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Background: Amidst current misinformation, media literacy is an essential competency for nursing professionals. This study aimed to analyze the level of media health literacy among Spanish undergraduate nursing students, stratifying the results by gender, region, and other associated factors. Methods: A cross-sectional study was conducted at five Spanish universities (N = 416) using the Spanish version of the Media Health Literacy (MeHLit-SV) Questionnaire. Results: Students presented an average media health literacy score of 48.73 points. The media health literacy level was significantly higher among students from universities in the central and northeastern regions of Spain (ANOVA Test, p = 0.0002), those who had previously studied in a city (ANOVA Test, p = 0.001), those who combined their studies with employment (ANOVA Test, p = 0.001), and those residing in communities with fewer than 500 inhabitants (ANOVA Test, p = 0.001). No differences were found based on gender. Conclusions: The media health literacy level of the students was deficient and varied according to socio-economic and socio-educational factors. Understanding the literacy level of future nurses and promoting the inclusion of this competency in their education will enable them to become leaders in improving the population’s health self-care.

Abstract Objectives To estimate the frequency of potentially inappropriate prescribing (PIP) in outpatients according to STOPP/START criteria, and to identify risk factors. For this purpose, an algorithm was developed and validated in RStudio® based on the information collected in the electronic prescription. Methods The data corresponds to dispensations from two pharmacies in Spain made to patients over 18 years, over 4 years. For the analysis, only patients aged ≥ 65 years who are targeted by the STOPP/START criteria are included. The statistical programming language RStudio® was used to develop the algorithm. The STOPP criteria used as models for the implementation of the method were L2 and B12. A logistic regression analysis was performed. Results A total of 15,601 treatment plans were obtained from 2312 patients ≥ 65 years (56% women), of whom 46.6% had polypharmacy (≥ 5 drugs) and 9.3% had excessive polypharmacy (≥ 10 drugs). In this group, PIPs were detected in 57% of patients and in 38% of their treatment plans; of these PIPs the most common were those related to the use of benzodiazepines for more than 28 days (D5 criterion) in 25.9% of patients, followed by the use of opioids prescribed without an associated laxative (L2 criterion) in 13.8% and finally, drugs duplication (A3 criterion) in 5.7%. The most numerous duplications related to criterion A3 were benzodiazepines (39%) and non-steroidal anti-inflammatory drugs (37.4%). Conclusions The method developed and validated in RStudio® with different STOPP criteria allows us to analyse the pharmacological treatment of many patients using different databases and to identify those at risk of suffering a PIP according to the STOPP criteria. Our results indicate a high prevalence of PIPs in patients ≥ 65 years, with polypharmacy being the most common risk factor affecting PIP.

Abstract Background Primary healthcare management efficiency conditions the functioning of specialized care and has a direct impact on the outcomes of the health system and its sustainability. The objective of this research is to develop models to evaluate the efficiency, including health outcomes, of the primary healthcare centres (PHC) of the Clínico – La Malvarrosa Health District in Valencia. Methods To evaluate efficiency, Data Envelopment Analysis (DEA) was used with output orientation and variable returns to scale, with panel data from the years 2015 to 2019. In rates per 10,000 inhabitants, the inputs are: medical and nursing staff and pharmacy cost. The outputs are: number of consultations, hospital emergencies, referrals, avoidable hospitalisations, avoidable mortality and pharmaceutical prescription efficiency. As exogenous variables: the percentage of population over 65 years old, over 80 and case-mix. Three models were developed, all of them with the same inputs and different combinations of outputs related to: healthcare activity, outcomes, and both, in order to study the influence of the different approaches on efficiency. Each model is analysed both without exogenous variables and with each of them. Results The efficiency results vary depending on the model used, although certain PHCs are always on, or very close to, the efficient frontier, while others are always inefficient. When healthcare activity outputs are considered, efficiency scores improve and the number of efficient PHCs increases. However, in general, the PHC score decreases throughout the evaluated period. This decrease is more pronounced when only activity outputs are included. Conclusions DEA allows the inefficiencies of PHCs to be analysed and the efficient ones are clearly distinguished from the inefficient, although different efficiency scores are obtained depending on the model used. Evaluation can be according to healthcare activity, health outcomes or both, making it necessary to identify the expected objectives of the PHCs, as the perspective of the analysis influences the results.

Anaerobic digestion is a biological process that transforms high-strength organic effluents into biogas with multiple benefits. However, concurrent with organics’ biological transformation, a liquid phase with a high solid content is also derived from this process. Valorizing this fraction is not an easy task if an agronomic application cannot be considered as a suitable option. The thermal valorization of this fraction allows for energy extraction but also gives rise to additional capital investment and increases the energy demand of the global process. In addition, the thermal treatment of digestate has to deal with a mineralized material. The changes in organic matter due to anaerobic digestion were studied in the present manuscript, by evaluating the thermal behavior of samples, activation energy, and organic transformation using Fourier transform infrared (FTIR) spectroscopy. Digested samples of a mixture composed of manure and glycerin (5% v/v) were studied. The stabilization caused a dramatic decrease in aliphatic compounds, greatly increasing the mineral content of the sample. Results from differential scanning calorimetry (DSC) indicated an energy content of 11 kJ/g for the feed material and a reduction to 9.6 kJ/g for the long-term stabilized sample. The activation energy of the feed was 249.5 kJ/mol, whereas this value was reduced to 70–80 kJ/mol for digested samples. If the valorization route selected for digestates is thermal conversion, the lower energy content and more complex structure of these materials (higher content of lignin and protein-type compounds) must be carefully evaluated.

Rapid development of energy, electrical and electronic technologies has put forward higher requirements for the thermal conductivities of epoxy resins and their composites. However, the thermal conductivity of conventional epoxy resins is relatively low, which could cause major heat dissipation issues. Therefore, the thermal conductivity enhancement of epoxy resins has long been a hot research topic in both academia and industry. In recent years, many promising advances have been made at the technical and mechanistic levels. This review includes the different approaches, the thermal conduction mechanisms implied, and the main research progresses. The research and academic achievements are mainly focused on the development of intrinsically liquid crystal epoxy resins and their composites, and the addition of fillers on amorphous epoxy resins. Finally, the challenges and prospects for thermal conductive epoxy resins are provided. Notably, this review can provide a more comprehensive understanding of thermally conductive epoxy resins and a guideline for the cutting-edge development direction of thermally conductive epoxy resins.

The Boston Keratoprosthesis (BKPro) serves as a medical solution for restoring vision in complex cases of corneal blindness. Comprising a front plate made of polymethylmethacrylate (PMMA) and a back plate of titanium (Ti), this device utilizes the beneficial biomaterial properties of Ti. While BKPro demonstrates promising retention rates, infection emerges as a significant concern that impacts its long-term efficacy. However, limited research exists on enhancement of BKPros through intrinsic infection-preventing mechanisms. In this regard, metal ions, especially the well-known Ag+ ions, are a promising alternative to obtain implants with innate antibacterial properties. However, little information is available about the effects of Ag in corneal tissue, especially within human corneal keratocytes (HCKs). In this work, an electrodeposition treatment using a constant pulse is proposed to attach Ag complexes onto rough Ti surfaces, thus providing antibacterial properties without inducing cytotoxicity. Complete physicochemical characterization and ion release studies were carried out with both control and Ag-treated samples. The possible cytotoxic effects in the short and long term were evaluated in vitro with HCKs. Moreover, the antibacterial properties of the silver-treated surfaces were tested against the gram-negative bacterial strain Pseudomonas aeruginosa and the gram-positive strain Staphylococcus epidermidis, that are common contributors to infections in BKPros. Physicochemical characterization confirmed the presence of silver, predominantly in oxide form, with low release of Ag+ ions. Ag-treated surfaces demonstrated no cytotoxicity and promoted long-term proliferation of HCKs. Furthermore, the silver-treated surfaces exhibited a potent antibacterial effect, causing a reduction in bacterial adhesion and evident damage to the bacterial cell walls of P. aeruginosa and S. epidermidis. The low release of Ag+ ions suggested reactive oxygen species (ROS)-mediated oxidative stress imbalance as the bactericidal mechanism of the silver deposits. In conclusion, the proposed electrodeposition technique confers antibacterial protection to the Ti backplate of BKPro, mitigating implant-threatening infections while ensuring non-cytotoxicity within the corneal tissue.

