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Abstract Background Frequent attendance is a common issue for primary care health centres. The phenomenon affects the quality of care, increases doctors’ workloads and can lead to burnout.This study presents the results of an educational intervention for primary care physicians, aimed at helping them to decrease the prevalence rate of excessive attendance by patients at their centres. Methods A training programme was carried out for 11 primary care doctors in Barcelona who had patient lists totalling 20,064 patients. The goal of the training was to provide the participating physicians with techniques to curb frequent attendance. Additionally, the programme sought to offer them strategies to prevent professional burnout and tools to better organize their everyday medical practice. The study used a quasi-experimental design for an evaluation of an educational intervention, featuring a pre-test assessment (before the training programme) and a post-test assessment (after the training programme), as well as comparison with a control group that did not undergo the training. The study assessed the effects of the programme on the rates of frequent attendance of patients served by the participating physicians. These rates were compared with those registered by the patients seen by the control group physicians over the same period. Results Among the group of physicians who received the training, the mean prevalence of patients who qualified as frequent attenders decreased from 22% prior to the training programme to 8% after completion of the programme. In other words, 14% of patients (2,809) limited the frequency of their visits to primary care physicians after their physicians had completed the training programme. Meanwhile, the study recorded an average decrease of 3.1 visits per year by the patients of the physicians who had undergone the training. Statistically significant differences between this group and the control group were observed. Conclusions The educational intervention proved effective at helping primary care physicians to decrease their patients’ rates of frequent attendance. It also contributes to the impact research of continuing education on doctors and their patients. We need to increase primary care spending from the current 14% to the 25%, to address this problem, among others.

Resumen: El Programa de Apoyo a los Estudiantes de Medicina de la Facultad de Medicina de la Universidad de Vic-Universidad Central de Cataluña (UVic-UCC) ofrece un acompañamiento a lo largo de todo el grado. Este programa tiene por objetivo identificar y atender las necesidades del estudiante que incluyen cualquier condición con impacto sobre su desarrollo académico. En cuanto se identifican dichas necesidades de apoyo se valora con un enfoque multidimensional (situación académica, psicoemocional y personal) con el fin de determinar un plan de actuación individualizado. Los servicios ofrecidos por el Programa de Apoyo a los Estudiantes de Medicina incluyen 3 abordajes: 1) optimización del rendimiento académico: tutorías grupales e individuales de orientación (metodología de estudio y técnica de examen); 2) atención psicológica individualizada, ya sea relacionada con dificultades psicológicas, de aprendizaje o bien con diversidades funcionales y 3) Mentorización: seguimiento y orientación en el itinerario curricular y en su desarrollo personal y profesional. El programa proporciona información que permite conocer más profundamente la realidad del estudiantado y posibilita la implementación de cambios docentes que tienen un impacto en la mejora del aprendizaje y también en la salud mental de los estudiantes. Abstract: The Support Program for Medical Students of the Faculty of Medicine, University of the Vic-Universitat Central de Catalunya (UVic-UCC) offers students support throughout the entire Degree. This program aims to identify and address the student's needs which include any condition that impacts their academic development. As soon as these support needs are identified, they are assessed with a multidimensional approach -academic, psycho-emotional and personal situation- in order to determine an individualized action plan. The services offered by the Support Program for Medical Students include 3 approaches: 1) Optimization of the academic performance: group and individual orientation tutorials (study strategies and exam techniques); 2) Individualized psychological care, whether related to psychological or learning difficulties, or functional diversity; 3) Mentoring: monitoring and guidance in the curricular itinerary and in their personal and professional development. Th program provides information that allows for a much deeper understanding of the reality of the students and makes it possible to implement teaching changes that have an impact on improving learning and, also, mental health of the students.

