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OBJECTIVE: An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world. METHODS: A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively. RESULTS: A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners. CONCLUSIONS: Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide.

Objective: In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world. Methods: A self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use. Results: A total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05). Conclusions: The uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years.

Resumen Introduccion y objetivos Dado el conocimiento epidemiologico del carcinoma escamoso de cabeza y cuello, pronostico y supervivencia segun el estadio al diagnostico, y ante la ausencia de programas de cribado que hayan demostrado ser coste-efectivos, nos propusimos evaluar un programa de diagnostico rapido. El objetivo del presente estudio fue analizar si la existencia de un circuito de diagnostico rapido desde Atencion Primaria, con base en una ponderacion de sintomas y signos, supondria un cambio en la proporcion de diagnosticos en estadios iniciales versus tardios en estos tumores. Metodos Se ha realizado un estudio observacional prospectivo de pacientes remitidos con la sospecha de un tumor en el area ORL en nuestro centro durante 24 meses consecutivos. Se creo un algoritmo con sintomas y signos de sospecha para utilizacion por el medico de familia y un circuito de remision rapida de los pacientes candidatos. Se registraron tambien los pacientes con sospecha de tumor provenientes de fuentes distintas de este circuito. Los datos obtenidos (edad, sexo, consumo de toxicos, tiempo y clinica de presentacion, localizacion del tumor y extension), se han comparado con los de los pacientes recogidos en la base de datos de tumores del Servicio de ORL diagnosticados durante los 4 anos previos al inicio del estudio. Resultados Se incluyo en el estudio a 199 pacientes y se diagnosticaron 82 tumores del area ORL. Los medicos de familia remitieron por el circuito de diagnostico rapido creado un total de 136 pacientes y 35 (26,1%) presentaban una tumoracion. Sin embargo, la mayoria de los tumores diagnosticados durante este periodo en el Servicio de ORL (47 pacientes, 57,3% de todos los tumores diagnosticados) no fueron sospechados por su medico de familia y no fueron remitidos al hospital utilizando el circuito de diagnostico rapido. Un 27% de los pacientes fue diagnosticado en estadios i y ii , y un 73% en estadios iii y iv , no hubo diferencias estadisticamente significativas con el grupo control y tampoco en los porcentajes de tumores recibidos por localizaciones (laringe, faringe, cavidad oral, primario desconocido, otros). Los sintomas iniciales mas repetidos fueron la disfonia, la aparicion de una masa cervical y la odino-disfagia. Se analizo la relacion entre el sintoma inicial y el estadio al diagnostico. En ninguno de los casos se obtuvieron diferencias significativas respecto al grupo control. Conclusiones La puesta en marcha de un circuito de atencion rapida a los pacientes que segun el algoritmo creado tenian una sospecha de presentar cancer de cabeza y cuello no ha supuesto un aumento de los diagnosticos en estadios precoces y una disminucion de los diagnosticos en estadios avanzados en nuestro centro.

Introduction and objectives : Given the epidemiological knowledge of squamous cell carcinomas of the head and neck (SCHN), the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours. Methods A prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A “suspicion algorithm” was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the four years prior to the start of the study. Results 199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP. Of the patients, 27% were diagnosed in stages I and II, and 73% in stages II and IV, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. Conclusions The implementation of a rapid diagnosis pathway for patients who, according to the algorithm created, had a suspected head and neck cancer, has not led to an increase in the diagnosis of these tumours in early stages or a decrease in diagnoses in advanced stages.

The main objective of this study was to obtain percentile curves of refractive errors in a Spanish paediatric population aged between 3 and 12 years.A descriptive, observational and cross-sectional study was conducted, including children aged between 3 and 12 years who did not present with any known ocular and/or systemic diseases. The convenience sampling method was used to select the sample from three schools and one hospital in the Community of Madrid. The refractive error was obtained using a Retinomax K-plus 3 autorefractometer (RTX; Right Mfg. Co. Ltd., Tokyo, Japan). The 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were calculated using the IBM SPSS Statistics v.24 statistical software (IBM Corporation, Armonk, NY, United States).A total of 688 children with a mean age of 7.68 ± 2.17 years were analysed. In the 50th percentile curve, spherical equivalent values started to become myopic at 3 years (SE-0.50 D) and the 75th percentile curve also turned myopic at 4 years. As a result, it was observed that the spherical equivalent value became more negative with time, starting from the ages indicated above. Therefore, the 90th percentile curve was negative at 11 years.Percentile curves of refractive errors in a Spanish paediatric population have been presented for the first time in order to help eyecare professionals detect children with refractive errors at an early age.

