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Early detection of disseminating vancomycin-resistant Enterococcus faecium (VREfm) in ICU wards is crucial for outbreak identification and the implementation of prompt infection control measures. Genotypic methods like pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) are costly and time-consuming, hindering rapid response due to batch dependency. Fourier-transform infrared spectroscopy (FT-IR) offers the potential for real-time outbreak detection and reliable strain typing. We utilized FT-IR to identify clonal VREfm dissemination and compared its performance to PFGE and WGS. Between February through October 2023, an unusually high number of VREfm were recovered at a tertiary hospital in Barcelona. Isolates were examined for antimicrobial susceptibility, carriage of vanA/vanB genes and clonality was also studied using FT-IR, PFGE, and WGS. Routine FT-IR inspections revealed recurring VREfm clustering during the outbreak's initial weeks. In total, 104 isolates were recovered from 75 patients and from multiple wards. However, only one isolate was recovered from an environmental sample, suggesting the absence of environmental reservoirs. An ST80 vancomycin-resistant (vanA) E. faecium strain was the main strain responsible for the outbreak, although a few additional VREfm strains were also identified, all belonging to CC17. PFGE and cgMLST (WGS) yielded identical clustering results to FT-IR, and WGS confirmed vanA/vanB gene carriage in all VREfm isolates. Infection control measures led to a rapid decline in VREfm isolates, with no isolates detected in November. FT-IR spectroscopy offers rapid turnaround times, sensitivity, and reproducibility, comparable to standard typing methods. It proved as an effective tool for monitoring VREfm dissemination and early outbreak detection.

Background:Ureteropelvic junction obstruction (UPJO) is one of the most frequent causes of congenital hydronephrosis. It is essential to distinguish UPJO which needs surgical treatment. fMRU combines high quality morphological details of the kidney and excretory pathways with functional data.ObjectiveThis study aims to introduce a new radiological score based on fMRU findings to be able to differentiate surgical from non-surgical kidneys.Materials and MethodsWe retrospectively selected patients with hydronephrosis due to UPJO who underwent fMRU (January 2009–June 2018). A multidisciplinary team identified a list of fMRU morpho-functional predictive variables to be included in the analysis. To evaluate the role of different independent variables in predicting the outcome, a multivariable logistic regression model has been performed; the outcome variable was the surgical intervention. For each predictive variable, Odds Ratio and 95% Confidence Intervals were calculated. The likelihood ratio test was used to assess the significance of the variables. Using the regression model, we assigned a numerical value to each predictive variable, rounding up the beta-coefficients. The cut-off value of the total score was obtained from the ROC curve analysis.ResultsA total of 192 patients were enrolled, corresponding to 200 pathological kidneys. All of them underwent fMRU; 135 were surgically treated, while 65 underwent ultrasound or MRU follow-up. Predictive variables significantly associated with surgery resulted to be the urographic phase, the presence of abnormal vessels, and a baseline anterior-posterior pelvic diameter >23 mm. Beta coefficients of the logistic regression model were then converted in scores. The ROC curve of the score showed high sensitivity (84.3%) and specificity (81.3%) with a cut-off > 2.5.ConclusionsWe propose a new fMRU score able to identify surgical vs. non-surgical kidneys with UPJO.

Objectives: The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in Catalonia, Spain.Methods: Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of bla genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids.Results: From July 2018 to February 2019, 125 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of Klebsiella pneumoniae belonging to sequence type ST15 and additional isolates of K. pneumoniae, Escherichia coli and Enterobacter sp. from different STs. All isolates but one carried the blaKPC–2 allelic variant. The blaKPC–2 gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn4401 element designated NTEKPC-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTEKPC-pMC-2-1 module was highly conserved.Conclusion: We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15 K. pneumoniae but also the intra- and inter-species transmission of the blaKPC–2 gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.

Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) in daily clinical practice has significantly reduced the use of contrast enhancement computed tomography (CECT) and contrast enhancement magnetic resonance (CEMR), especially in patients with renal disease. Although there are many situations in which CECT and CEMRI are primarily indicated, their use may be limited by the administration of the contrast medium, which may involve a risk of renal function impairment, especially in the elderly, and in patients with acute kidney injury (AKI) and moderate to severe chronic kidney disease (CKD). In these cases, CEUS can be a valid diagnostic choice. To date, numerous publications have highlighted the role of CEUS in the study of parenchymal micro-vascularization and renal pathology by full integration with second level imaging methods (CECT and CEMRI) both in patients with normal renal function and with diseased kidneys. The aim of this review is to offer an updated overview of the limitations and potential applications of CEUS in native kidney disease.

Introduction. High-flow priapism is a rare condition in children, usually due to a perineal trauma. Materials and methods. We present a case of traumatic highflow priapism investigated by Doppler ultrasound and managed by angiography and selective embolization of a branch of the internal pudendal artery. Results. A 13-year-old gymnast underwent perineal trauma during training and developed a high-flow priapism. The first ultrasound (immediately after the trauma) showed the presence of an inhomogeneous area of 3 x 2 cm associated with an anechoic vascularized area (pseudoaneurysm) in the right corpus cavernosum. On the left side there was a similar finding, but of smaller size. After 3 weeks the pseudoaneurysm on the left was completely obliterated while the right one was still present. Angiography and superselective catheterization of a branch of the left pudendal artery and its embolization with microspheres and with metal microcoils were performed. After the procedure, ultrasound showed that the right pseudoaneurysm was completely obliterated and there were no more branches reaching it. The cavernous arteries were both pervious. Conclusions. Selective arterial embolization is a safe treatment that can also be used in pediatric patients.

Purpose: To identify the skills that, in the processes of digitalization and Industry 4.0, contribute to improving the professional behaviours of the employees involved in these processes. Design/methodology/approach: For this purpose, a Delphi study was carried out, collecting the opinions of 38 teaching and professional experts, through face-to-face meetings or by videoconference, and analysing their opinions using descriptive statistics and structural equation models. Findings: The results obtained show that the key skills for improving professional behaviours are teamwork, conduct, management, and problem-solving, which influence most of the behaviours studied. Originality/value: In practice, these results allow companies to be guided in terms of employee training in relation to digitalization skills and assist their selection processes. Additionally, educational institutions can review their study plans, increasing the relevance of the skills that companies value the most.

Background Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application.Objectives To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists.Material and Methods We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries.Results Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research.Conclusions Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists.Significance Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

Purpose: To identify the technical skills which, linked to digitalization processes, are required to achieve different types of business results. Design/methodology/approach: The Delphi method was applied, through the opinions of a group of Spanish experts, to identify the importance of certain skills for the advancement of digitalization and the implementation of Industry 4.0. Findings: The results show that: 1) skills in Robotics, the Internet of Things, Networks and Artificial Intelligence are necessary to achieve results in the management of company technical areas; 2) commercial management needs skills in Intelligent Systems, Big Data, Cybersecurity, Distributed Technology and Contents; and 3) for the business challenges of sustainable development, the environment and energy efficiency, the most needed skills are in Big Data, Intelligent Systems and Artificial Intelligence. Originality/value: The results are useful, firstly, in providing firms with a training and selection tool for the development of I4.0 and, secondly, in offering training centers criteria for drawing up their training programs.

Purpose: Previous research has highlighted that employee wellbeing in the workplace is closely linked to equity, achievement, and interactions. However, gender inequality in employment opportunities, work-life imbalance, the gender pay gap, and the existence of the glass ceiling are workplace realities and generate failures that can reduce women’s happiness and wellbeing. Based on the theories of organisational justice, affective events, and transactional stress, this research attempts to identify the initiatives or actions that can act as true levers to promote equality and to contribute to the creation of inclusive and enchanting workplaces for female employees. Design: This study was carried out using the Delphi method. The panel consisted of a group of Spanish experts from the academic and professional fields who had close relationships with the topic of research. Findings: Parity objectives and flexibility measures are actions that can be effective in achieving gender equality in companies. Factors related to equitable, fair, and non-discriminatory treatment are the main determinants of female wellbeing in the workplace. The quality of female employment and having leaders capable of creating inclusive environments increases the attractiveness of organisations for women. Originality/value: This research yields interesting findings on the responsibility and role of companies in fulfilling the demands of female employees and in making women fall in love with the workplace. It may be especially relevant in the COVID-19 scenario.