Abstract Background Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author’s purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. Methods The authors applied the Arksey and O’Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin. Results The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren’t worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation. Conclusion PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

Abstract Background Despite advances in the treatment of chronic urticaria, in a significant percentage of the patients symptoms are not fully controlled with conventional approaches. New strategies under development include blocking intracellular mediators of mast cell and basophil activation. Objective We aim to investigate the effects of the Bruton's tyrosine kinase (BTK) inhibitor remibrutinib on human blood basophils and CD34+‐derived mast cells activation induced by serum obtained from chronic urticaria patients. Methods Twenty‐two patients with chronic spontaneous urticaria (mean age 52 years, 27% women) and 22 patients with chronic inducible urticaria (46 years, 27% women) were included in the study together with a sex‐matched control group. Patients were classified as responders or non‐responders to anti‐IgE therapy on the basis of their clinical data, FcεR1a expression on blood basophils and total IgE levels. Changes on CD63 expression—as an activation marker‐, were used to evaluate in vitro the response of basophils and mast cells to serum exposure and the inhibitory effects of remibrutinib. Results Remibrutinib inhibits degranulation induced by IgE cross‐linking in mast cells and basophils and also the activation triggered by factors present in the sera of spontaneous and inducible chronic urticaria patients. Patient's serum induces a greater degranulation of effector cells than controls. Activation of mast cells and basophils by patient sera and remibrutinib effects were not related to omalizumab responsiveness. Conclusion Remibrutinib inhibits activation of human basophils and mast cells induced in vitro by exposure to the serum of chronic urticaria patients independently of their response to omalizumab.

Abstract Background Recurrent falls represent a priority in geriatric research. In this study we evaluated the influence of pain as a risk factor for recurrent falls (two or more in 1 year) in the older (65–79 years) and oldest-old (80 or more years) non-institutionalized population. Methods Prospective cohort study. 772 non-institutionalized individuals with ages of 65 years or older (with overrepresentation of people aged 80 years or older [n = 550]) were included through randomized and multistage sampling, stratified according to gender, geographic area and habitat size. Basal evaluation at participant’s home including pain evaluation by Face Pain Scale (FPS, range 0–6) and then telephonic contact every 3 months were performed until complete 12 months. Multivariate analysis by logistic regression (recurrent falls as outcome variable) for each age group (older and oldest-old group) were developed considering pain as a quantitative variable (according to FPS score). Models were adjusted for age, gender, balance, muscle strength, depressive symptoms, cognitive decline, number of drugs and number of drugs with risk of falls. Results 114 (51.35%) and 286 (52%) participants of older and oldest-old group, respectively, reported pain; and recurrent falls occurred in 6.93% (n = 12) of the older group and 12.06% (n = 51) of the oldest-old group. In the older group, pain was associated with recurrent falls, with an associated odds ratio (OR) of 1.47 (95% CI 1.08–2.00; beta 0.3864) for each unit increase in pain intensity (thus, participants with the most severe pain [FPS 6] had OR of 10.16 regarding to participants without pain [FPS 0]). In the oldest-old group, pain was not associated with recurrent falls. Conclusions Pain, a potentially modifiable and highly prevalent symptom, is a risk factor for recurrent falls in the older people (65–79 years). However, we have not been able to demonstrate that this relationship is maintained in the oldest-old population (80 or more years).

Objetivo: El objetivo de nuestro estudio es analizar si el hecho de combinar los estudios universitarios y la Actividad Laboral Remunerada se asocia con el síndrome de burnout académico en los estudiantes de 1º curso de la Universidad de Vic-Universidad Central de Catalunya (UVic-UCC) y si existe una relación sobre el rendimiento académico. Metodología: Es un estudio observacional, transversal. La muestra comprende 301 estudiantes de 1º curso. Los instrumentos utilizados son una encuesta telemática y el Maslach Burnout Inventory-Student Survey. Resultados: El 16,9% de los estudiantes presentan Burnout Académico. No se observan diferencias significativas según el sexo. El 33% de los estudiantes combinan actividad laboral remunerada y estudios. De estos, el 14,1% presentan Burnout Académico. No se observan diferencias significativas en el rendimiento académico entre los estudiantes que trabajan y estudian y los que solo estudian. Conclusión: Los estudiantes presentan burnout tanto sí trabajan como no. Al inicio del primer curso del grado, un tercio de los estudiantes combinaban sus estudios con el trabajo y no se aprecia un incremento de burnout académico. El rendimiento académico no se ve afectado por el hecho de combinar el trabajo y los estudios universitarios. Abstract. Goal. The aim of our study is to analyze whether combining university studies and professional work activity is associated with academic burnout syndrome in 1st year students at the University of Vic-Central University of Catalonia (UVic-UCC) and the relationship on performance academic. Methodology. It is a non-experimental observational study of cross-sectional design. The sample consisted of 301 1st year undergraduate students in the UVic-UCC. The instruments used consist of a telematic structured survey and the Maslach Burnout Inventory-Student Survey questionnaire. Results. 16.9% of the students present academic burnout. No statistically significant differences were observed by sex. 33% of students have a remunerated job that they combine with their studies. Of these students, 14.1% have academic burnout. There are no significant differences in academic performance between students who work and study and those who only study. Conclusion: At the beginning of the first year of the university degree, a third of the students combined their studies with work. The fact of working and starting university studies does not produce an increase in academic burnout. Students show burnout whether they work or not. Academic performance is not affected by combining work and university studies.