Resumen Antecedentes y objetivo La mielofibrosis es una neoplasia mieloproliferativa cronica infrecuente. Nuestro objetivo fue describir las caracteristicas clinico-biologicas, el tratamiento y el curso evolutivo de los pacientes con mielofibrosis en Espana. Material y metodos Se analizaron 1.000 pacientes del Registro Espanol de Mielofibrosis diagnosticados de mielofibrosis primaria (n = 641) o secundaria (n = 359). Resultados La mediana de edad era de 68 anos. La frecuencia de sintomatologia constitucional, anemia moderada o severa (Hb Conclusiones la mielofibrosis es una enfermedad invalidante que afecta sobre todo a personas de edad avanzada y cuyo tratamiento es fundamentalmente sintomatico. A pesar de su heterogeneidad clinica se dispone de modelos pronosticos utiles para la seleccion de candidatos a trasplante.

BACKGROUND AND OBJECTIVE MYELOFIBROSIS: is an infrequent chronic myeloproliferative neoplasm. We aimed to describe the clinico-biological characteristics, treatment, and evolutive course of myelofibrosis patients in Spain.; MATERIAL AND METHODS: A total of 1,000 patients from the Spanish Registry of Myelofibrosis diagnosed with primary (n=641) or secondary (n=359) myelofibrosis were analysed.; RESULTS: Median age was 68 years. The frequency of constitutional symptoms, moderate to severe anaemia (Hb

Introduction Bipolar disorder (BD) has been reconceptualised as a progressive disorder that develops from mild to severe presentations. An empirical staging model – the Empirically Developed Clinical Staging Model for BD (EmDe-5) – was developed in a previous study. This study aims to further validate that model using a larger and more representative Spanish sample. Material and methods 183 BD outpatients were recruited at 11 sites in Spain. Assessment included clinical characteristics of the BD (number of hospitalisations, number of suicide attempts, comorbid personality disorders), physical health (BMI, metabolic syndrome, number of physical illnesses), cognition (SCIP), functioning (permanently disabled due to BD, FAST), and quality of life (SF-36). The CGI-S, VAS-S, and psychopharmacological treatment pattern were used as external validators. Results Ten patients (51.5%) were classified as stage 1, 33 (18%) as stage 2, 93 (50 8%) as stage 3, 37 (20 2%) as stage 4, and 10 (5 5%) as stage 5. All profilers, other than number of suicide attempts (p = 0.311) and comorbid personality disorder (p = 0.061), exhibited worse scores from stage 1 to 5. As expected, VAS-S and CGI-S scores were worse in the later stages. Regarding treatment, early stages (1–2) were associated with the use of one to three drugs while late stages (4–5) were associated with four or more drugs (p = 0.002). Conclusions We confirm the EmDe-5 staging model's construct validity. The ease of obtaining the profilers, together with the operational criteria provided to quantify them, will facilitate the use of the EmDe-5 staging model in daily clinical practice.

Background: COVID-19 is the pandemic most affected since the 1918 influenza In order to control its effects, the governments of different countries, including Spain, adopted exceptional measures such as lockdown and the suspension of non-essential economic activity Studies carried out in China, where the population was also confined, have found an increase in the prevalence of post-traumatic stress symptom among the most affected regions compared to other less affected [1] Aim: To describe the presence of post-traumatic symptom among a large sample from the general population in the different regions of Spain after two weeks from the declaration of the state of alarm in Spain Methods The data was obtained through an online questionnaire two weeks after the declaration of the state of alarm in Spain (performed between 19 and 26 March, 2020) addressed to general population over eighteen years old [2] It was spread using an online “snowball” method Assessment sociodemographic, clinical variables and psychometric scales Post-traumatic stress symptoms were measured by the Stressful Impact Scale (EIE), which consists of 15 items, divided into two subscales related to symtoms of intrusion and avoidance The SPSS v24 0 program was used in the statistical analysis Results: The sample consists of 21,153 individuals [30 3% men] with an average age of 39 75 ± 14 04 (18 to 100 years) A) Intrusive response: regions with the highest prevalence of intrusive response are Castilla La Mancha (31 2%), Andalusia (30 7%) and Extremadura (26 2%);regions with the lowest prevalence of intrusive response are Aragon (18 9%), Navarra (16 0%) and La Rioja (21 4%) B)Avoidance response: regions with the highest prevalence of avoidance response are Andalusia (55 7%), Extremadura (53 7%) and Castilla La Mancha (51 3%);regions with the lowest prevalence of avoidance response are Galicia (39%), Aragon (37 6%) and Navarra (32 7%) In Madrid, the prevalence of avoidant and intrusive symptoms was 43 1% and 26 0%, respectively Conclussions: Avoidance symptoms were more frequent than intrusion symptoms in all regions Andalusia, Extremadura and Castilla La Mancha are the regions with the highest prevalence of post-traumatic stress symptoms, both intrusive and avoidant In addition, Aragon and Navarra presented low post-traumatic symptoms prevalence The situation in the Community of Madrid is particularly garish Despite being the region most affected by the COVID-19 pandemic in Spain, the prevalence of post-traumatic stress symptoms, both intrusive and avoidant, is close to average The representativeness of the regions in the sample is a limitation of our study However, the Madrid region is well represented in terms of the percentage share of the total sample The results obtained do not seem consistent with the epidemiological situation of these regions at that time It neither are according to the findings of other studies, so it would be necessary to investigate the existence of other factors that contribute to explaining these results No conflict of interest