Suicide is a serious public health problem, with a global mortality rate of 1.4% of all deaths worldwide and the leading cause of unnatural death in Spain. Clinical simulation has proven to be a beneficial tool in training nursing students. Such experiences allow them to develop cognitive and affective skills that are fundamental for the detection of warning signs and the use of interventions in cases of people who want to take their own lives. Working in a mental health environment can be difficult for nursing students; therefore, the purpose of this study was to explore the perceptions of nursing students on the approach, management, and intervention of suicidal crisis through clinical mental health simulation. Methods: qualitative descriptive phenomenological study through focus groups and reflective narratives in a sample of 45 students. A thematic analysis was performed using ATLAS-ti. Results: After the analysis, three themes were obtained: (a) management and handling of emotions, (b) identification of suicide motives, and (c) intervention in suicidal crisis. Discussion: Clinical simulation in mental health allows students to exercise clinical judgment reasoning, detect warning signs for a better treatment approach, and provide tools for effective intervention and management of patient care. The results of this study indicate that nursing students face challenges in approaching mental health clinical simulation due to a lack of prior exposure.

Single-cell RNA sequencing (scRNA-seq) technology has emerged as a powerful tool for dissecting cellular heterogeneity and understanding the intricate biology of diseases, including cancer. Endometrial cancer (EC) stands out as the most prevalent gynecological malignancy in Europe and the second most diagnosed worldwide, yet its cellular complexity remains poorly understood. In this review, we explore the contributions of scRNA-seq studies to shed light on the tumor cells and cellular landscape of EC. We discuss the diverse tumoral and microenvironmental populations identified through scRNA-seq, highlighting the implications for understanding disease progression. Furthermore, we address potential limitations inherent in scRNA-seq studies, such as technical biases and sample size constraints, emphasizing the need for larger-scale research encompassing a broader spectrum of EC histological subtypes. Notably, a significant proportion of scRNA-seq analyses have focused on primary endometrioid carcinoma tumors, underscoring the need to incorporate additional histological and aggressive types to comprehensively capture the heterogeneity of EC. By critically evaluating the current state of scRNA-seq research in EC, this review underscores the importance of advancing towards more comprehensive studies to accelerate our understanding of this complex disease.

Esophagectomy remains being a surgical procedure with a high morbidity and mortality rate. Therefore, prehabilitation, defined as the group of interventions performed on the patient in the preoperative period to improve their functional capacity and clinical condition, becomes highly important to ensure that the patient faces the stress that surgery entails under the best possible clinical situation. Hereby, we describe our prehabilitation protocol that has been implementedsince 2017 and we present the clinical results achieved so far. Preoperative risk assessment and various modalities of prehabilitation protocols are discussed to enhance the patient´s preoperative physiological condition and to reduce the impact of the neuroendocrine and inflammatory response induced by an esophagectomy. Finally, we describe the protocol we intend to implement to improve our clinical practice and reduce complications.

The Via Francigena stands as a European Cultural Route recognized by the Council of Europe, serving as a link between Northern and Southern Europe, extending from Canterbury through France and Switzerland to Rome in Italy. The Universal Declaration of Human Rights underscores the right of all individuals to partake in the cultural life of their communities, which entails ensuring that heritage sites remain accessible to everyone, regardless of their physical, cognitive or sensory abilities. To achieve this, the ‘rurAllure’ project has been initiated to promote and disseminate the cultural and natural heritage along this pilgrimage route in an inclusive manner. This paper reviews the existing resources regarding accessibility in the Italian segment of the Via Francigena, comparing them to initiatives undertaken on other European Cultural Routes. This serves as an initial step to comprehend the measures required to guarantee that everyone can fully engage with and comprehend these cultural experiences. The analysis revealed that most of the limited accessibility efforts along this route have primarily focused on physical accessibility. Regrettably, cognitive and sensory accessibility has received considerably less attention. In this context, this paper proposes the thermal heritage located along the Val d’Orcia section in Tuscany, Italy, as particularly promising for the development of accessible experiences due to its tactile characteristics. The future efforts to enhance accessibility along this route should consider approaches like Universal Design for Learning and the geography of perception to create resources and new experiences that cater to a wide range of individuals.

The industrial production of polyhydroxyalkanoates (PHAs) faces several limitations that hinder their competitiveness against traditional plastics, mainly due to high production costs and complex recovery processes. Innovations in microbial biotechnology offer promising solutions to overcome these challenges. The modification of the biosynthetic pathways is one of the main tactics; allowing for direct carbon flux toward PHA formation, increasing polymer accumulation and improving polymer properties. Additionally, techniques have been implemented to expand the range of renewable substrates used in PHA production. These feedstocks are inexpensive and plentiful but require costly and energy-intensive pretreatment. By removing the need for pretreatment and enabling the direct use of these raw materials, microbial biotechnology aims to reduce production costs. Furthermore, improving downstream processes to facilitate the separation of biomass from culture broth and the recovery of PHAs is critical. Genetic modifications that alter cell morphology and allow PHA secretion directly into the culture medium simplify the extraction and purification process, significantly reducing operating costs. These advances in microbial biotechnology not only enhance the efficient and sustainable production of PHAs, but also position these biopolymers as a viable and competitive alternative to petroleum-based plastics, contributing to a circular economy and reducing the dependence on fossil resources.

Abstract Photonic crystals (PhCs) are interesting structures for photocatalytic applications because of their capability of harnessing distinct forms of light–matter interactions within the PhCs. Of all these, overlapping one of the photonic stopband's (PSB) edge with the absorption of the PhC material or adsorbed molecules improves their excitation and generated charge carriers can subsequently induce photocatalytic reactions. The PSB position of anodic aluminum oxide PhCs (AAO‐PhCs) can be easily adjusted by modifying the anodization profile. Herein, AAO‐PhCs are designed to match the band gap of a model semiconductor enabling a general photocatalytic activity enhancement independent of the chemical to be decomposed. Fe2O3, as an example photocatalyst, is coated onto AAO‐PhCs to demonstrate efficient photocatalytic systems by utilizing the slow photon effect. Tailored Fe2O3‐AAO‐PhCs with their PSB edge at 564 nm matching the Fe2O3 band gap exhibit generally enhanced degradation of three different organic dyes while a significant activity decrease is observed when the PSB edge does not overlap with the Fe2O3 absorption. Furthermore, photocatalyst degradation can be reduced down to only 4% activity loss over six consecutive measurements by an ultra‐thin alumina coating.

La internacionalización como proceso estratégico de las universidades, es una vía para lograr estándares académicos de calidad. En tiempos de COVID-19, ha resultado ser uno de los principales desafíos a los cuales se enfrenta la educación superior. Por lo cual, presentamos la experiencia de la Universidad de La Habana, frente a esta pandemia. Es por ello que el objetivo del trabajo es analizar la incidencia de la COVID-19 en la gestión de la calidad del proceso de internacionalización en la Universidad de La Habana. La metodología utilizada se basó en el análisis documental y la síntesis de literatura especializada en los temas abordados, la observación y la experiencia de los autores en estos meses de cuarentena y distanciamiento social. Cuba y su sistema de educación superior, se han preparado para responder al nuevo escenario impuesto por la aparición de la COVID-19, a través de la implementación de políticas educativas. A partir de ahí la Universidad de La Habana se trazó una serie de acciones que han permitido el ajuste de calendarios docentes, la contribución desde la investigación para eliminar la propagación de la pandemia, la colaboración con resultados de la innovación, al cuidado de estudiantes y trabajadores docentes y no docentes, todo ello con la garantía de la continuidad de actividades formativas cuando la situación epidemiológica lo permita. En la actualidad, la pandemia de COVID-19 deja metas complejas para la comunidad universitaria, a partir de este punto, la Universidad de La Habana se trazará estrategias para lograr que el proceso de internacionalización continúe manteniendo los estándares de calidad que presentaba hasta el momento.