Actinic keratosis is a common skin disease that may progress to invasive squamous cell carcinoma if left untreated. Ingenol mebutate has demonstrated efficacy in field treatment of actinic keratosis. However, molecular mechanisms on ingenol mebutate response are not yet fully understood. In this study, we evaluated the gene expression profiles of actinic keratosis lesions before and after treatment with ingenol mebutate using microarray technology. Actinic keratoses on face/scalp of 15 immunocompetent patients were identified and evaluated after treatment with topical ingenol mebutate gel 0.015%, applied once daily for 3 consecutive days. Diagnostic and clearance of lesions was determined by clinical, dermoscopic, and reflectance confocal microscopy criteria. Lesional and non-lesional skin biopsies were subjected to gene expression analysis profiled by Affymetrix microarray. Differentially expressed genes were identified, and enrichment analyses were performed using STRING database. At 8 weeks post-treatment, 60% of patients responded to ingenol mebutate therapy, achieving complete clearance in 40% of cases. A total of 128 differentially expressed genes were identified following treatment, and downregulated genes (114 of 128) revealed changes in pathways important to epidermal development, keratinocyte differentiation and cornification. In responder patients, 388 downregulated genes (of 450 differentially expressed genes) were also involved in development/differentiation of the epidermis, and immune system-related pathways, such as cytokine and interleukin signaling. Cluster analysis revealed two relevant clusters showing upregulated profile patterns in pre-treatment actinic keratoses of responders, as compared to non-responders. Again, differentially expressed genes were mainly associated with cornification, keratinization and keratinocyte differentiation. Overall, the present study provides insight into the gene expression profile of actinic keratoses after treatment with ingenol mebutate, as well as identification of genetic signatures that could predict treatment response.

Ray tracing software systems are commonly used to analyze the optics of solar energy devices, since they allow to predict the energy gains of devices in real conditions, and also to compare them with other systems constantly emerging in the market. However, the available open-source packages apply excessive simplifications to the model of light-matter interaction, making that the optical behaviour of the systems can not be properly characterized, which in turn implies disagreements between physical experiments and computer simulations. We present here the open source python package OTSun, which applies the Fresnel equations in their most general form, without further simplifications, and is suitable for the simulation of both solar-thermal and photovoltaic systems. The geometrical objects used in this package are created using the parametric 3D modeler FreeCAD, which is also a free and open source program and allows for the construction of arbitrary geometries that can be analyzed with OTSun. These, and other software capabilities, make OTSun extremely flexible and accurate for the optical analysis of solar devices with arbitrary geometry. Additionally, OTSun has a companion webtool, OTSunWebApp, that allows for the usage of certain features of the package without the need to install anything locally. We also show here two numerical experiments that we performed in order to validate the model and implementation: The analysis of the optical efficiency of a Linear Fresnel Reflector (with moving objects), and of a second surface mirror (with variable wavelengths). In each case, the numerical computations had deviations of less than 0.25% from reference models (either computed with another program or with exact formulas).