Open Science is a disruptive phenomenon that is emerging around the world and especially in Europe. Open Science brings about socio-cultural and technological change, based on openness and connectivity, on how research is designed, performed, captured, and assessed. Several studies show that there is a lack of awareness about what Open Science is, mainly due to the fact that there is no formal definition of Open Science. The purpose of this paper is to build a rigorous, integrated, and up-to-date definition of the Open Science phenomenon through a systematic literature review. The resulting definition “Open Science is transparent and accessible knowledge that is shared and developed through collaborative networks” helps the scientific community, the business world, political actors, and citizens to have a common and clear understanding about what Open Science is, and stimulates an open debate about the social, economic, and human added value of this phenomenon.

The oceanic waters beneath Antarctica’s Ross Ice Shelf are among the largest unexplored habitats on Earth. Previous studies have shown active microorganisms reside in these waters, but their identity and capabilities remain unknown. Here, we combined multi-omics and biogeochemical measurements to determine the composition and metabolic activities of microbial communities in the water column under the Ross Ice Shelf. We reveal that these waters harbour diverse and distinct assemblages of microorganisms. In an ecosystem devoid of photosynthesis, the heterotrophic majority are largely sustained by highly active nitrifying archaea and bacteria (using ammonium from basal ice) and by other chemolitoautotrophs using reduced sulfur compounds. This suggests that chemolitoautotrophy is an important ecosystem driver in the waters below the RIS. Our data provide a valuable insight into the processes that sustain the largest sub-ice marine ecosystem, and will help predictions of the evolution of this system in a rapidly evolving climatic scenario.

This paper analyzes the effect of wealth taxation on mobility and the consequences for tax revenue and wealth inequality. We exploit the unique decentralization of the Spanish wealth tax system in 2011—after which all regions levied positive tax rates except for Madrid—using linked administrative wealth and income tax records. We find that five years after the reform, the stock of wealthy individuals in the region of Madrid increases by 10% relative to other regions, while smaller tax differentials between other regions do not matter for mobility. We rationalize our findings with a theoretical model of evasion and migration, which suggests that evasion is the mechanism most consistent with all of the mobility response being driven by the paraiso fiscal. Combining new subnational wealth inequality series with our estimated elasticities, we show that Madrid’s status as a tax haven reduces the effectiveness of raising tax revenue and exacerbates regional wealth inequalities.

Certain fungal endophytes improve plant resistance to biotic stresses in forest trees. In this study, three stem fungal endophytes belonging to classes Cystobasidiomycetes, Eurotiomycetes and Dothideomycetes were selected from 210 isolates for their potential as enhancers of Ulmus minor resistance to Ophiostoma novo-ulmi. We evaluated phenotypic traits of these endophytes that could be beneficial for inhibiting O. novo-ulmi in the host plant. Under in vitro conditions, the Dothideomycetous isolate YCB36 strongly inhibited O. novo-ulmi growth, released antipathogenic VOCs, chitinases and siderophores, and overlapped with the pathogen in nutrient utilization patterns. These functional traits could explain the 40% reduction in leaf wilting due to O. novo-ulmi in elm trees pre-inoculated with this endophyte. Ulmus minor trees inoculated with this endophyte showed increased leaf stomatal conductance and higher concentrations of flavonoids and total phenolic compounds in xylem tissues, suggesting induction of defence metabolism.

The purpose of this article is to enhance scholars' understanding of work-life balance (WLB) policies in small and medium enterprises (SMEs). The study explores whether SMEs display a common pattern of behavior when implementing WLB policies. The benefits of implementing WLB policies either improve conditions for the workers themselves or improve the firm's productivity. Empirical evidence on the effects of WLB, however, is scarce. This empirical study uses fuzzy-set qualitative comparative analysis (fsQCA). Findings fail to show an association between a particular combination of factors and the implementation of WLB policies. Nevertheless, the firm's decision to implement WLB policies depends on how the firm perceives the benefits of such policies. If the firm fails to perceive organizational performance benefits, the firm will not implement WLB policies. This finding leads to two conclusions: first, potential market-based benefits represent the main factor determining whether the firm will implement WLB policies. Second, a greater degree of perceived benefits (organizational performance) makes the implementation of WLB policies more attractive to human resources managers.

