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The present study aims to examine the predictive capacity that passion for studies and multidimensional academic procrastination have on burnout. The sample included 1648 first-year students at the National University of Distance Education (UNED). Hierarchical regression analyses were conducted in two blocks. The results reveal that both psychological processes influence burnout, but in distinct ways. Passion, particularly the harmonious type, acts as a protective factor, while the obsessive type has a slightly detrimental effect on all dimensions of burnout. The introduction of academic procrastination dimensions significantly enhances the predictive capacity of the model: core procrastination and work disengagement are positive predictors of burnout, while poor time management has a reverse effect concerning cynicism, functioning as a shield against detachment and devaluation of study. This study suggests new lines of research to address unresolved debates on academic procrastination and understand its impact on well-being, performance, and student dropout rates. [ABSTRACT FROM AUTHOR]

The aim of this work was to develop, for the first time, sustainable strategies, based on the use of Ultrasound-Assisted Extraction, Natural Deep Eutectic Solvents, and Pressurized Liquid Extraction, to extract proteins from lime (Citrus x latifolia) peels and to evaluate their potential to release bioactive peptides. PLE showed the largest extraction of proteins (66–69%), which were hydrolysed using three different enzymes (Alcalase 2.4 L FG, Alcalase®PURE 2.4 L, and Thermolysin). The in vitro antioxidant and antihypertensive activities of released peptides were evaluated. Although all hydrolysates showed antioxidant and antihypertensive activity, the hydrolysate obtained with Thermolysin showed the most significant values. Since the Total Phenolic Content in all hydrolysates was low, peptides were likely the main contributors to these bioactivities. Hydrolysates were analyzed by UHPLC-QTOF-MS and a total of 98 different peptides were identified. Most of these peptides were rich in amino acids associated with antioxidant activity. • Sustainable extraction of proteins from lime peels achieved by UAE, NaDES, and PLE. • Thermolysin enzyme originated most antioxidant and antihypertensive hydrolysates. • 98 peptides were identified in the hydrolysates by UHPLC-MS/MS. • Most identified peptides were rich in aromatic and non-polar residues. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022. Methods: Comparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors. Final sample n = 3308 in 2017 and n = 2277 in 2022. Outcome variables: experience of cross-level information and clinical management coordination and perception of cross-level clinical coordination in the healthcare area and related factors. Stratification variables: level of care and year. Adjusting variables: sex, years of experience, type of specialty, type of hospital, type of management of PC/SC. Descriptive bivariate and multivariate analysis using Poisson regressions models to detect changes between years in total and by levels of care. Results: Compared with 2017, while cross-level clinical information coordination remained relatively high, with a slight improvement, doctors of both care levels reported a worse experience of cross-level clinical management coordination, particularly of care consistency (repetition of test) and accessibility to PC and, of general perception, which was worse in SC doctors. There was also a worsening in organisational (institutional support, set objectives, time available for coordination), attitudinal (job satisfaction) and interactional factors (knowledge between doctors). The use of ICT-based coordination mechanisms such as shared electronic medical records and electronic consultations between PC and SC increased, while the participation in virtual joint clinical conferences was limited. Conclusions: Results show a slight improvement in clinical information but also less expected setbacks in some dimensions of clinical management coordination and in the perception of clinical coordination, suggesting that the increased use of some ICT-based coordination mechanisms did not counteract the effect of the worsened organisational, interactional, and attitudinal factors during the pandemic. Strategies are needed to facilitate direct communication, to improve conditions for the effective use of mechanisms and policies to protect healthcare professionals and services in order to better cope with new crises. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022. Methods: Comparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors. Final sample n = 3308 in 2017 and n = 2277 in 2022. Outcome variables: experience of cross-level information and clinical management coordination and perception of cross-level clinical coordination in the healthcare area and related factors. Stratification variables: level of care and year. Adjusting variables: sex, years of experience, type of specialty, type of hospital, type of management of PC/SC. Descriptive bivariate and multivariate analysis using Poisson regressions models to detect changes between years in total and by levels of care. Results: Compared with 2017, while cross-level clinical information coordination remained relatively high, with a slight improvement, doctors of both care levels reported a worse experience of cross-level clinical management coordination, particularly of care consistency (repetition of test) and accessibility to PC and, of general perception, which was worse in SC doctors. There was also a worsening in organisational (institutional support, set objectives, time available for coordination), attitudinal (job satisfaction) and interactional factors (knowledge between doctors). The use of ICT-based coordination mechanisms such as shared electronic medical records and electronic consultations between PC and SC increased, while the participation in virtual joint clinical conferences was limited. Conclusions: Results show a slight improvement in clinical information but also less expected setbacks in some dimensions of clinical management coordination and in the perception of clinical coordination, suggesting that the increased use of some ICT-based coordination mechanisms did not counteract the effect of the worsened organisational, interactional, and attitudinal factors during the pandemic. Strategies are needed to facilitate direct communication, to improve conditions for the effective use of mechanisms and policies to protect healthcare professionals and services in order to better cope with new crises. [ABSTRACT FROM AUTHOR]

