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Purpose: This study serves a dual purpose. Our initial aim is to study how a cancer diagnosis is disclosed to patients by different physicians (oncologists, consultants, and general practitioners). Secondly, we set out to study how the way in which oncologists normally communicate with their patients is related to variables such as anxiety, depression, coping mechanisms, and the perception of both their health and their quality of life. Methods: A cohort of 177 patients from three cancer associations answered a battery of questionnaires on sociodemographic data, aspects of the disease, monitoring of the SPIKES protocol by the physician delivering the diagnosis, and their satisfaction with their communication with the oncologist (EORTC QLQ-COMU26). The patients also completed the ADAF screening questionnaire for detecting the presence of anxiety, depression, and dysfunctional coping strategies. Results: The analyses recorded medium-low scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences in some of them among the different physicians. It seems that oncologists perform this task better than consultants. In turn, satisfaction with the communication with oncologists is related to the levels of anxiety, depression, vulnerability, and the perception of health and quality of life among cancer patients. Conclusions: Better communication strategies are called for among all healthcare professionals to enable them to deal with the task of breaking bad news to their patients. This will have a positive impact on patients’ emotional and health issues, while reducing stress and burnout among the physicians themselves.

This study presents a techno-economic assessment of the use of Linear Fresnel Solar Collectors for the heat supply in traditional fruits and vegetable processing industries in Almeria’s province. This assessment is justified by the high availability of solar radiation in the area under study, the evaluation of complementary energy self-consumption modalities, and the suitability of using local resources for the preservation and improvement of traditional productive activities. The work starts with an identification of the potential user’s needs and their location in the province. Afterward, the solar radiation resources have been estimated as they constitute one of the basic inputs for sizing the proposed systems. Together with the above, representative thermal demands have been considered and different configurations of commercial Linear Fresnel Solar Collector thermal plants aimed to contribute to solarize the analyzed productive processes have been designed and the corresponding techno-economic assessment have been undertaken. Main findings advance the profitability that can be achieved with this technology, reaching, after an optimized integration of the solar plant in the industrial process, a solar fraction between 66-82 % and payback periods of the investment between 6-12 years

La ciudad de San Cristóbal de La Laguna fue inscrita en la lista de Patrimonio Mundial en el año 1999. Si bien la declaratoria ha generado beneficios, sobre todo orientado a un nuevo modelo económico centrado en el sector servicios del turismo, también ha generado impactos negativos para los barrios del municipio, tanto en términos de desigualdad, gestión del patrimonio, pérdida de identidad, homogeneización y sostenibilidad. El reciente informe de ICOMOS España sobre los riesgos que amenazan la declaración de Patrimonio de la Humanidad, confirman una situación que, ya la propia sociedad civil alertaba desde hace años. Lo cual pone en evidencia la escasa importancia de la participación de la comunidad, en la gobernanza de un municipio de estas características, frente al peso de la opinión de los “expertos”, que generan discursos al margen de la percepción de la ciudadanía y deciden los modelos de gestión o el tipo de turismo y productos asociados, de manera unilateral.

Background: In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. Aim: To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. Method: The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003–2007) and II (2014–2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. Results: No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.

In this work, one-pot synthesis of metal nanoparticles from organometallic precursors namely Pt2(dba)3, Pd(dba)2 and Ni(cod)2 employing octylamine as stabilizer and carbon Vulcan XC-72R as support was carried out to obtain Ni/C, PtNi/C, and PtPdNi/C catalysts. Transmission Electron Microscopy (TEM) analysis of the as-synthesized materials shows semi-spherical particles with good dispersion on the carbon Vulcan having sizes of 3.2, 2.5 and 2.2 nm for Ni, PtNi, and PtPdNi, respectively. X-ray diffraction (XRD) confirms the presence of Pt, Pd, and Ni FCC crystal structure and reveals the formation PtNi and PtPdNi solid solutions. Additionally, XPS Pt4f core-level spectra shown a shift to lower binding energy at the alloy formation due to the addition of nickel and palladium evidencing a solid solution. The tri-metallic PtPdNi/C catalyst exhibits better performance than PtNi/C and Ni/C catalysts toward urea oxidation reaction in alkaline conditions suggesting an activity enhancement due to the oxidized Ni species from NiOOH. Using differential electrochemical mass spectroscopy (DEMS), it has been demonstrated that species such as NH3 (m/z = 17), CO2 -or N2O- (m/z = 44) and NO (m/z = 30) are generated during polarization at 4 mV s−1. Concomitant pollution control, this study demonstrated that urea could be used as a source of protons for energy generation in fuel cells systems.

