TAU and FibroQoL was 4.0 (95% confidence interval [CI] = 2.1-6.5) and 5.0 (95% CI = 2.7-37.3). An unreliable number needed to treat value of 9 (not computable 95% CI) was found for FibroQoL vs TAU. Changes produced by MBSR in functional impact were mediated by psychological inflexibility and the mindfulness facet acting with awareness. These findings are discussed in relation to previous studies of psychological treatments for FM.

The main objective of this study is to identify fibromyalgia syndrome (FMS) clusters using the Revised Fibromyalgia Impact Questionnaire (FIQR), and to examine whether the clusters differ in sociodemographic characteristics, clinical measures, direct and indirect costs, levels of inflammatory markers, and brain morphometry. A hierarchical cluster analysis was performed to classify a large, pooled Spanish sample of patients with FMS (N = 947) using the FIQR as clustering variable. A latent profile analysis was subsequently conducted to confirm the optimal number of FMS clusters. To examine external validity, a battery of clinical measures, economic costs, inflammatory markers, and gray matter volumes of relevant cortical and subcortical areas were analyzed. We also compared the discriminant validity of the clusters with the original FIQR severity categories. To promote the implementation in real-world clinical practice, we built a free online cluster calculator. Our findings indicated that a four-cluster solution more clearly captured the heterogeneity of FIQR data and provided the best fit. This cluster solution allowed for detection of differences for most clinical outcomes and economic costs. Regarding the inflammatory and brain-based biomarkers, differences were found in C-reactive protein, and tendencies were found in the right medial prefrontal cortex, the right parahippocampal gyrus, and the right middle cingulate cortex; brain regions associated with executive functions and pain processing. The original FIQR categories presented similar results, although their precision in discriminating among the nonextreme categories (ie, moderate and severe) was not sound. These findings are discussed in relation to previous research on FMS clustering.

Fibromyalgia (FM) is a highly prevalent and disabling syndrome characterized by chronic widespread musculoskeletal pain and a broad range of cognitive and affective symptoms. Up to now, the pathogenesis of FM is unknown although a peripheral and central sensitization involving an imbalance on immune biomarkers appears to have a relevant role in its aetiology. The aim of this study was to extend previous clinical findings of Mindfulness-Based Stress Reduction (MBSR) to both its impact on clinical symptomatology and immune biomarkers (IL-6, CXCL8, IL-10 and hs-CRP), and also to explore the role of biomarkers as predictors of efficacy. METHODS: A total of 70 female patients with FM were randomly assigned to two treatment modalities, namely Treatment as Usual (TAU) plus MBSR (n?=?35) or TAU alone (n?=?35). This study is embedded within a larger RCT (n?=?225) that includes three study arms (TAU; TAU plus MBSR; and TAU plus the psychoeducative intervention FibroQoL), and a 12-month follow-up (clinical trial registration: NCT02561416). Blood cytokine assays and clinical assessment were conducted at baseline and post-treatment. Treatment effects were analysed using linear mixed models with intention to treat and per protocol analyses. In order to evaluate the balance between pro- and anti-inflammatory pathways, ratios of pro-inflammatory IL-6, CXCL8 and hs-CRP with the anti-inflammatory cytokine IL-10 were calculated (i.e. IL-6/IL-10, CXCL8/IL10 and hs-CRP/IL-10). RESULTS: The results show that MBSR is an efficacious intervention to reduce clinical severity of patients with FM. MBSR also prevents the tendency of IL-10 to decrease as observed in the TAU group. Higher levels of baseline CXCL8 levels attenuate the beneficial effect of MBSR practice on clinical symptomatology, including pain, energy, stiffness or quality of sleep. Furthermore, higher baseline IL-6/IL-10 and CXCL8/IL-10 ratios were associated with less improvement in psychological inflexibility following MBSR treatment. DISCUSSION: Our results show that mindfulness training has clinical efficacy in patients with FM. The results suggest that MBSR has significant immune regulatory effects in FM patients, while immune-inflammatory pathways may in part predict the clinical efficacy of MBSR. These cytokines and chemokines may be adequate biomarkers to monitor responsivity to MBSR.

La arquitectura regionalista en Sevilla no se comprende sin su contexto europeo. La ideología regionalista estaba presente también en Inglaterra, Francia, Alemania y otros países europeos, aunque se conoce con nombres diferentes como Arts and Crafts, Heimatarchitektur o tradicionalismo. Al final la dominación de la arquitectura regionalista en Sevilla a principios del siglo XX, con Anibal González Álvarez como su principal representante, se compara con la situación en Hamburgo donde Fritz Schumacher impuso el regionalismo - el estilo neo-hanseatico - como estilo dominante.