Two of the most significant challenges that higher education institutions are currently addressing is the prevention of students' failure and drop-out, and the promotion of students' retention, success, and wellbeing. Within the framework of the demands-resources model, the present study explored the role that different variables play in predicting academic engagement and burnout, two relevant and distinct characteristics that have been previously related to students' well-being and academic performance. We applied a multivariate approach with this aim in mind to analyse the contribution of relevant psychological strengths in academic environments (resilience, personal initiative, and academic motivation), the perception of academic demands, procrastination and different coping strategies when approaching studies (persistence, avoidance and anxiety), student's affect and academic satisfaction. The contribution of the efficacy subscale of academic burnout as an independent personal resource and the consideration of the so-called core burnout were also assessed. A sample of 173 first-year students of 20 face-to-face teaching universities participated in this study. The results showed, on the one hand, the positive nature of academic engagement, predicted by personal resources, characterised by intrinsic motivation and efficacy, as well as academic persistence, high levels of well-being and academic satisfaction. On the other hand, the predictors of academic burnout were mainly the perception of academic demands, procrastination, and negative affect, besides, in a negative sense, low levels of engagement and intrinsic motivation. Likewise, core burnout showed the same pattern of predictors as burnout, except for engagement and intrinsic motivation. [ABSTRACT FROM AUTHOR]

Introduction: Serveis de Salut Integrats Baix Empordà, SSIBE (Integrated Health Services Baix Empordà) is a healthcare organization which provides primary, acute and chronic care to a population of 130,000 inhabitants (17% aged 65 and over) in Catalonia, Spain. SSIBE put into effect a Proactive Attention Programme for patients with chronic, complex conditions in 2011. The population was identified as Chronic Complex Patient (CCP) by a predictive model which was based on health status (provided by Clinical Risk Group -CRG- system), pharmaceutical expenditure, and utilization of health resources. The interventions of the programme were: 1-Identification label (2011): it was available in the electronic medical record to identify CCP; 2-CCP lists (2012): delivered to primary doctors encouraging them to do a proactive attention; 3-CCP Day Hospital (2012): it was put into effect for preventing emergency admissions; 4-Shared Individual Intervention Plan (2012) health professionals wrote down physical, psychic, and social necessities of the patients. 5-Support Programme for Discharges (from 2010 to 2013): specialised care notified primary care of discharges;. In order to carry out the evaluation of the programme we grouped the target population into three groups randomly: the Partial Intervention Group (PIG): interventions 1 and 3-5 were applied; the Total Intervention Group (TIG): interventions from 1 to 5 were applied; and the Control Group (CG), usual care. Previously, we assessed the processes and clinical effectiveness of the programme and the findings didn't show relevant differences among groups. That encouraged us to close the whole evaluation process through an economic evaluation to measure the economic impact of it. Theory / Methods: The objectives were: to determine which intervention group was the better option, to obtain basic information about costs and how these had evolved in time horizon; and to know better the consumption patterns of the interventions groups in the integration context. Method: economic evaluation - minimization-cost analysis. Catchment: 4 areas in Baix Empordà managed by SSIBE. Population target: 6,490 patients aged 18 and over. Time horizon: 2011 (zero year); 2012 (put into effect of the interventions); 2013 (consolidation of the programme). Perspective from analysis: 1) activity, individual contacts (visits, admissions, re-admissions, medical sessions, etc.) of patients done during the time horizon, and 2) costs, the activity expressed in monetary units. Both perspectives had the following approaches: - Annual analysis: it was considered the annual activity of target population. - Time-series analysis: it was considered the whole activity of non-exitus population who were assigned to the same group each year. Results: For the zero year, the per-capita cost (net of drug cost) was: CG: 2.300€, PIG: 2.500€, and TIG: 2.540€. For the following years, it increased in CG / TIG while in PIG, it decreased only in 2012. For the time-series, the per-capita cost increased in all groups. The range cumulative variation of percentage was: PIG: 20%; CG: 31%, TIG: 35%. Approximately 60% of patients with chronic, complex conditions needed one or two resources. Nearly 35% needed from three to four resources and only the 2% of them needed all resources available. Discussion: In spite of our findings which are similar to ones of the other research, we know better how the cost has change over time and which combination of resources was more common among all those with chronic, complex conditions. Conclusion: Nonetheless the per-capita cost increased in all groups during the time analysed, there is not a clear evidence to determine which intervention group is the better option. 1. Key findings to date: The factors which could have increased the per-capita cost can be: the exacerbations suffered by patients, the combination of three or more health resources, the major complexity of patients treated. 2. Lessons learned: To know about the consumption patterns of the patients can be a clue when we decide to put into effect health programmes. 3. Limitations: The factors which could have affected the programme can be the organizational culture, the behaviour consumption of patients, the time to consolidate the interventions of the programme, and the external factors such as economic crisis. 4. Future research: The consumption patterns of all those with chronic, complex problems could be a key to understand better how the integration, coordination context works. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Materials and Methods: We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC). Results: We included 1064 patients (mean age 63years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n=621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001). Conclusions: Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach. [Copyright &y& Elsevier]