Resumen Objetivos Medida de variaciones de la presion intracraneal estimada mediante medida ecografica del diametro del nervio optico en perioperatorio de cirugia traumatologica de extremidad inferior. Comparacion de los cambios registrados entre pacientes intervenidos bajo anestesia general o anestesia raquidea. Metodologia Estudio de cohortes prospectivo en 30 pacientes programados para cirugia traumatologica: 24 bajo anestesia raquidea y 26 con anestesia general. Se recogieron datos de filiacion, anestesico-quirurgicos y diametros ecograficos 3 mm retrobulbares bilaterales en tres momentos: basal, 10 minutos tras la puncion dural o induccion y 10 minutos tras recuperar bloqueo motor. Analisis estadistico descriptivo de las variables analizadas y estudio de correlacion entre los dos grupos (anestesia general y raquidea) en los tres momentos del estudio mediante el indice Rho de Spearman para pruebas no parametricas. Resultados Se estudiaron 25 varones y 25 mujeres, de 63,40 ± 16,36 anos, 77 ± 10,66 kg de peso, tiempo quirurgico 93,20 ± 23,659 minutos; 28 casos precisaron isquemia con duracion de 58,15 ± 10,57 minutos. Medidas ecograficas del nervio optico preoperatorias: 5,06 ± 0,89 mm (ojo derecho) y 4,45 ± 0,7955 (ojo izquierdo); intraoperatorias: 5,70 ± 0,77 mm (ojo derecho) y 4,84 ± 0,75 (ojo izquierdo) y postoperatorias: 4,91 ± 0,88 mm (ojo derecho) y 4,46 ± 0,64 (ojo izquierdo). Ambos grupos presentaron parametros comparables. Significacion estadistica bilateral entre valores preoperatorios (p Conclusiones El diametro del nervio optico aumenta tras la induccion anestesica o anestesia intradural, para recuperar valores basales en postoperatorio inmediato.

A randomised trial implementing Enhanced Recovery After Surgery (ERAS) for high complexity advanced ovarian cancer (AOC) surgery (PROFAST) demonstrated a reduction of median length of stay and hospital readmissions when compared to patients managed conventionally. One secondary objective was to determine if an ERAS pathway in the perioperative management of advanced ovarian cancer patients led to cost savings.Secondary objective of a prospective randomised trial of patients with suspected or diagnosed advanced ovarian cancer allocated to conventional or ERAS perioperative management, carried out at a referral centre from June 2014 to March 2018. Treatment was determined by a computer-generated random allocation system.Gross counting was employed to estimate the cost of hospitalisation in wards, intensive care unit (ICU) and surgical care, while micro-costing was used to obtain image and laboratory test costs. Mean costs between trial arms were considered. Sensitivity analyses were performed.Ninety-nine patients (n = 50 ERAS group, n = 49 Conventional group) were included. Mean costs per patient were 10,719€ in the ERAS group and 11,028€ in the conventional group, leading to an average saving of 309€ per patient. These results were based on 96 patients, excluding 3 extreme outliers mainly related with very high ICU costs. Savings, which were significant for hospital ward costs (-33% total; 759€ per patient in first hospitalisation, and 914€ per partient/day of readmission) were found as robust in the sensitivity analysis.Implementation of an ERAS pathway leads to cost savings when compared to conventional management after AOC surgery.