This article aims to detect lung cavitations using lung ultrasound (LUS) in a cohort of patients with pulmonary tuberculosis (TB) and correlate the findings with chest computed tomography (CT) and chest X-ray (CXR) to obtain LUS diagnostic sensitivity. Patients with suspected TB were enrolled after being evaluated with CXR and chest CT. A blinded radiologist performed LUS within 3 days after admission at the Infectious Diseases Department. Finally, 82 patients were enrolled in this study. Bronchoalveolar lavage (BAL) confirmed TB in 58/82 (71%). Chest CT showed pulmonary cavitations in 38/82 (43.6%; 32 TB patients and 6 non-TB ones), LUS in 15/82 (18.3%; 11 TB patients and 4 non-TB ones) and CXR in 27/82 (33%; 23 TB patients and 4 non-TB ones). Twelve patients with multiple cavitations were detected with CT and only one with LUS. LUS sensitivity was 39.5%, specificity 100%, PPV 100% and NPV 65.7%. CXR sensitivity was 68.4% and specificity 97.8%. No false positive cases were found. LUS sensitivity was rather low, as many cavitated consolidations did not reach the pleural surface. Aerated cavitations could be detected with LUS with relative confidence, highlighting a thin air crescent sign towards the pleural surface within a hypoechoic area of consolidation, easily distinguishable from a dynamic or static air bronchogram.

Purpose: To diagnose the situation of vocational continuing training in Spain and propose improvements to its management to reduce the structural unemployment rate, taking into account the effects of Industry 4.0 and COVID-19. Design/Methodology: Study of the background and current context of vocational continuing training and Industry 4.0 in Spain based on a review of previous academic literature, legislative developments in education and training, and various reports from public and private institutions on productivity and employment. Findings: Definition of eight challenges and lines of action related to completing the implementation of Industry 4.0 and adopting coordinated policies to develop VCT, improving the governance of the FCP by the public administration, promoting training in work and vocational training and guidance for the unemployed, meeting business recruitment needs, promoting business–university relationships, and reducing unemployment. Practical Implications: Adapting vocational continuing training to economic sectors where there is more demand for employment and to regions where there is more structural unemployment can contribute to the overall reduction of structural unemployment in Spain. These decreases could have immediate consequences for those who become employed and allow a quicker recovery in future economic crises. Originality/value: This study, despite the scarce empirical evidence that exists about Spanish vocational continuing training, provides a vision of the four areas in which it is developed -professional training, postgraduate training, on-the-job training, and training for the unemployed- to provide thirty proposals that, through education and training, promote the competitiveness of the Spanish economy and permanent employment.

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COVID-19 has been associated with a broad range of long-term sequelae, commonly referred to as “long-COVID” or “post-COVID-19” syndrome. Despite an increasing body of literature, long COVID remains poorly characterized. We retrospectively analysed data from electronic medical records of patients admitted to the post-COVID-19 outpatient service of the Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy, between June 2020 and June 2021, 4–12 weeks after hospital discharge. A total of 428 patients, 41% women, median age 64 years, underwent a follow-up visit a median 53 days after hospital discharge. Overall, 76% patients reported at least one persistent symptom, including dyspnoea (37%), chronic fatigue (36%), insomnia (16%), visual disorders (13%) and brain fog (13%). Increasing oxygen support (OR 1.4, 95% CI 1.1–1.8), use of immunosuppressants (OR 6.4, 95% CI 1.5–28) and female sex (OR 1.8, 95% CI 1.1–2.9) were associated with a higher risk of long COVID symptoms. Comparison between symptomatic patients infected in the period March–December 2020 (prevalent circulation of wild-type SARS-CoV-2) with those infected in the period January–April 2021 (prevalent circulation of B.1.1.7 Alpha variant) showed a significant modification in the pattern of symptoms belonging to the neurological and cognitive/emotional categories. Our findings confirmed shortness of breath and chronic fatigue as the most frequent long COVID manifestations, while female sex and severe COVID-19 course were the main risk factors for developing lingering symptoms. SARS-CoV-2 variants may induce different long COVID phenotypes, possibly due to changes in cell tropism and differences in viral–host interaction.