Concentrated Solar Power (CSP) technologies offer significant potential as renewable energy sources, particularly when integrated with storage systems. To address the challenges of energy transport and re-radiation losses, beam-down configurations combined with paraboloid-type dish concentrators provide a compact and efficient solution. In this study, we perform an optical analysis of a Cassegrain concentrator using the open-source software OTSunWebApp, a ray-tracing program that allows for the spectral optical analysis of solar collectors. The analysis accounts for specular scattering of the reflectors, the spectral behavior of the materials, and the angular size of the sun. The geometric design is parametrized with six degrees of freedom, while some other parameters, such as the number of mirrors and the aperture area, have been previously chosen. The resulting aperture area is 67.52 m2. We optimize the optical efficiency for operation at 600C∘, identifying the key parameters that influence performance. The system achieves a power output greater than 45 kW under direct radiation of 900 W/m2. Additionally, maintaining optical efficiency above 74% requires a tracking error below 0.2∘, with peak radiation values at the receiver reaching 26 kW/m2. These results underscore the potential of Cassegrain concentrator designs to advance CSP technology, suggesting that they could significantly enhance this field.

Abstract From early in medical school, students need to learn about patient safety, and how to prevent and reduce risks, errors and harm that occur to patients during health care provision. Cinemeducation is a teaching methodology that uses fragments of feature films or TV series in medical education. We hypothesized that cinemeducation could help simplify the comprehension of complex situations for students, aiding in the learning of patient safety and the understanding of human behaviors that impact it. This concept stands as an integral component within a comprehensive medical humanities approach. The study population was the 70 medical students of the second course of a six-year undergraduate program. In a 2-h class, after learning objectives were established, students watched a fragment from TV series The Resident centered on adverse events, and discussed them afterward. To measure learning achievements, we administered a 10-question multiple-choice pre and post-test and a 2-question open-essay post-test. Given the complexity of the concepts related to patient safety, we used a mixed quali-quantitative approach. An exploratory descriptive and content analysis was performed. Sixty-eight students participated and completed the questionnaires. Despite high pre-intervention scores, post-intervention scores improved (mean difference 0.779, 95% CI: 0.475–1.083, p

In the field of solar energy, simulation tools based on ray tracing are crucial for the design and optimization of solar energy systems. However, the limitations of existing free ray tracing software, such as the inability to simulate both thermal and photovoltaic systems with any geometry while considering real optical phenomena, hinder their usefulness for researchers. In this paper, we present the webtool OTSunWebApp, built upon the python library OTSun, which allows the user to analyze solar harvesting devices regardless of its application (thermal/PV). It can be used either by installing the program locally, which is simplified thanks to the use of docker containers, or by using the server we provide, which means that the users does not have to install anything. The free software FreeCAD is used to draw the mechanical system to be simulated. Here we show the structure of the webtool, how to manage the FreeCAD file in order to simulate the system and which experiments can be performed. We finish giving two illustrative examples, one of a solar power tower plant, and one of a photovoltaic cell. Having already reported on the library OTSun in a previous publication, the present manuscript shows how the functionality of OTSunWebApp constitutes a very powerful scientific online tool for the design and improvement of solar harvesting systems.

The compound parabolic concentrator (CPC) is a core technology in the field of solar concentration. Nevertheless, it only has one degree of freedom in the choice of its half-acceptance angle. In this study, extending the idea of the three-dimensional CPC, a design method for new kinds of concentrators having a CPC shape at each profile with various acceptance angles in all directions is proposed. The feature of this method is that the receiver can take any shape. Here, elliptical and rectangular receivers are assumed, and the shape and concentration performance of the concentrators with multiple CPC profiles and an elliptical receiver (MultiPro-ECPCs) and the concentrators with multiple CPC profiles and a rectangular receiver (MultiPro-RCPCs) are derived. The new designs are compared to the conventional CPC and a mirrorless flat receiver through ray-tracing simulations in terms of energy distribution on the receiver, optical efficiency, and optical concentration ratio based on axial and solar angles. The results show that in terms of optical efficiency, the MultiPro-RCPCs cover a wider range of incident angles after the 3DCPC. In terms of the optical concentration ratio, the MultiPro-ECPC with a longitudinal half-acceptance angle of 15° has the highest peak value of 19.5, followed by the MultiPro-RCPC. This study enlightens that with the concentration system settings adapted to the acceptance range of the proposed concentrators, a higher concentration can be achieved with the MultiPro-ECPC and MultiPro-RCPC compared to the conventional CPC.