The total phenols in virgin olive oil are highly dependent on cultivar, but also on ripening stage and other agronomic factors. The focus of most studies on agronomic factors has been irrigation, while fertilization has received less attention. Most of the fertilization works find that nitrogen over-fertilization leads to a decrease in phenol contents in virgin olive oil (VOO) and extra virgin olive oil (EVOO), under rain-fed or irrigation management. Ortho-diphenols also decrease with high doses of nitrogen, with no effect on secoiridoids. Phosphorous has a minor effect on irrigated trees; while the role of potassium is controversial, with a lack of trials with calcium and micro-nutrients. Due to the great impact of the fertilization on the phenol content and quality of VOO, new research is necessary with focus aimed at different cultivars and agronomic factors. Los fenoles del aceite de oliva tienen un fuerte componente varietal, estando influenciados por el estado de maduración y otros factores agronómicos. Entre estos últimos, el efecto del riego es el más conocido, mientras que la fertilización está menos estudiada. La mayoría de los trabajos existentes sobre fertilización, muestran que el incremento en el abonado nitrogenado disminuye los niveles de fenoles totales del aceite de oliva virgen o virgen extra, tanto en secano como en regadío. También se han observado niveles inferiores de ortodifenoles en tratamientos con aplicación de nitrógeno, sin detectar diferencias en el contenido de secoiridoides. El fósforo tiene una influencia menor y la del potasio es algo controvertida, quedando por explorar la influencia del calcio y de los micronutrientes. Debido al considerable impacto que tiene la fertilización en los fenoles así como en la calidad del aceite, sería necesario incrementar los estudios de fertilización con diferentes variedades y sistemas productivos.

Polyurethanes, one of the most used polymers worldwide, are strongly dependent of non-renewable fossil resources. Thus, boosting the production of new polyurethanes based on more sustainable raw materials is crucial to move towards the footwear industry decarbonisation. The aim of this study is to synthesise and characterise reactive hotmelt polyurethanes from biomass and CO2-based polyols as bioadhesives for the footwear industry. The influence of biobased polyols on the polyurethane structure, and therefore, on their final properties was analysed by different experimental techniques such us Fourier transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), Thermogravimetric analysis (TGA), Melting viscosity, Softening temperature and T-peel strength test, in order to assess their viability for the upper to sole bonding process. The results obtained indicated that the incorporation of different amounts of the biobased polyols produces changes in the structure and final performance of the polyurethanes. Therefore, adhesion test carried out by the T-peel test 72 h after the upper -to- sole bonding of the sustainable adhesives show high final adhesion values. These sustainable raw materials provide polyurethane adhesives with additional beneficial non-toxicity and sustainable characteristics, without harming their properties during their useful life.

Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid. This article reviews nine cases treated at our centre to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.

La Guerra de Castas fue un hecho histórico ocurrido en la selva de la Península de Yucatán a finales del siglo XIX. En el año 1993, se inauguró un museo dedicado a este conflicto, en torno al cual giran diferentes iniciativas locales turísticas en la región. Este museo, denominado Museo de la Cultura Indígena en Tihosuco, en Quintana Roo, es comúnmente conocido como el Museo de la Guerra de Castas y difunde un peculiar binomio de argumentos en torno al conflico: uno para la comunidad local y otro para los turistas.

A 57-year-old man with miliary tuberculosis reported visual loss in his right eye, a month after starting a four-drug antituberculous treatment regimen. On exploration, an inferior segmental optic disc edema was objectived and it was attributed to ischemic aetiology. Ethambutol was withdrawn and 60mg of oral prednisone daily were given with a tapering dosage. One and a half months later, he presented a sudden loss of vision in his left eye. In fundoscopy, a papillary edema accompanied by a foveal neurosensory detachment was observed but with no more accompanying uveitic signs. Treatment was intensified with moxifloxacin and corticosteroids were reduced, showing a resolution of the macular detachment but with optic atrophy. Isolated tuberculous involvement of the optic nerve may possible in the context of miliary tuberculosis. In this case, the adopted therapeutic approach to the initial papillitis, which was interpreted as ischemic, could favour the appearance of a neuroretinitis in the fellow eye.