The purpose of this study is to explore the relationship between Academic Procrastination and Engagement, as well as the pattern of academic functioning of both variables, regarding the use of self-regulated learning strategies, both efficient and inefficient, as well as students' state previous to the exams. All variables were measured through self-report questionnaires, in a population of distance learning / online university students. Also, a possible buffering effect of Engagement on the harmful effects of academic procrastination is postulated. This differential pattern is more accurately analyzed by considering three profiles of students, those characterized by Pure Engagement, those characterized by pure Academic Procrastination and a mixed profile of procrastinators with medium-high Engagement levels. The results corroborate, on the one hand, the large differences that exist in how engaged and procrastinator students cope with their studies and, on the other hand, the clear buffering effect of engagement on academic procrastination that can be observed in the significant and positive improvement showed by the mixed profile both, in the type of self-regulated learning strategies used, and in its prior state to the exams. [ABSTRACT FROM AUTHOR]

The challenges posed by assessing learning in competence-based education become clearer when we deal with blended-learning systems, increasingly common even among "traditional" universities. In these systems, changes in pedagogic design and methodological renewal in the teaching and learning imply a series of complex processes. This article describes how the assessment of competences, especially generic ones, is being carried out in a blended-learning model. In order to do this, we analyse the introduction of new EHEA Degrees in UNED, in the 2009/10 academic year, from the point of view of the design of new courses. Our results are derived from two empirical phases: a quantitative one, in which we analyse study guides handed out to students by lecturers; and a qualitative one, for which we have carried out 23 in-depth interviews with those responsible for the implementation of degrees and lecturers, in order to find out about their views of the EHEA adaptation process. In both phases we stress the new competence-based assessment model and the use of homogenous protocols, such as rubrics. [ABSTRACT FROM AUTHOR]

According to post-mortem studies, luminal thrombosis occurs from plaque rupture, erosion and calcified nodules. In vivo studies have found thin cap fibroatheroma (TCFA) as the main vulnerable lesion, prone to rupture. Few data about other post-mortem lesions have been reported in vivo. Our main objective is to characterize in vivo the coronary plaques with intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT), in order to detect not only thin cap fibroatheroma (TCFA), but also other possible vulnerable lesions. The secondary objective is to correlate these findings with clinical and analytical data. Twenty-five patients (18 stable) submitted to coronary angiography were included in this pilot study. After angiography, the three vessels were studied (when possible) with IVUS-VH and OCT. Plaque characteristics were correlated with clinical and analytical data. Forty-six lesions were analyzed. IVUS-VH detected significant necrotic core in 15 (3 were definite TCFA). OCT detected TCFA in 10 lesions, erosion in 6, thrombus in 5 and calcified nodule in 8. Possible vulnerable lesion was found in 61% of stable and 57% of unstable patients. Erosions and calcified nodules were only found in stable patients. Those with significant necrotic core had higher body mass index (P=0.016), higher levels of hs-CRP (P=0.019) and triglycerides (P=0.040). The higher the levels of hs-CRP, the larger the size of the necrotic core (r=0.69, P=0.003). Lesions with characteristics of vulnerability were detected by IVUS-VH and OCT in more than 50% of stable and unstable coronary patients. A significant necrotic core was mainly correlated with higher hs-CRP. [ABSTRACT FROM AUTHOR]