Background: The relationship between children's sleep and health has been widely examined; however, research focused on the link between sleep and sensory reactivity in children without medical conditions is relatively new and based on studies with small samples. Hence, we aimed at exploring the association between sleep duration and quality and prevalence of sensory reactivity in a population-based sample of children aged 3–7.Methods: We examined data on 579 school-age children from the InProS project, a cross-sectional population-based study. Children's sleep duration was classified as

This study examines the relationship between female representation in different organisational positions and performance using a sample of Spanish secondary schools. These organizations have been usually depicted as 'feminised environments' although women in managerial positions are still underrepresented. Based on different theoretical approaches, we separately investigate the relationship between a greater female presence and school performance in three positions: a) as principal; b) on the management team; and c) as teachers. We also investigate if having a female leader exerts a significant mediator role on the relationship between greater female representation on the management team and teachers, respectively, and school performance. Our results reveal a positive and significant relationship between having a woman principal or a greater proportion of women teachers and school performance. However, the relationship between a high proportion of women on the management team and school performance is negative. We also find that a female principal does not play a significant role as mediator in the relationship between having a greater proportion of women on the management team and as teachers and school performance.

We report the results of a targeted testing strategy for five emerging infectious diseases (Chagas disease, human T-lymphotropic virus 1 infection, malaria, schistosomiasis, and Zika virus infection) in pregnant women accessing an Italian referral centre for infectious diseases in pregnancy for unrelated reasons. The strategy is based on a quick five-question questionnaire which allows the identification of pregnant women at risk who should be tested for a specific disease. One hundred and three (24%) out of 429 pregnant women evaluated in a 20 month period were at risk for at least one emerging infectious disease. Three (2.9%, all from sub-Saharan Africa) out of 103 at-risk women resulted in being affected (one case of Plasmodium falciparum malaria, two cases of schistosomiasis) and were appropriately managed. Prevalence of emerging infectious disease was particularly high in pregnant women from Africa (three out of 25 pregnant women tested, 12%). The proposed strategy could be used by health care professionals managing pregnant women in non-endemic setting, to identify those at risk for one of the five infection which could benefit for a targeted test and treatment.

Desde mediados del siglo XIX, la enseñanza ha sido el sector que la mujer ha utilizado para entrar en el mercado de trabajo, produciéndose, a partir de entonces, una feminización de la profesión docente en España. Numerosos procesos políticos, socioeconómicos y culturales han permitido el acceso masivo de la mujer a la enseñanza superior y una paulatina expansión de profesoras desde la enseñanza primaria a todos los niveles del profesorado. Sin embargo, pese a los altos índices de feminización de la profesión, aún existen diferencias de género que se evidencian en la disminución de su presencia a medida que aumenta el nivel educativo y en los cargos de poder de las instituciones educativas, entre otras. Este trabajo pone el énfasis en el análisis descriptivo de la composición del profesorado según el género y su relación con los niveles y enseñanzas impartidas, la titularidad del centro, los equipos directivos, la edad, la dedicación horaria y otras variables referidas al desempeño de la profesión como la motivación o la satisfacción laboral. Se concluye que, para las Enseñanzas de Régimen General No Universitarias en el periodo 1999-2013 para el que existen datos disponibles, se encuentran diferencias por sexo significativas que permiten concretar algunas iniciativas para reducir las desigualdades de género, incrementar el número de varones en la profesión y avanzar hacia la equiparación de oportunidades en la participación femenina en los puestos de dirección. Por último, este estudio se propone como punto de partida para un trabajo empírico posterior acerca del efecto de la composición del profesorado atendiendo al género sobre los resultados académicos del alumnado.