Resumen: Introducción: La TSH neonatal (TSHn) es un marcador de nutrición de yodo en la población. La OMS relaciona una prevalencia 5 mUI/L, obtenida a partir de las 72 h del nacimiento, con un adecuado estado nutricional de yodo. El objetivo de este estudio es conocer la prevalencia de TSHn > 5 mUI/L en una población yodosuficiente y su relación con factores maternos, neonatales y obstétricos. Materiales y métodos: Se reclutaron 243 gestantes entre mayo-junio de 2017 en nuestra área sanitaria. Se realizó un cuestionario sobre consumo de yodo y determinación de yoduria, función y autoinmunidad tiroideas en el primer trimestre de gestación. Se analizó la TSHn entre 48-72 h del nacimiento, así como otros factores obstétricos y neonatales. Resultados: La TSHn media fue 2,43 ± 1,68 mUI/L, con un 7,8% de neonatos con TSHn > 5 mUI/L. La TSHn más elevada pertenecía a los neonatos de madres con yodurias insuficientes (p = 0,021) o con TSH > 2,5 mUI/L, tanto en autoinmunidad tiroidea negativa (p = 0,049) como positiva (p = 0,006). La yoduria materna 5 mUI/L (3,70 [1,06-14,60], p = 0,046), mientras que el peso neonatal ≥ 2500 g fue un factor protector (0,14 [0,02-1,00], p = 0,038). Conclusiones: La prevalencia de TSHn > 5 mUI/L en nuestra área sanitaria fue elevada, según las recomendaciones de la OMS. Se asoció el déficit de yodo materno con mayor riesgo de TSHn > 5 mUI/L. Dado que en la actualidad la determinación de la TSHn se realiza antes de las 72 h del nacimiento, precisamos de nuevos puntos de corte para continuar empleando la TSHn como marcador de nutrición de yodo. Abstract: Introduction: Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5 mIU/L in samples obtained within 72 h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5 mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. Materials and methods: A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72 h post birth and other obstetric and neonatal factors. Results: The mean nTSH level (standard deviation) was 2.43 (1.68 mIU/L), with 7.8% of neonates having levels greater than 5 mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (p = .021) or TSH levels greater than 2.5 mIU/L, in both the case of negative (p = 0.049) and positive (p = 0.006) thyroid autoimmunity results. Maternal ioduria greater than 150 μg/L was a risk factor for nTSH levels greater than 5 mIU/L (3.70 [1.06–14.60]; p = 0.046), while a neonatal weight of 2500 g or greater was a protective factor (0.14 [0.02–1.00]; p = 0.038). Conclusions: The prevalence of nTSH levels greater than 5 mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels less than 5 mIU/L. Given that nTSH is currently measured before 72 h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status.

Introduction: Endothelial dysfunction and platelet activation have been highlighted as possible mediators in Takotsubo syndrome (TTS). Nevertheless, to date, evidence on the usefulness of antiplatelet therapy in TTS remains controversial. The aim of our study is to evaluate long-term prognosis in TTS patients treated with antiplatelet therapy (APT) at hospitalization discharge. Material and methods: An ambispective cohort study from the Spanish National Takotsubo Registry database was performed (June 2002 to March 2017). Patients were divided into two groups: those who received APT at hospital discharge (APT cohort) and those who did not (non-APT cohort). Primary endpoint was all-cause death. Secondary endpoints included the composite of recurrence or readmission and a composite of death, recurrence or readmission. Results: From a total of 741 patients, 728 patients were alive at discharge. Follow-up was performed in 544 patients, who were included in the final analysis: 321 patients (59.0%) in the APT cohort and 223 patients (41.0%) in the non-APT cohort. The APT cohort had a better clinical presentation and received more heart failure and acute coronary syndrome-like therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers: 75.1% vs. 51.1%; p

Objective: The aim of this study is to identify and analyze adults aged ≥65 years living in the Canary Islands, Spain, who are prescribed medications that increase the risk of falls and are polymedicated. To do so we have made use of the electronic prescription and the RStudio®. Method: For the detection of Fall-Risk-Increasing Drugs (FRIDs), outpatient electronic prescription dispensing data were used in two pharmacies. A total of 118,890 dispensations grouped into 15,601 treatment plans for 2,312 patients were analyzed. The FRIDs analyzed were antipsychotics (APSI), benzodiazepines (BZPN), antidepressants (DEPR), opioids (OPIO) and Z-hypnotics (ZHIP). For the development of the algorithms for the construction of tables and data screening, the statistical programming language RStudio® was used. Results: Of the total number of patients and prescriptions analyzed, 46.6% were polymedicated and 44.3% had prescribed an FRID. 28.7% of the patients presented both factors, had a dispensation from an FRID and were polymedicated. Of the 14,278 dispensations with FRID, 49% had a benzodiazepine, 22.7% opioids, 18% antidepressants, 5.6% hypnotics, and finally 4.4% antipsychotics. At least 32% of the patients had been dispensed a benzodiazepine together with another FRID and 23% an opioid together with another FRID. Conclusions: The method of analysis developed and applied in RStudio® allows to detect and determine in a simple and fast way polymedicated patients, as well as the number and therapeutic class of drugs in their treatment plan and identify prescriptions that can increase the risk of falls. Our results show a high number of prescriptions for benzodiazepines and opioids.

Dentro de la investigación que se está llevando a cabo para identificar y caracterizar el mármol empleado en Galicia desde la Antigüedad, en este trabajo se presenta por primera vez un inventario de los capiteles marmóreos tardorromanos y altomedievales localizados en el ámbito del actual territorio gallego, incluyendo un importante número de piezas inéditas que amplían significativamente el número de ejemplares conocidos hasta el momento. En efecto, a pesar del interés y la calidad de estas piezas, hasta el momento no se había realizado ninguna revisión de conjunto sobre los capiteles marmóreos gallegos a pesar de la singularidad que representan dentro del panorama eminentemente granítico que identifica este territorio. Aunque la mayor parte de estos ejemplares aparecen descontextualizados o en posición secundaria, entendemos que existen elementos coincidentes que evidencian el interés mostrado desde la Antigüedad por obtener y utilizar el mármol en diferentes construcciones, realidad que siguió vigente en las múltiples reutilizaciones y usos a los que estas piezas se vieron sometidas. Así, al tiempo que se está completando el estudio analítico de este conjunto, en este artículo se presenta un primer avance sobre la caracterización del material empleado en la realización de estos capiteles, se reflexiona sobre sus principales características formales y estilísticas, se consideran los contextos de localización y conservación de cada una de las piezas, y se apuntan distintas consideraciones vinculadas al uso y reutilización de unas piezas de mármol que pueden ser de enorme importancia para comprender un poco mejor este fenómeno en el noroeste peninsular.

IntroductionThe aim of this systematic review is to assess the relationship between patient empowerment and other empowerment-related constructs, and affective symptoms and quality of life in patients with type 2 diabetes.MethodsA systematic review of the literature was conducted, according to the PRISMA guidelines. Studies addressing adult patients with type 2 diabetes and reporting the association between empowerment-related constructs and subjective measures of anxiety, depression and distress, as well as self-reported quality of life were included. The following electronic databases were consulted from inception to July 2022: Medline, Embase, PsycINFO, and Cochrane Library. The methodological quality of the included studies was analyzed using validated tools adapted to each study design. Meta-analyses of correlations were performed using an inverse variance restricted maximum likelihood random-effects.ResultsThe initial search yielded 2463 references and seventy-one studies were finally included. We found a weak-to-moderate inverse association between patient empowerment-related constructs and both anxiety (r = −0.22) and depression (r = −0.29). Moreover, empowerment-related constructs were moderately negatively correlated with distress (r = −0.31) and moderately positively correlated with general quality of life (r = 0.32). Small associations between empowerment-related constructs and both mental (r = 0.23) and physical quality of life (r = 0.13) were also reported.DiscussionThis evidence is mostly from cross-sectional studies. High-quality prospective studies are needed not only to better understand the role of patient empowerment but to assess causal associations. The results of the study highlight the importance of patient empowerment and other empowerment-related constructs such as self-efficacy or perceived control in diabetes care. Thus, they should be considered in the design, development and implementation of effective interventions and policies aimed at improving psychosocial outcomes in patients with type 2 diabetes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192429, identifier CRD42020192429.