Serotyping, cry gene content, and toxicity to Helicoverpa armigera were determined for 178 isolates of Bacillus thuringiensis native to Spain. A total of 13 different cry1 and cry2 genes were detected when isolates were screened by PCR analysis. Results showed that cry2 and cry1Ia were the most frequent cry genes in the collection (74 and 57%, respectively); whereas cry1D, cry1Aa, cry1Ab, and cry1C were only moderately abundant (49, 48, 47, and 36%, respectively). The most uncommon cry genes were cry1Ac, cry1E, cry1B, cry1Ib, cry1Ad, cry1F, and cry1G, with frequencies of 24, 14, 13, 8, 5, 5, and 1%, respectively. The distribution of some cry genes was somewhat associated with particular serovars. For example, genes cry1C and cry1D were especially frequent in the serovar aizawai, while cry1B was very frequent in the serovar thuringiensis. Bioassays against H. armigera larvae showed a wide variation in the insecticidal potency, even among strains sharing the same set of cry genes and within the same serotype.

To understand the interaction of Trypanosoma cruzi with caviomorph rodents, which supposedly have an ancient co-evolutionary history with this parasite, experimental infection of laboratory reared Trichomys apereoides with several isolates of both genotypes of the parasite was studied. Parasitemia, pattern of hematic cells, specific humoral immune response, histopathological features and parasite clearance were appraised. T. apereoides maintained stable infections independent of the T. cruzi genotype as demonstrated by positive PCR results in analyses of several tissues after a 5 months follow-up. The acute phase was characterized by abundant and disseminated presence of amastigotes, vacuolization and/or myocytolysis. Lymphocytosis was a common feature. The chronic phase was characterized mainly by lymphomacroeosinophilic infiltrates independent of the inoculated T. cruzi isolate. T. cruzi of different genotypes did not show any tissular preference in T. apereoides.

La refractariedad es una de las complicaciones inducidas por las transfusiones de plaquetas que, en ocasiones, puede resultar muy grave. En general, se acepta que el paciente es refractario cuando tras dos transfusiones consecutivas no se produce el incremento esperado en la cifra de plaquetas 1,2 . No es posible estimar el indice real de refractariedad entre los pacientes repetidamente transfundidos porque los criterios empleados para catalogar al paciente como refractario no son uniformes. Sin embargo, existe un acuerdo unanime al senalar que en los ultimos anos se viene observando un descenso del indice de refractariedad. En 1991 se estimaba que aproximadamente un 50% de los pacientes politransfundidos se hacian refractarios 3 , y 6 anos despues este indice se redujo hasta un 16% 4 . Las causas

Inspired by the Colombian mobile telecommunications market, this paper reviews the process by which a government’s spectrum agency decides on the allocation of new spectrum bands to the mobile communications markets, including 4G and mobile broadband. It discusses the elements the spectrum agency needs to consider in order to build an analytical framework that helps assess the most important issues that may have a potential impact on the efficient allocation of spectrum and, consequently, on future market development.

Using phosphocellulose affinity chromatography we were able to separate two pyruvate kinase (EC 2.7.1.40) activities in the parasitic protozoan Leishmania mexicana amazonesis . One activity (PYKi) showed hyperbolic kinetics and was decreased by fructose 2,6-bisphosphate, whereas the second activity (PYK2) showed sigmoidal kinetics for the substrate phosphoenolpyruvate and was activated by fructose 2,6-bisphosphate. Molecular sieve chromatography (Sephacryl S-400) of PYKI produced a single peak of apparent molecular mass around 200,000, while PYK2 eluted at a position corresponding to M r 55,000.

482 patients with monoclonal gammopathy including MGUS, smoldering MM and symptomatic MM patients. X-ray survey, positron emission tomography (PET)/computerized tomography (CT) and magnetic resonance imaging (MRI) were performed in MM patients to define the presence of bone disease. Any significant correlation between osteolytic lesions and cytogenetic profiles was not found with the exception for the presence of t(11;14). On the other hand significant higher BM median levels of both CCL3 and CCL20 were found in MM patients with osteolytic lesions at X-rays as compared to those negative and in PET/CT positive patients as compared to those negative. Moreover the BM levels of CCL3, CCL20, Activin-A and DKK-1 were significantly higher in high bone disease patients as compared to low bone disease ones whereas significant higher BM median levels of Activin A and CCL20 were found in MM patients with bone fractures as compared to those without fractures. By a logistic multivariate analysis, we found that BM CCL20 levels were significant predictors of osteolysis at the Xrays. In relationship with the presence of lesions at the MRI in all MM patients we found that BM median levels of CCL3, CCL20, Activin-A and DKK-1 were significantly higher although only those of DKK-1 were related to the presence of MRI lesions independently to the osteolysis at the X-rays. Our data define the relationship between bone disease and the molecular and BM cytokine and chemokine features suggesting the role of BM CCL20 levels as a new marker of osteolysis in MM patients.