Sustainable development has become a leading value of the 21st century society. Throsby’s and Hutter’s recent studies on inter and intra-generational equity, diversity maintenance and interdependence have demonstrated that sustainability values promote a different perspective on cultural institutions. Particularly, they incite to reorganize the production and consumption patterns, and rethink about the construction of meanings in permanent displays. The paper wants to explore how sustainability principles are an approach to develop a “sustainable museology”, which cares about making visitors more critic and aware of the political, sociological, epistemological and cultural implications that lay behind the making of exhibitions. Museums undertaking a sustainable development of their narrative making processes overpass the Foucauldian idea of art museums as heterotopy, (space of otherness), and approach that of archétopy. This model offers rooms to rethink about narratives as stakeholders’ collective processes capable to “meet the needs of the present without compromising those of the future generations”, as stated in the “Brundtland Commision” Report of 1987. The last display done by the Berlin Neue Nationalgalerie is analysed as a case-study for archétopy. Il paper analizza il concetto di sostenibilità nelle politiche governative dei musei d’arte. Lo studio osserva tale valore da un punto di vista sia teorico che pratico e cita l’esempio dei grandi musei europei, facendo più volte riferimento al caso della Tate Modern di Londra. Se da un lato l’argomento è esplicitamente collegato ai musei d’arte in quanto essi operano per la sostenibilità del bene comune, dall’altro i musei europei hanno basato le proprie politiche culturali adottando il così detto approccio “three bottom” già intrapreso dalle grandi aziende e dalle business companies. Tale approccio si basa sull’elaborazione di politiche attente alla sostenibilità ambientale, economica e sociale che i musei scelgono di adottare per incrementare i propri finanziamenti. Ne risulta che l’attenzione alla sostenibilità delle politiche governative di un museo è legata a questioni economiche piuttosto che culturali. Tuttavia, la sostenibilità delle politiche culturali nei musei d’arte moderna risiede non solo nel seguire strategie economiche e ambientali, ma principalmente nel creare iniziative che offrano nuove prospettive curatoriali e idee manageriali. Il modello di museo attento alla sostenibilità delle proprie politiche oltrepassa la nozione foucauldiana che il museo d’arte sia “eterotopia”, e cioè spazio dove l’arte viene presentata come un fenomeno che accade lontano dalla realtà. Al contrario, tale modello agisce come “archetopia”, ovvero come luogo in cui l’elaborazione di decisioni, narrative e significati legati alla collezione e alla storia dell’arte coinvolge tutti gli stakeholders (curatori, visitatori e trustees) sin dal principio (archè) del processo creativo.

Identification of sensitive and specific biomarkers with clinical and translational utility will require smart experimental strategies that would augment expanding the breadth and depth of molecular measurements within the constraints of currently available technologies. Exosomes represent an information rich matrix to discern novel disease mechanisms that are thought to contribute to pathologies such as dementia and cancer. Although proteomics and transcriptomic studies have been reported using Exosomes-Like Vesicles (ELVs) from different sources, exosomal metabolome characterization and its modulation in health and disease remains to be elucidated. Here we describe methodologies for UPLC-ESI-MS based small molecule profiling of ELVs from human plasma and cell culture media. In this study, we present evidence that indeed ELVs carry a rich metabolome that could not only augment the discovery of low abundance biomarkers but may also help explain the molecular basis of disease progression. This approach could be easily translated to other studies seeking to develop predictive biomarkers that can subsequently be used with simplified targeted approaches.