Abstract The SARS-CoV-2 Spike protein mediates docking of the virus onto cells prior to viral invasion. Several cellular receptors facilitate SARS-CoV-2 Spike docking at the cell surface, of which ACE2 plays a key role in many cell types. The intermediate filament protein vimentin has been reported to be present at the surface of certain cells and act as a co-receptor for several viruses; furthermore, its potential involvement in interactions with Spike proteins has been proposed. Nevertheless, the potential colocalization of vimentin with Spike and its receptors on the cell surface has not been explored. Here we have assessed the binding of Spike protein constructs to several cell types. Incubation of cells with tagged Spike S or Spike S1 subunit led to discrete dotted patterns at the cell surface, which consistently colocalized with endogenous ACE2, but sparsely with a lipid raft marker. Vimentin immunoreactivity mostly appeared as spots or patches unevenly distributed at the surface of diverse cell types. Of note, vimentin could also be detected in extracellular particles and in the cytoplasm underlying areas of compromised plasma membrane. Interestingly, although overall colocalization of vimentin-positive spots with ACE2 or Spike was moderate, a selective enrichment of the three proteins was detected at elongated structures, positive for acetylated tubulin and ARL13B. These structures, consistent with primary cilia, concentrated Spike binding at the top of the cells. Our results suggest that a vimentin-Spike interaction could occur at selective locations of the cell surface, including ciliated structures, which can act as platforms for SARS-CoV-2 docking.

Resumen: Escenario: La prevalencia de enfermedad renal crónica (ERC) aumenta en población mayor de 65 años y asocia morbilidad, dependencia y fragilidad. La diálisis peritoneal (DP) se ha considerado una técnica de paciente joven y vida activa. Hipótesis: La DP puede ser adecuada en pacientes de edad avanzada. Buscamos resultados desfavorables que contravengan esta hipótesis. Objetivo: Describir el tratamiento con DP en mayores de 65 años, evaluar su evolución clínica comparada con los menores de 65 e identificar áreas de mejora asistencial. Estudio: Prospectivo, observacional y multicéntrico en incidentes en DP, seguimiento hasta evento o fin del estudio (ene-2003 a ene-2018). Resultados: Se incluyen 2.435 pacientes; el 31,9% (777) eran mayores de 65 años. El tiempo medio de seguimiento fue de 2,1 años para ambos grupos. El grupo de edad avanzada era 25 años mayor, con más comorbilidad: diabetes (29,5% vs. 17,2%; p 65: 2,4 [1,9-3,0]; DM: 1,6 [1,3-2,1]; CV: 2,1 [1,7-2,7]. Y para el evento fallo de la técnica y paso a HD: Edad > 65: 1,5 [1,3-1,9]; DM: 1,6 [1,3-1,9]; trasplante renal previo: 1,5 [1,2-2,0]. Conclusión: Los pacientes mayores de 65 años cumplen los objetivos de calidad intermedios y se mantienen en DP el tiempo suficiente como para seguir ofertando esta técnica. Es necesario mejorar la prevención de infecciones y del agotamiento del paciente/cuidador con medidas de soporte para evitar la transferencia a HD por causas ajenas a las complicaciones de la técnica. Abstract: Background: Chronic kidney disease (CKD) is increasing in patients older than 65 years and is related to morbidity, frailty, and dependence. Peritoneal dialysis (PD) has classically been associated with young patients with an active life. Hypothesis: PD should be offered to patients over 65 years. We search for any unfavorable results that may advice not to recommend PD therapy for this group. Objective: To describe PD treatment and outcomes in patients > 65 years, to compare their results with patients 65 years. The main reason was caregiver or patient fatigue (20.2%), and not technique failure (7.3%).Multivariate Cox regression analysis showed a relation (HR [95%CI]) between mortality and age > 65 years 2.4 [1.9-3.0]; DM 1.6 [1.3-2.1]; CV events 2.1 [1.7-2.7]. Multivariate Cox regression analysis identify a relation between technique failure and age > 65 years 1.5 [1.3-1.9]; DM 1.6 [1.3-1.9] and previous transplant 1.5 [1.2-2.0]. Conclusion: Patients older than 65 years fulfilled PD adequacy criteria during the follow up. We believe PD is a valid option for patients older 65 years. It is necessary to try to prevent infections and patient/caregiver fatigue, to avoid HD transfer for reasons not related to technique failure.

Background: Chronic kidney disease (CKD) is increasing in patients older than 65 years and is related to morbidity, frailty, and dependence. Peritoneal dialysis (PD) has classically been associated with young patients with an active life. Hypothesis: PD should be offered to patients over 65 years. We search for any unfavorable results that may advice not to recommend PD therapy for this group. Objective: To describe PD treatment and outcomes in patients > 65 years, to compare their results with patients < 65 years and to identify areas with room for improvement in a real-life study. Study: Prospective, observational, and multicenter study performed in incident PD patients, from January 2003 until January 2018. Results: We included 2,435 PD patients, 31.9% were older than 65 years; there was a difference of 25 years between both groups. Median follow up was 2.1 years. Older than 65 years group had more comorbidity: Diabetes (29.5% vs 17.2%; p < 0.001), previous CV events 34.5% vs 14.0%; p < 0.001), Charlson index (3.8 vs 3.0; p < 0.001).We did not find differences in efficacy and PD adequacy objectives fulfillment, anaemia management or blood pressure during follow-up. Peritonitis rate was higher in older 65 years group (0.65 vs 0.45 episodes/patient/year; p < 0.001), but there was not differences in germs, admission rate and follow up. Mortality was higher in older 65 years group (28.4% vs 9.4%) as expected. PD permanence probability was similar (2.1 years). The main cause of PD withdrawal was transplant in group < 65 years (48.3%) and transfer to HD in group > 65 years. The main reason was caregiver or patient fatigue (20.2%), and not technique failure (7.3%).Multivariate Cox regression analysis showed a relation (HR [95%CI]) between mortality and age > 65 years 2.4 [1.9-3.0]; DM 1.6 [1.3-2.1]; CV events 2.1 [1.7-2.7]. Multivariate Cox regression analysis identify a relation between technique failure and age > 65 years 1.5 [1.3-1.9]; DM 1.6 [1.3-1.9] and previous transplant 1.5 [1.2-2.0]. Conclusion: Patients older than 65 years fulfilled PD adequacy criteria during the follow up. We believe PD is a valid option for patients older 65 years. It is necessary to try to prevent infections and patient/caregiver fatigue, to avoid HD transfer for reasons not related to technique failure. Resumen: Escenario: La prevalencia de enfermedad renal crónica (ERC) aumenta en población mayor de 65 años y asocia morbilidad, dependencia y fragilidad. La diálisis peritoneal (DP) se ha considerado una técnica de paciente joven y vida active. Hipótesis: La DP puede ser adecuada en pacientes de edad avanzada. Buscamos resultados desfavorables que contravengan esta hipótesis. Objetivo: Describir el tratamiento con DP en mayores de 65 años, evaluar su evolución clínica comparada con los menores de 65 e identificar áreas de mejora asistencial. Estudio: Prospectivo, observacional y multicéntrico en incidentes en DP, seguimiento hasta evento o fin del estudio (ene-2003 a ene-2018). Resultados: Se incluyen 2.435 pacientes; el 31,9% (777) eran mayores de 65 años. El tiempo medio de seguimiento fue de 2,1 años para ambos grupos. El grupo de edad avanzada era 25 años mayor, con más comorbilidad: diabetes (29,5% vs. 17,2%; p < 0,001), evento CV previo (34,5% vs. 14,0%; p < 0,001) e índice de Charlson sin edad (3,8 vs. 3,0; p < 0,001). No encontramos diferencias en cumplimiento de objetivos intermedios de eficacia de DP, control de anemia o hipertensión durante el seguimiento. La tasa de peritonitis fue mayor en la cohorte mayor de 65 años (0,65 vs. 0,45 episodios/paciente-año; p < 0,001), aunque la distribución gérmenes, tasa de ingreso y evolución final fue similar en ambos grupos. Lógicamente, registramos mayor mortalidad en el grupo mayor de 65 años (28,4% vs. 9,4%), aunque el tiempo de permanencia en DP fue similar (2,1 años). La principal causa de salida fue el trasplante renal en jóvenes (48,3%), mientras que en los pacientes de mayor edad fue el paso a hemodiálisis, principalmente por cansancio de cuidador/autocuidado (20,2%) y no por fallo de la técnica (7,3%). El análisis multivariante por regresión de Cox identifica los factores de riesgo para mortalidad con los siguientes HR [IC 95%]: Edad > 65: 2,4 [1,9-3,0]; DM: 1,6 [1,3–2,1]; CV: 2,1 [1,7–2,7]. Y para el evento fallo de la técnica y paso a HD: Edad > 65: 1,5 [1,3–1,9]; DM: 1,6 [1,3–1,9]; trasplante renal previo: 1,5 [1,2-2,0]. Conclusión: Los pacientes mayores de 65 años cumplen los objetivos de calidad intermedios y se mantienen en DP el tiempo suficiente como para seguir ofertando esta técnica. Es necesario mejorar la prevención de infecciones y del agotamiento del paciente/cuidador con medidas de soporte para evitar la transferencia a HD por causas ajenas a las complicaciones de la técnica.