Introduction and objectives: Contemporary data on the incidence and prognosis of heart failure (HF) and the influence of left ventricular ejection fraction (LVEF) in the setting of acute coronary syndrome (ACS) are scant. The aim of this study was to examine the relationship between LVEF and HF with long-term prognosis in a cohort of patients with ACS. Methods: This is a retrospective observational study of 6208 patients consecutively admitted for ACS to 2 different Spanish hospitals. Baseline characteristics were examined and a follow-up period was established for registration of death and HF rehospitalization as the primary endpoint. Results: Among the study participants, 5064 had ACS without HF during hospitalization: 290 (5.8%) had LVEF < 40%, 540 (10.6%) LVEF 40% to 49%, and 4234 (83.6%) LVEF >= 50%. The remaining 1144 patients developed HF in the acute phase: 395 (34.6%) had LVEF < 40%, 251 (21.9%) LVEF 40% to 49%, and 498 (43.5%) LVEF >= 50%. Patients with LVEF 40% to 49% had a demographic and clinical profile with intermediate features between the LVEF < 40% and LVEF >= 50% groups. Kaplan-Meier curves showed that mortality and HF readmissions were statistically different depending on LVEF in the non-HF group but not in the HF group. Left ventricular ejection fraction >= 50% was an independent prognostic factor in the non-HF group only. Conclusions: In ACS, long-term prognosis is considerably worse in patients who develop HF during hospitalization than in patients without HF, irrespective of LVEF. This parameter is a strong prognostic predictor only in patients without HF. (C) 2017 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

RESUMEN Fundamento. La cirugía en sitio erróneo (CSE) es un evento adverso de la asistencia sanitaria potencialmente prevenible. Material y método. Análisis retrospectivo de las 9.129 reclamaciones registradas entre 1986 y 2017 en el Servicio de Responsabilidad Profesional Médica del Consejo de Colegios de Médicos de Cataluña. Resultados. Se localizaron 57 reclamaciones sobre CSE (1,78 reclamaciones/año) con incremento en los últimos diez años (0,92 a 3,83). Hubo un error de paciente correspondiente al procedimiento anestésico; las zonas anatómicas más implicadas fueron los dedos (17,5%) y la columna (15,8%), seguidos de la rodilla y los dientes (12,3% cada uno). Cirugía Ortopédica y Traumatología fue la especialidad más implicada (54,4%). Los procedimientos más frecuentemente implicados en la CSE fueron extracción dental, cirugía de hernia discal y resección ósea en dedo (7 casos cada uno, 12,3%). La vía de reclamación fue penal en 16 casos (28,1%) y civil en 9 (15,8%), con dos sentencias condenatorias por vía civil. El 59,6% de los expedientes conllevaron indemnización, con una cuantía media de 9.210,23 euros por caso, un 65,6% en vía extrajudicial y un 50% en vía judicial. Conclusiones. La CSE presenta una incidencia no desdeñable de reclamación y elevadas tasas de responsabilidad profesional médica, reforzando la necesidad de incrementar los esfuerzos en materia de seguridad del paciente en esta área.

This research work shows a model to simulate alkaline electrolysis systems with the objective of evaluating the thermodynamic performance of the system through a detailed energy and exergy analysis. This analysis includes the operation of all components in the system and has as aim to identify the sources of energy losses and find the key points to optimize the process. The model has been implemented in a process simulator, namely HYSYS ASPENTECH. As this type of simulators are not able to simulate the electrolysis cells, a mathematical model of the curve polarization has been developed using MATLAB and integrated in HYSYS, as a submodel, in order to describe the electrochemical performance of the cells. The completed model has been validated experimentally. The results of the present study can further be applied to perform process optimization to maximize the cost-effectiveness of alkaline electrolysis system for hydrogen production.

Mental disorders are highly prevalent in the general population, and people who experience them are frequently stigmatized. Stigma has a very negative impact on social, academic/professional, and personal life. Considering the high rates of mental disorders among children and adolescents (13.4%) and how critical this age is in the formation of nuclear beliefs, many campaigns to combat stigma have been developed in the last decade, with mixed results. The OBERTAMENT initiative has produced various anti-stigma campaigns in Catalonia (Spain). In the present study, the main objective was to report on the effectiveness of the OBERTAMENT What's up! intervention, a curricular intervention including education and social contact conducted by the teachers in the classroom with teenagers aged between 14 and 18. Prior to this, we examined the psychometric properties of the Youth Program Questionnaire (YPQ), our main outcome measure, in terms of dimensionality, reliability, and validity. A cluster non-randomized controlled trial was conducted to assess this intervention, which was tested in nine high schools situated in the Barcelona region. A convenience sample of 261 students formed the intervention group and 132 the control group (52% women, mean age = 14, SD = 0.47). The assignment to study conditions was conducted by Departament d'Ensenyament (Department of Education), Generalitat de Catalunya (Catalan Government). Participants were evaluated at baseline, post-intervention, and 9-month follow-up. The main outcome measure of this study was the YPQ. The Reported and Intended Behavior Scale (RIBS) was used as secondary outcome measure. The statistical analysis indicated that the YPQ possesses a two-factor structure (stereotypical attitudes and intended behavior) and sound psychometric properties. The multilevel mixed-effects models revealed statistically significant interactions for both study measures and post hoc intragroup analyses revealed a significant but small improvement in the YPQ and RIBS scores in the intervention group. Overall, our results indicate that What's up! produced statistically significant, albeit small improvements in stereotypical attributions and intended behavior toward people with mental disorders. Some methodological limitations and the relatively low levels of stigma observed in our sample may undermine our results. The implications of our results are discussed in relation to stigma research.