Resumen Varon de 57 anos con tuberculosis miliar que refirio perdida visual por ojo derecho, al mes de iniciar un regimen antituberculoso de 4 farmacos. En la exploracion se objetivo un edema papilar sectorial inferior que fue atribuido a etiologia isquemica. Se le retiro el etambutol y se le administraron 60 mg diarios de prednisona oral en pauta descendente. Al mes y medio, presento una perdida subita de vision en el ojo izquierdo. En el fondo de ojo se observo un edema de papila acompanado de un desprendimiento neurosensorial de la fovea, sin mas signos uveiticos acompanantes. Le fue intensificado el tratamiento con moxifloxacino y se redujeron los corticoides, objetivandose una resolucion del desprendimiento macular, pero con atrofia optica. Es posible la afectacion tuberculosa aislada del nervio optico en el contexto de una tuberculosis miliar. En este caso, la actitud terapeutica adoptada ante la papilitis inicial, al ser interpretada como isquemica, pudo favorecer la aparicion de la neurorretinitis en el ojo adelfo.

A new method for the quantification of metabolites in the absence of a chemically synthetized authentic standard is described herein. Metabolites to be used as reference standards were obtained biologically from microsomes incubation. The method is a stepwise process in which, only the radiolabeled (14C) and non-radiolabeled parent compound are required. Briefly, the separation and principles of equimolar detection of LC-radioactivity were applied and, a calibration curve of the 14C-parent compound was used to quantify the formation of its 14C-metabolite. In turn, serial dilutions of this 14C-metabolite were the base for the calibration curve that allowed the quantification of the non-radiolabeled metabolite. This method was applied in plasma samples obtained from a dog pharmacokinetic study in which, a PharmaMar compound (lurbinectedin) and its N-desmethylated metabolite were quantified and, the results compared to those obtained by the classical approach (with the chemically synthetized N-desmethylated metabolite). Plasma concentrations obtained with the two methods were very similar, with standard relative errors between −11% to −4%. Similar, main pharmacokinetic parameters were calculated with the concentrations obtained either thru this method or by using a chemically synthetized authentic standard

Resumen Objetivo Evaluar la efectividad de la implantacion de un protocolo de control glucemico del paciente critico liderado por enfermeras, en terminos de mantenimiento de un rango preestablecido de glucemias, reduccion de hiperglucemia y prevencion de hipoglucemia severa. Metodo Estudio cuasiexperimental prospectivo «pre-pos» realizado en una unidad de cuidados intensivos polivalente. Se incluyeron pacientes adultos en tratamiento con insulina endovenosa. Se registraron todas las determinaciones de glucemia desde noviembre de 2014 a agosto de 2015 (preintervencion) y desde noviembre de 2015 a agosto de 2016 (pos). La intervencion consistio en la implementacion de un protocolo basado en la evidencia, para conseguir rangos de glucemia entre 140-180 mg/dl. Las variables principales incluyeron proporciones de glucemias dentro de rango, tasas de hipoglucemia severa (menos de 40 mg/dl) y tasas de hiperglucemia superior a 200 mg/dl. Resultados Se evaluaron 7864 determinaciones de glucemia pertenecientes a 125 pacientes, 66 preintervencion y 59 postintervencion. La edad media fue de 66,24±13,99 anos, el 64% eran hombres. La proporcion de determinaciones dentro del rango fue superior en el grupo postintervencion (38,82 vs. 44,34 p Conclusiones Nuestra experiencia muestra que una implantacion basada en la evidencia puede mejorar el control glucemico en pacientes criticos. Se observaron mayores tasas de glucemia dentro de rango. El protocolo resulto util en la prevencion de la hipoglucemia severa. El liderazgo del equipo de enfermeria y la toma de decisiones autonomas basadas en datos clinicos permitio mejorar los resultados en salud de los pacientes.

Aim To assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. Method Prospective “pre-post” quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140–180 mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40 mg/dl) and hyperglycaemia over 200 mg/dl. Results We analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24 ± 13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p Conclusions Our experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.