Iron participates in myriad processes necessary to sustain life. During the past decades, great efforts have been made to understand iron regulation and function in health and disease. Indeed, iron is associated with both physiological (e.g., immune cell biology and function and hematopoiesis) and pathological (e.g., inflammatory and infectious diseases, ferroptosis and ferritinophagy) processes, yet few studies have addressed the potential functional link between iron, the aforementioned processes and extramedullary hematopoiesis, despite the obvious benefits that this could bring to clinical practice. Further investigation in this direction will shape the future development of individualized treatments for iron-linked diseases and chronic inflammatory disorders, including extramedullary hematopoiesis, metabolic syndrome, cardiovascular diseases and cancer.

In last years, the requirements for materials and devices have increased exponentially. Greater competitiveness; cost and weight reduction for structural materials; greater power density for electronic devices; higher design versatility; materials customizing and tailoring; lower energy consumption during the manufacturing, transport, and use; among others, are some of the most common market demands. A higher operational efficiency together with long service life claimed. Particularly, high thermally conductive in epoxy resins is an important requirement for numerous applications, including energy and electrical and electronic industry. Over time, these materials have evolved from traditional single-function to multifunctional materials to satisfy the increasing demands of applications. Considering the complex application contexts, this review aims to provide insight into the present state of the art and future challenges of thermally conductive epoxy composites with various functionalities. Firstly, the basic theory of thermally conductive epoxy composites is summarized. Secondly, the review provides a comprehensive description of five types of multifunctional thermally conductive epoxy composites, including their fabrication methods and specific behavior. Furthermore, the key technical problems are proposed, and the major challenges to developing multifunctional thermally conductive epoxy composites are presented. Ultimately, the purpose of this review is to provide guidance and inspiration for the development of multifunctional thermally conductive epoxy composites to meet the increasing demands of the next generation of materials.

Se presenta una revisión analítica de las dos placas marmóreas localizadas en la parroquia de Carcacía (Padrón), expuestas en el Museo de la Catedral de Santiago de Compostela. En función del análisis arqueométrico realizado dentro del proyecto “Marmora Galicia”, frente a la consideración generalizada de que se trataba de piezas realizadas en mármol local, éste se ha podido caracterizar como procedente de las canteras de Trigaches-São Brissos, en la provincia romana de Lusitania. Esa y otras consideraciones llevan a cuestionarse el momento de importación de estas piezas al noroeste, así como el sentido y la función que podrían haber cumplido estas piezas en su lugar de destino.

The bioavailability and regulation of iron is essential for central biological functions in mammals. The role of this element in ferroptosis and the dysregulation of its metabolism contribute to diseases, ranging from anemia to infections, alterations in the immune system, inflammation and atherosclerosis. In this sense, monocytes and macrophages modulate iron metabolism and splenic function, while at the same time they can worsen the atherosclerotic process in pathological conditions. Since the nucleotide-binding oligomerization domain 1 (NOD1) has been linked to numerous disorders, including inflammatory and cardiovascular diseases, we investigated its role in iron homeostasis. The iron content was measured in various tissues of Apoe-/- and Apoe-/-Nod1-/- mice fed a high-fat diet (HFD) for 4 weeks, under normal or reduced splenic function after ligation of the splenic artery. In the absence of NOD1 the iron levels decreased in spleen, heart and liver regardless the splenic function. This iron decrease was accompanied by an increase in the recruitment of F4/80+-macrophages in the spleen through a CXCR2-dependent signaling, as deduced by the reduced recruitment after administration of a CXCR2 inhibitor. CXCR2 mediates monocyte/macrophage chemotaxis to areas of inflammation and accumulation of leukocytes in the atherosclerotic plaque. Moreover, in the absence of NOD1, inhibition of CXCR2 enhanced atheroma progression. NOD1 activation increased the levels of GPX4 and other iron and ferroptosis regulatory proteins in macrophages. Our findings highlight the preeminent role of NOD1 in iron homeostasis and ferroptosis. These results suggest promising avenues of investigation for the diagnosis and treatment of iron-related diseases directed by NOD1.

The sperm nucleus is prone to sustain DNA damage before and after ejaculation. Distribution of the damage is not homogeneous, and the factors determining differential sensitivity among nuclear regions have not yet been characterized. Human sperm chromatin contains three structural domains, two of which are considered the most susceptible to DNA damage: the histone bound domain, harboring developmental related genes, and the domain associated with nuclear matrix proteins. Using a quantitative polymerase chain reaction (qPCR) approach, we analyzed the number of lesions in genes homeobox A3 (HOXA3), homeobox B5 (HOXB 5), sex-determining region Y (SRY)-box 2 (SOX2), β-GLOBIN, rDNA 18S, and rDNA 28S in human sperm after ultraviolet irradiation (400 μW cm−2, 10 min), H2O2treatment (250 mmol l−1, 20 min), and cryopreservation, which showed differential susceptibility to genetic damage. Differential vulnerability is dependent on the genotoxic agent and independent of the sperm nuclear proteins to which the chromatin is bound and of accessibility to the transcription machinery. Immunodetection of 8-hydroxy-2'-deoxyguanosine (8-OHdG) showed that the highest level of oxidation was observed after H2O2treatment. The distribution of oxidative lesions also differed depending on the genotoxic agent. 8-OHdG did not colocalize either with histone 3 (H3) or with type IIα + β topoisomerase (TOPO IIα + β) after H2O2treatment but matched perfectly with peroxiredoxin 6 (PRDX6), which is involved in H2O2metabolism. Our study reveals that the characteristics of the sperm head domains are responsible for access of the genotoxicants and cause differential degree of damage to nuclear areas, whereas chromatin packaging has a very limited relevance. The histone-enriched genes analyzed cannot be used as biomarkers of oxidative DNA damage.

San Cristóbal de Las Casas es una ciudad dinámica y compleja, entre otras cosas por alojar diferentes interpretaciones en torno a lo sagrado que la convierten en un espacio de disputa entre diversos grupos religiosos, entre ellos los musulmanes de reciente aparición. La presencia del islam en la región de los Altos de Chiapas está estrechamente relacionada con la expulsión de indígenas conversos al protestantismo de San Juan Chamula. En San Cristóbal de las Casas, actualmente se ubica una población aproximada de 300 musulmanes, en su mayoría chamulas. La relevancia de la presencia del islam en Chiapas se manifiesta en una de sus mezquitas: Imam Malik, considerada el centro islámico de oración más ambicioso en México por su construcción, materiales y extensión. Los distintos inmuebles materializan el islam por medio de la orientación, el color, la ornamentación y la disposición, sin marginar la lógica y función de áreas fundamentadas en la jurisprudencia islámica, sin embargo, se adaptan a dinámicas, tradiciones y visiones particulares como la chamula.