Abstract CADASIL is a small vessel disease caused by mutations in NOTCH3 that lead to an odd number of cysteines in the EGF-like repeat domain, causing protein misfolding and aggregation. The main symptoms are migraine, psychiatric disturbances, recurrent strokes and dementia, being executive function characteristically impaired. The molecular pathways altered by this receptor aggregation need to be studied further. A genome-wide transcriptome study (four cases paired with three healthy siblings) was carried out, in addition to a qRT-PCR for validation purposes (ten new cases and eight new controls). To study the expression profile by cell type of the significant mRNAs found, we performed an in situ hybridization (ISH) (nine cases and eight controls) and a research in the Single-nuclei Brain RNA-seq expression browser (SNBREB). Pathway analysis enrichment was carried out with Gene Ontology and Reactome. Neuropsychological tests were performed in five of the qRT-PCR cases. The two most significant differentially expressed mRNAs (BANP, p-value = 7.23 × 10–4 and PDCD6IP, p-value = 8.36 × 10–4) were selected for the validation study by qRT-PCR. Additionally, we selected two more mRNAs (CAMK2G, p-value = 4.52 × 10–3 and E2F4, p-value = 4.77 × 10–3) due to their association with ischemic neuronal death. E2F4 showed differential expression in the genome-wide transcriptome study and in the qRT-PCR (p = 1.23 × 10–3), and it was upregulated in CADASIL cases. Furthermore, higher E2F4 expression was associated with worse executive function (p = 2.04 × 10–2) and attention and information processing speed (IPS) (p = 8.73 × 10–2). In situ hibridization showed E2F4 expression in endothelial and vascular smooth vessel cells. In silico studies indicated that E2F4 is also expressed in brain endothelial cells. Among the most significant pathways analyzed, there was an enrichment of vascular development, cell adhesion and vesicular machinery terms and autophagy process. E2F4 is more highly expressed in the skin biopsy of CADASIL patients compared to controls, and its expression is present in endothelial cells and VSMCs. Further studies are needed to understand whether E2F4 could be useful as a biomarker, to monitor the disease or be used as a therapeutic target.

Abstract Background Iron deficiency (ID) in patients with chronic heart failure (CHF) is considered an adverse prognostic factor. We aimed to evaluate if ID in patients with CHF is associated with increased mortality and hospitalizations. Methods We evaluated ID in patients with CHF at 3 university hospitals. ID was defined as absolute (ferritin 45%. Patients were well treated, with 87% and 88% of patients receiving renin-angiotensin inhibitors and beta-blockers, respectively. Median transferrin saturation index was 20%, median ferritin 155 ng/mL and median haemoglobin 13 g/dL. ID was present in 53% of patients; in 35% it was absolute and in 18% functional. Median follow-up was 20 months. ID was a predictor of death, hospitalization due to heart failure or to any cause in univariate analysis but not after multivariate analysis. No differences were found between absolute or functional ID regarding prognosis. Conclusion In a real life population of patients with CHF and a high prevalence of heart failure with preserved ejection fraction, ID did not predict mortality or hospitalizations after adjustment for comorbidities, functional class and neurohormonal treatment.

The article discusses a case study of a 40-year-old woman with a history of hidradenitis suppurativa who developed injection-site reactions to secukinumab treatment due to a hypersensitivity reaction to polysorbate 80. The study highlights the importance of testing excipients in biologic drugs to identify the cause of hypersensitivity reactions. Polysorbate 80, a common excipient in biologics, can induce contact urticaria, and its role in immediate hypersensitivity reactions is underexplored. The study suggests that excipients should be carefully considered in cases of unclear reactions to biologics to prevent potential severe reactions. [Extracted from the article]