Surface treatment is essential to ensure the resistance and durability of adhesive upper-to-sole joints for footwear. This study investigates robotised atmospheric pressure plasma technology to increase adhesion on styrene-butadiene vulcanised (SBR) and styrene-butadiene-styrene thermoplastic (SBS) rubbers, which constitutes a more sustainable surface treatment as an alternative to solvent-based chemical treatments (i.e., halogenation). In this work, the different parameters such as application speed and distance of the nozzle of the atmospheric plasma system have been optimised and the effects of the plasma treatment on the physicochemical properties in the materials’ surface, roughness, wettability, as well as the adhesion properties have been evaluated by means of different experimental techniques: Fourier Transform Infrared Spectroscopy (FTIR), X-Ray Photoelectron Spectroscopy (XPS), Field Emission Scanning Electron (FESEM), Contact Angles (CA) and Surface Free Energy (SFE) measurements and T-peel strength tests. The results show that the values obtained for the T-peel strength of the reactive hot melt polyurethane adhesive (HMPUR) joints studied exceed the minimum quality requirements for footwear according to standardised tests. In consequence, the optimisation and validation of operating plasma conditions and adhesion properties of rubbers could consolidate atmospheric plasma as a solvent-free alternative for the preparation of footwear soling materials. The great advantage of this technology is its introduction into the production line by fully automating the bonding process with the use of robots.

En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center.Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered.We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients' age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis).The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

This article belongs to the Special Issue Non-alcoholic Fatty Liver Disease: From Lifestyle to Environmental Factors., Our aim was to analyze how type 2 diabetes and obesity influence quality of life (QoL) and coping in patients with nonalcoholic fatty liver disease (NAFLD), and which coping strategies predict diabetic or obese participants’ QoL. QoL (SF-12, CLDQ-NAFLD) and coping strategies (COPE-28) were evaluated in 307 biopsy-proven NAFLD patients with absence or presence of diabetes or obesity. QoL was compared with normality tables for the general Spanish population. Interactive effects were found in physical functioning (p = 0.008), role-physical (p = 0.016) and activity (p = 0.014). Diabetic patients reported worse scores when they were also obese and vice versa, that is, obese patients scored worse when they were also diabetic. Both diabetic and obese patients had lower QoL than those without metabolic pathology or the general population, and obese patients also reported more passive/avoidance coping. Active coping, positive reframing and acceptance predicted better QoL, while denial, self-blame, self-distraction, disengagement and religion predicted lower QoL. In conclusion, diabetes and obesity were associated with lower QoL in patients with NAFLD. Obesity was also associated with more passive/avoidance coping. Furthermore, passive/avoidance coping strategies predicted lower QoL than active, recommending modification of maladaptive coping strategies in future multidisciplinary NAFLD treatments., This research was funded by FEDER/Ministry of Science and Innovation—State Secretariat for Research (FEDER/Ministerio de Ciencia e Innovación – Agencia Estatal de Investigación), project PSI2017-83365-P; Ministry of Education and Professional Training (Ministerio de Educación y Formación Profesional), project FPU16/03146; and Gilead Sciences, Inc., unrestricted grant.

Background Multiple sclerosis (MS) is a chronic neurodegenerative disease that can negatively affect functioning across a wide spectrum of domains. This study aims to investigate the development of mental health and quality of life in MS patients over 18-months and to identify predictive factors. Method 314 MS outpatients of Virgen Macarena University Hospital in Sevilla/Spain (mean age 45 years, 67.8% women, on average 12.1 years since diagnosis) participated in the study. Health-related quality of life (HRQOL) and mental health were assessed by the 12-Item Short Form Health Survey (SF-12) and the General Health Questionnaire-28 (GHQ-28) twice over an 18-months follow up period. Results HRQOL and mental health significantly improved in almost all domains, except for a worsening of vitality. Mental and physical HRQOL improved by a large effect size. Binomial logistic regression models showed that disability status (Expanded Disability Status Scale) predicted both components of HRQOL and age the physical component of HRQOL. Sex, educational level, and disease duration predicted mental health. Conclusions Our findings confirm the possibility of a significant large-sized improvement of HRQOL in the course of 18-months even 12 years after MS diagnosis on average. The study showed the importance of sociodemographic as well as clinical variables to predict HRQOL and mental health. Further longitudinal research is needed to better understand their impact on patients’ outcomes.