Introducción: En la estenosis aórtica grave con gradiente bajo, fracción de expulsión preservada (≥ 50%) y flujo bajo (GB/FBp), la disminución del índice de volumen sistólico (IVS) podría deberse a una reducción de la contractilidad. El objetivo de este estudio fue analizar si la disminución del IVS se relaciona con la de la contractilidad. Métodos: Se estudió a 30 pacientes con GB/FBp y 63 individuos normales con Doppler cardíaco. El nivel de contractilidad (NC) se valoró mediante la relación entre la fracción de acortamiento mesoparietal (FAm) y el estrés de fin de sístole (EFS). Se calculó el espesor parietal relativo (EPR) y el área valvular aórtica (AVA). Resultados: El NC estuvo disminuido en el 40% de los pacientes con GB/FBp. En el análisis bivariado, el NC se correlacionó con el EPR y la FAm, pero no con el IVS, el cual mantuvo correlación con el AVA. En el análisis de regresión lineal múltiple, el EPR y la FAm fueron variables predictoras independientes del NC y el AVA del IVS. Conclusión: La contractilidad estuvo deprimida en el 40% de los pacientes con GB/FBp a pesar de tener fracción de expulsión preservada. El NC se correlacionó con el acortamiento circunferencial (FAm) y la geometría ventricular (EPR). La disminución del IVS que caracteriza a los pacientes con GB/FBp parece vincularse más con la gravedad de la estenosis aórtica y menos con la disminución de la contractilidad.

Self-healing materials have attracted great interest in recent years. Particularly, the use of thermoset/thermoplastics blends has emerged as a good option with relatively low activation temperatures and potential infinite healing cycles. Nevertheless, a methodical study of healing conditions and evaluation is still required for further industrial development. The effect of activation temperature and crack morphology in polycaprolactone (PCL)/epoxy blends are explored. For this purpose, PCL content was varied (5, 10, and 15 wt %) with contents lower than critical composition. Therefore, the morphology of all studied blends is the epoxy matrix with a separated PCL phase. In this sense, an increase in PCL content leads to a reduction in the Tg, due to the partial PCL miscibility, and the presence of larger PCL domains. It was observed that a higher temperature (150 °C) and PCL content led to a more efficient self-healing process because of both the lower viscosity of the melted PCL at higher temperatures and the presence of larger PCL reservoirs when increasing the PCL content. Crack morphology influence was studied by inducing cracks with different tools: a custom crack machine with a cutting blade, a scalpel, and a pin. The results show that the recovery was better when the cracks were smaller and shallower, that is, with the pin. In addition, the healing efficiency by means of both parameters, crack volume and depth change, showed more similar results in slimmer cracks, due to a lower crack width-to-depth ratio.

El yacimiento arqueológico de Currás (Tomiño), descubierto en el año 1972, ha sido objeto de nuevos estudios 40 años después. Gracias al proyecto de investigación llevado a cabo entre los años 2013 y 2015, se ha recuperado material gráfico y arqueológico inédito de la primera intervención, y se han documentado en detalle las principales características de este yacimiento, lo que ha permitido obtener una percepción más completa de este asentamiento romano y de su necrópolis tardorromana y altomedieval. En este artículo presentamos los principales resultados de esta investigación que aporta nuevos datos sobre los asentamientos rurales en el territorio del Baixo Miño y consecuentemente en el Noroeste de la Península Ibérica. [gl] O xacemento arqueolóxico de Currás (Tomiño), descuberto no ano 1972, voltou a ser obxecto de estudio 40 anos despois. Grazas a un proxecto de investigación levado a cabo entre os anos 2013 e 2015 recuperouse material gráfico e arqueolóxico inédito do momento da descuberta, así como se documentaron en detalle as principais características deste xacemento romano e da súa necrópole tardorromana e altomedieval. Neste artigo presentamos os principais resultados deste estudo que aporta novas consideracións sobre este tipo de asentamentos rurais no territorio do Baixo Miño e consecuentemente no Noroeste da Península Ibérica.

Major Depression is a complex disorder with a growing incidence worldwide and multiple variables have been associated with its etiology. Nonetheless, its diagnosis is continually changing and the need to understand it from a multidimensional perspective is clear. The purpose of this study was to identify risk factors for depression in a case-control study with 100 depressive inpatients and 87 healthy controls. A multivariate logistic regression analysis was performed including psychosocial factors, cognitive maladaptive schema domains, and specific epigenetic marks (BDNF methylation levels at five CpG sites in promoter IV). A family history of depression, the cognitive schemas of impaired autonomy/performance, impaired limits, other-directedness, and the methylation level of a specific CpG site were identified as predictors. Interestingly, we found a mediating effect of those cognitive schemas in the relationship between childhood maltreatment and depression. Also, we found that depressive patients exhibited hypomethylation in a CpG site of BDNF promoter IV, which adds to the current discussion about the role of methylation in depression. We highlight that determining the methylation of a specific region of a single gene offers the possibility of accessing a highly informative an easily measurable variable, which represents benefits for diagnosis. Following complete replication and validation on larger samples, models like ours could be applicable as additional diagnostic tools in the clinical context.

The repair performance of the so-called self-healing polymer systems has been extensively studied in recent works. However, the characterization methodology carried out to analyze the repair performance of these materials has not been widely discussed. Herein, a study of the influence of the characterization parameters on the self-healing capabilities of a 2-Aminophenyl disulfide (AFD)/epoxy system via convective heating is carried out. Results show a decrease in the self-healing efficiency proportional to the damage depth. Finally, increasing the healing temperature and time does not significantly affect the repair performance, obtaining similar self-healing efficiency values (>>95%) in all cases.

Adipose tissue secretes various peptides, including leptin. This hormone acts through the leptin receptor (Ob-R), which is expressed ubiquitously on the surface of various cells, including breast cancer cells and immune cells. Increasing evidence points to an interaction between the tumor microenvironment, tumor cells, and the immune system. Leptin plays an important role in breast cancer tumorigenesis and may be implicated in activation of the immune system. While breast cancer cannot be considered an immunogenic cancer, the triple-negative subtype is an exception. Specific immune cells - tumor infiltrating lymphocytes - are involved in the immune response and act as predictive and prognostic factors in certain breast cancer subtypes. The aim of this article is to review the interaction between adipose tissue, through the expression of leptin and its receptor, and the adaptive immune system in breast cancer.

Objetivos: Analizar las infecciones del orificio de salida del catéter peritoneal, identificando los principales factores relacionados con las mismas; asimismo se ha comparado la efectividad de un protocolo basado en la utilización diaria de mupirocina tópica en la cura del orificio de salida frente a la utilización suero salino. Material y Método: Estudio observacional, retrospectivo. Recogimos variables demográficas, clínicas, la etiología y evolución de los episodios de infección del orificio en un periodo de 2 años. Utilizamos un protocolo de profilaxis con suero fisiológico y con mupirocina crema al 2%. Resultados: Estudiamos 75 pacientes, edad media 60,3±13,9 años, 66,7% varones, mediana de tiempo en diálisis peritoneal 24,3 meses (rango intercuartílico 11-48,7). La incidencia de infección del orificio de salida fue del 26,7%, el 77% fueron originadas por microorganismos de piel y mucosas. La infección del orificio de salida se relacionó con el estado portador nasal de Staphylococcus aureus (p=0,048) y la extrusión del dacron externo (p=0,004). De los 4 pacientes que presentaron una peritonitis secundaria a la infección del orificio de salida, 3 fueron trasferidos a hemodiálisis (p=0,025). Con el protocolo de antibioterapia tópica diaria se redujo un 68% la tasa de infecciones. Conclusiones: La exteriorización del anillo externo del catéter peritoneal es un factor predisponente de infecciones. La aplicación diaria de mupirocina es una estrategia efectiva para reducir la incidencia de infección del orificio y peritonitis. La erradicación de portadores nasales de Staphylococcus aureus puede contribuir a reducir la pérdida del catéter y la transferencia a hemodiálisis.