The European Higher Education Area (EHEA) requires from universities a considerable organizational and methodological adaptation. One of the most interesting contributions of the EHEA is the treatment confered to the so-called generic or transversal competences, due to the relevat role they play as main contributors to the training of XXI century professionals, as well as to an integral formation of persons. The main goal of this study is to analyse how Spanish universities have come up with the incorporation of this type of competences from an institutional, degree and subject perspective. The methodology consisted in the development of a detailed study about the information available at universities public websites, which in turn led to an analysis of the quality of this information, according of the transparency and comparability of the degrees that EHEA advocates. The results show, first, the need to improve the public information of universities and, secondly, the desirability of giving an integral institutional support and monitoring to the development of the generic skills of each degree, in order to achieve the expected results. [ABSTRACT FROM AUTHOR]

Background: Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors. Methods: Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. Data collection: October–December 2017. Study population: PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. Outcome variables: cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. Results: The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient's discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors. Conclusions: Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination. [ABSTRACT FROM AUTHOR]

Objectives To assess the usefulness of the MGuard stent in patients with ST-segment elevation myocardial infarction (STEMI) in whom a high thrombus burden persists after manual aspiration. Background In some patients with STEMI, a high thrombus burden may persist after manual aspiration. These patients may be at high risk of distal embolization and therefore impaired myocardial reperfusion. The MGuard is a novel mesh-covered stent designed to minimize thrombus embolization. Methods Single-arm, prospective registry of patients with STEMI and high thrombus burden after aggressive thrombus aspiration treated with the MGuard stent. High thrombus burden was defined as thrombus burden grade 4 or 5 according to the TIMI score. Lesions with a side branch ≥2 mm and patients with cardiogenic shock were not included. The study end-points were proportion of final TIMI 3 flow, normal myocardial blush, and complete ST-segment resolution. Results Fifty-six patients were included. After MGuard stent implantation >85% of cases had thrombus score = 0. Final TIMI 3 flow was achieved in 82% of cases, normal myocardial blush in 55%, and complete ST-segment resolution in 59%. Occlusion of a side branch (<2 mm) occurred in 2 cases (3.5%), embolization to a distal branch in 5 cases (8.9%), and transient no-reflow in 4 cases (7.1%). Major adverse cardiac events rate at 9 months was 3.6%, including 1 definite acute stent thrombosis and 1 target-vessel revascularization. Conclusions The MGuard stent may be useful to prevent distal embolization in patients with STEMI and high thrombus burden despite mechanical aspiration. [ABSTRACT FROM AUTHOR]

Background: The resting full-cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use.Materials and Methods: Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR "grey zone" in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective).Results: A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; P < 0.001) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the "grey zone" (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%.Conclusions: Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use. [ABSTRACT FROM AUTHOR]

Background Prognostic impact of anaemia in the elderly with acute coronary syndromes has not been specifically analysed, and little information exists about causes of mortality in this setting. Methods We prospectively included consecutive patients with acute coronary syndromes. Anaemia was defined as haemoglobin < 130 g/L in men, and < 120 g/L in women. Primary outcome was mid-term mortality and its causes. Analyses were performed by Cox regression method. Results We included 2128 patients, of whom 394 (18.6%) were aged 75 years or older. Anaemia was more common in the elderly (40.4% vs 19.5%, p <0.001). Mean follow-up was 386 days. Anaemia independently predicted overall mortality (HR 1.47, 95% CI 1.05-2.06), cardiac mortality (HR 1.76, 95% CI 1.06-2.94) and non-cardiac mortality (HR 1.59, 95% CI 1.03-2.45) in the overall cohort. In young patients the association between anaemia and mortality was significant only for non-cardiac causes. The association between anaemia and mortality was not significant in the elderly (HR 1.08, 95% CI 0.71-1.63, p 0.736). Conclusions The impact of anaemia on cause specific of mortality seem to be different according to age subgroup. The association between anaemia and mortality was not observed in elderly patients from our series. [ABSTRACT FROM AUTHOR]