Las redes sociales virtuales se han convertido en los últimos años en el fenómeno tecnológico-humano que ha marcado un antes y un después en la sociedad. Las relaciones comerciales y laborales, la transmisión de la información, la adquisición de conocimiento, pero también las interacciones grupales y personales han experimentado una regeneración que obliga a plantearse si los viejos paradigmas pueden seguir siendo útiles para comprender las reglas sociales. En el presente artículo expondremos el surgimiento de las redes sociales virtuales, cómo estas se diferencian de las redes tradicionales o clásicas y cuáles son los aspectos que en este nuevo modelo de interacción, permiten mejorar nuestras relaciones con los demás y nuestra propia satisfacción.

Bath constructions are today among other monuments one of the better preserved and studied monuments of the Roman Empire. Nevertheless, there remains a significant research gap as to the nature of water exploited within. The mineral-medicinal waters, in fact, conditioned not only the location, but also the function and, consequently, the architecture of these features. Hence, one of the main objectives of our current study is to highlight the main architectonic and functional characteristics of these bathing complexes. This paper thus advances a first distribution map specifically defining the spread of the better preserved and/or better documented spas using mineral-medicinal waters in the Roman Empire (henceforth referred to as healing or thermal spas/baths). This study also advances the current state of research on the question, some of the main characteristics of these types of complexes, as well as some of the drawbacks to their study. Resumen Hoy en día los edificios de baños son uno de los monumentos mejor conservados y estudiados del Imperio Romano. Sin embargo, existe un significativo vacío en su caracterización en función del agua utilizada en ellos. Las aguas mineromedicinales, de hecho, condicionaron no solo la localización, sino también la función, y consecuentemente, la arquitectura de estos edificios. De acuerdo con esa consideración, uno de los principales objetivos de este estudio es proporcionar una primera síntesis de los rasgos más característicos de estos complejos de baños, a partir de una selección de los edificios balnearios con aguas mineromedicinales mejor conservados y documentados del Imperio Romano. En ese sentido, se presenta un primer mapa de distribución, así como una revisión del estado de la investigación sobre estos establecimientos, atentos a algunas de las dificultades de su estudio desde una perspectiva global.

Background and aims: Acute kidney injury (AKI) is associated with higher mortality and length of stay (LOS) for hospitalized patients. To improve outcomes, an electronic detection system could be a useful tool for early diagnosis. Methods: A fully automated real-time system for detecting decreased glomerular filtration rate in adult patients was developed in our hospital, DETECT-H project. AKI was established according to KDIGO guidelines. Results: In six months, 1241 alerts from 11,022 admissions were issued. Overall incidence of AKI was 7.7%. Highest AKI stage reached was: stage 1 (49.8%), 2 (24.5%) and 3 (25.8%), in-hospital mortality was 10.9%, 22.7%, 33.9% respectively and 57.1% in AKI requiring dialysis; mortality in stable CKD was 4.3%. Median LOS was 8 days versus 5 days for all patients. AKI was associated with a mortality of 3.18 (95% CI 1.80–5.59) and a LOS 1.52 (1.11–2.08) times as high as that for admissions without AKI. Multivariate analysis indicated that a LOS higher than 8 days was associated with AKI. Previous CKD was noted in 31.9% and AKI in 45.3% at discharge. As compared to the use of the detect system, only one third of CKD patients and half of AKI episodes were identified. Conclusions: CKD and in-hospital AKI are under-recognized entities. Mortality and LOS are increased in-hospital patients with renal dysfunction. AKI severity was associated with higher mortality and LOS. An automated electronic detection system for identifying renal dysfunction would be a useful tool to improve renal outcomes. Resumen: Introducción y objetivos: El fracaso renal agudo (FRA) aumenta la mortalidad y la estancia hospitalarias (EH). El empleo de sistemas de detección electrónica podría ser una herramienta beneficiosa para mejorar estos resultados. Métodos: Se desarrolló un sistema de detección automático a tiempo real de pacientes ingresados con función renal alterada, denominado proyecto DETECT-H. El FRA se estableció de acuerdo con las guías KDIGO. Resultados: En 6 meses, 1.241 alertas fueron recogidas de 11.022 ingresos. La incidencia global del FRA fue del 7,7%. La distribución en función del estadio máximo del FRA alcanzado fue: estadio 1: 49,8%, estadio 2: 24,5% y estadio 3: 25,8%; con una mortalidad hospitalaria del 10,9, 22,7 y 33,9%, respectivamente. En el caso del FRA con necesidad de diálisis fue del 57,1%. La mortalidad en pacientes con enfermedad renal crónica (ERC) estable fue del 4,3%. La mediana de EH en pacientes detectados fue 8 vs. 5 días para todos los pacientes hospitalizados. El FRA se asoció con una mortalidad 3,18 (1,8-5,59) y una EH 1,52 (1,11-2,08) veces superior que aquellos ingresos sin FRA. El análisis multivariante indicó que el FRA se asociaba con la EH > 8 días.En los informes de alta, la presencia de ERC previa solo fue registrada en el 31,9% de los pacientes con ERC y el FRA hospitalario en el 45,3%. Conclusiones: La ERC y el FRA intrahospitalario son entidades infradiagnosticadas. La mortalidad y la EH están aumentadas en pacientes con disfunción renal. La gravedad del FRA se asoció con mayor mortalidad y EH. Un sistema de detección automático para identificarlos podría ser útil para mejorar estos resultados. Keywords: Acute kidney injury, Automated electronic detection system, Chronic kidney disease, Diagnosis, Health information technology, Mortality, Palabras clave: Fracaso renal agudo, Sistema de detección electrónica automática, Enfermedad renal crónica, Diagnóstico, Tecnología de información de la salud, Mortalidad

Abstract Evolutionary multiobjective optimization has been a research area since the mid-1980s, and has experienced a very significant activity in the last 20 years. However, and in spite of the maturity of this field, there are still several important challenges lying ahead. This paper provides a short description of some of them, with a particular focus on open research areas, rather than on specific research topics or problems. The main aim of this paper is to motivate researchers and students to develop research in these areas, as this will contribute to maintaining this discipline active during the next few years.

Polychlorinated dibenzo-p-dioxins (PCDDs) are known to be a group of compounds of high toxicity for animals and, particularly, for humans. Given that the most common method to destroy these compounds is by high-temperature combustion, finding other routes to render them less toxic is of paramount importance. Taking advantage of the physisorption properties of nanotubes, we studied the reactions of atomic hydrogen on physisorbed PCDDs using DFT; likewise, we investigated the reaction of molecular hydrogen on PCDDs aided by Ni10 and Ni13 clusters adsorbed on single-wall carbon nanotubes. Because dihydrogen is an easily accessible reactant, we found these reactions to be quite relevant as dehydrohalogenation methods to address PCDD toxicity.

Two series of novel amphiphilic compounds were synthesized based on carbamates and ureas structures, using a modification of the synthesis methods reported by bibliography. The compounds were tested for organic solvent removal in a model wastewater. The lipophilic group of all compounds was a hexadecyl chain, while the hydrophilic substituent was changed with the same modifications in both series. The structures were confirmed by FT-IR, NMR, molecular dynamic simulation and HR-MS and their ability to gel organic solvents were compared. The SEM images showed the ureas had a greater ability to gel organic solvents than the carbamates and formed robust supramolecular networks, with surfaces of highly interwoven fibrillar spheres. The carbamates produced corrugated and smooth surfaces. The determination of the minimum gelation concentration demonstrated that a smaller quantity of the ureas (compared to the carbamates, measured as the weight percentage) was required to gel each solvent. This advantage of the ureas was attributed to their additional N-H bond, which is the only structural difference between the two types of compounds, and their structures were corroborated by molecular dynamic simulation. The formation of weak gels was demonstrated by rheological characterization, and they demonstrated to be good candidates for the removal organic solvents.

Background: Existing surveys on telenursing refer to specific areas of nursing after the implementation of a programme, but telenursing in general has not been fully evaluated from a prospective approach. Aim: Design and statistical validation of a telenursing questionnaire. Methods: A new questionnaire was designed with 18 paired (to avoid leading) questions (Likert-5) plus three dichotomous questions (randomly ordered, inspired by existing validated tests) to analyse the dimensions of: acceptance, usefulness and appropriateness of telenursing from the nursing point of view (7 min test). The questionnaire was validated by classical tests and item response tests (Rasch) using six computer-generated databases with different response profiles (tendency to be positioned against, neutral and positioned in favour) with two degrees of agreement between each pair of responses for each option. Results: Classical testing: Cronbach’s alphas (from 0.8 to 0.95), Kaiser–Meyer–Olkin (KMO) (0.93 to 0.95) and a significant p < 0.0001 for Bartlett’s test of sphericity were obtained. Rasch analysis: Reliability coefficients (0.94). Warm’s mean weighted likelihood estimates (0.94). Extreme infit-t and outfit-t values (+1.61 to −1.98). Conclusions: Both the classical test and the Rasch approaches confirm the usefulness of the new test for assessing nurses’ positioning in relation to telenursing.

Descripción del caso: Presentamos un informe de un caso sobre entrenamiento en diálisis peritoneal automatizada no asistida en una paciente con una deficiencia visual adquirida grave, cuya pérdida de visión se produjo de forma rápida y progresiva una vez elegida la técnica dialítica. Descripción del plan de cuidados: Se identificaron 5 diagnósticos enfermeros: Conocimientos deficientes: Tratamiento, dieta, higiene en Diálisis Peritoneal; disposición para mejorar el manejo del régimen terapéutico; trastorno de la percepción sensorial visual y auditiva; riesgo de cansancio en el desempeño del rol cuidador; temor y riesgo de infección. Se diseñó un plan de cuidados que incluía un plan de entrenamiento adaptado. Evaluación del plan: se logró un adecuado manejo de la técnica y de los problemas detectados, con un cambio positivo en todos los NOC establecidos en el plan: Conocimiento: Procedimientos terapéuticos; Preparación para el alta: Vida independiente; Conducta de cumplimiento; Orientación cognitiva; Conducta de compensación auditiva y visual; Bienestar del cuidador familiar; Conocimiento: Conductas sanitarias; Control del miedo; Integridad del acceso de DP y Control del riesgo.

Currently, the design of highly efficient materials for photochemical applications remains a challenge. In this study, an efficient semiconductor was prepared, based on a coordination complex (Cu-TTC) of Cu(I) and trithiocyanuric acid on ZnTiO3/TiO2 (ZTO/TO). The Cu-TTC/ZTO/TO composite was prepared by the solvothermal method at room temperature. The structural, optical, and electrochemical characteristics, as well as the photocatalytic performance of the composite, were experimentally and computationally studied. The results show that the Cu-TTC/ZTO/TO composite efficiently extended its photoresponse in the visible region of the electromagnetic spectrum. The electrochemistry of the proposed tautomeric architecture (s-Cu-TTC) clearly reveals the presence of metal–ligand charge-transfer (MLCT) and π → π* excitations. The maximum methylene blue (MB) dye photodegradation efficiency of 95% in aqueous solutions was achieved under the illumination of simulated solar light. Finally, computational calculations based on the Density Functional Theory (DFT) method were performed to determine the electronic properties of the s-Cu-TTC tautomeric structure and clarify the adsorption mechanism of this complex on the surface (101) of both ZnTiO3 and TiO2 oxides. The results obtained allow us to suggest that the Cu-TTC complex is an effective charge carrier and that the Cu-TTC/ZTO/TO composite can be used efficiently for photochemical applications.

Cardiovascular diseases (CVDs) incidence is becoming higher. This fact is promoted by metabolic disorders such as obesity, and aging. Atherosclerosis is the underlying cause of most of these pathologies. It is a chronic inflammatory disease that begins with the progressive accumulation of lipids and fibrotic materials in the blood-vessel wall, which leads to massive leukocyte recruitment. Rupture of the fibrous cap of the atherogenic cusps is responsible for tissue ischemic events, among them myocardial infarction. Extramedullary hematopoiesis (EMH), or blood cell production outside the bone marrow (BM), occurs when the normal production of these cells is impaired (chronic hematological and genetic disorders, leukemia, etc.) or is altered by metabolic disorders, such as hypercholesterolemia, or after myocardial infarction. Recent studies indicate that the main EMH tissues (spleen, liver, adipose and lymph nodes) complement the hematopoietic function of the BM, producing circulating inflammatory cells that infiltrate into the atheroma. Indeed, the spleen, which is a secondary lymphopoietic organ with high metabolic activity, contains a reservoir of myeloid progenitors and monocytes, constituting an important source of inflammatory cells to the atherosclerotic lesion. Furthermore, the spleen also plays an important role in lipid homeostasis and immune-cell selection. Interestingly, clinical evidence from splenectomized subjects shows that they are more susceptible to developing pathologies, such as dyslipidemia and atherosclerosis due to the loss of immune selection. Although CVDs represent the leading cause of death worldwide, the mechanisms involving the spleen-atherosclerosis-heart axis cross-talk remain poorly characterized.

Background: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%–23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%–6.2%, 95% CI), asthma 2.7% (2.2%–3.0%, 95% CI), coronary heart disease 2.4% (2.0%–2.7%, 95% CI), stroke and heart failure 1.5% (1.2%–1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%–1.5%, 95% CI), and cancer 1.2% (1.0%–1.5%, 95% CI). Among the study sample, 23.3% (22.4%–24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%–7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education. The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.

Background: The 5-year survival rate of patients with pancreatic ductal adenocarcinoma (PDAC) is around 5% due to the fact that the majority of patients present with advanced disease that is treatment resistant. Familial pancreatic cancer (FPC) is a rare disorder that is defined as a family with at least two affected first degree relatives, with an estimated incidence of 4%–10%. The genetic basis is unknown in the majority of families although around 10%–13% of families carry germline mutations in known genes associated with hereditary cancer and pancreatitis syndromes. Methods: Panel sequencing was performed of 35 genes associated with hereditary cancer in 43 PDAC cases from families with an apparent hereditary pancreatic cancer syndrome. Findings: Pathogenic variants were identified in 19% (5/26) of PDAC cases from pure FPC families in the genes MLH1, CDKN2A, POLQ and FANCM. Low frequency potentially pathogenic VUS were also identified in 35% (9/26) of PDAC cases from FPC families in the genes FANCC, MLH1, PMS2, CFTR, APC and MUTYH. Furthermore, an important proportion of PDAC cases harboured more than one pathogenic, likely pathogenic or potentially pathogenic VUS, highlighting the multigene phenotype of FPC. Interpretation: The genetic basis of familial or hereditary pancreatic cancer can be explained in 21% of families by previously described hereditary cancer genes. Low frequency variants in other DNA repair genes are also present in 35% of families which may contribute to the risk of pancreatic cancer development. Funding: This study was funded by the Instituto de Salud Carlos III (Plan Estatal de I + D + i 2013–2016): ISCIII (PI09/02221, PI12/01635, PI15/02101 and PI18/1034) and co-financed by the European Development Regional Fund ‘‘A way to achieve Europe’’ (ERDF), the Biomedical Research Network in Cancer: CIBERONC (CB16/12/00446), Red Temática de investigación cooperativa en cáncer: RTICC (RD12/0036/0073) and La Asociación Española contra el Cáncer: AECC (Grupos Coordinados Estables 2016). Keywords: Familial pancreatic cancer, Panel sequencing, DNA repair and hereditary cancer genes, Pathogenic variants

Deprivation is associated with an increased risk of developing chronic health conditions and with worse outcomes in multimorbidity. The goal of our study was to develop an integrated population index of deprivation (IPID) to observe the influence of deprivation on morbidity and the subsequent use of healthcare resources in one health district, using the socioeconomic, clinical and geographical data from its administrative health records. Eight socioeconomic indicators were identified and weighted using the methodology of two-phase principal component analysis, providing an index that allowed each census section to be classified into seven deprivation groups. Secondly, the possible relation between the IPID and the variables for multimorbidity and healthcare resources was analysed using the theory of multiple comparisons. It was observed that places with a greater proportion of healthy people presented lower values of deprivation and that, at lower levels of deprivation, there were fewer hospital admissions. The results show that living in an area with a higher deprivation index is associated with greater consumption of healthcare resources and disease burden. Identifying areas of sociosanitary vulnerability can help to identify health inequalities and allow intervention by clinical practices and healthcare management to reduce them.