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Abstract Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors.

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Abstract Huntington’s disease (HD) is caused by an aberrant expansion of CAG repeats in the HTT gene that mainly affects basal ganglia. Although striatal dysfunction has been widely studied in HD mouse models, other brain areas can also be relevant to the pathology. In this sense, we have special interest on the retina as this is the most exposed part of the central nervous system that enable health monitoring of patients using noninvasive techniques. To establish the retina as an appropriate tissue for HD studies, we need to correlate the retinal alterations with those in the inner brain, i.e., striatum. We confirmed the malfunction of the transgenic R6/1 retinas, which underwent a rearrangement of their transcriptome as extensive as in the striatum. Although tissue-enriched genes were downregulated in both areas, a neuroinflammation signature was only clearly induced in the R6/1 retina in which the observed glial activation was reminiscent of the situation in HD patient’s brains. The retinal neuroinflammation was confirmed in the slow progressive knock-in zQ175 strain. Overall, these results demonstrated the suitability of the mouse retina as a research model for HD and its associated glial activation.

Fifth-generation mobile networks (5G) are designed to support enhanced Mobile Broadband, Ultra-Reliable Low-Latency Communications, and massive Machine-Type Communications. To meet these diverse needs, 5G uses technologies like network softwarization, network slicing, and artificial intelligence. Multi-connectivity is crucial for boosting mobile device performance by using different Wireless Access Technologies (WATs) simultaneously, enhancing throughput, reducing latency, and improving reliability. This paper presents a multi-connectivity testbed from the 5G-CLARITY project for performance evaluation. MultiPath TCP (MPTCP) was employed to enable mobile devices to send data through various WATs simultaneously. A new MPTCP scheduler was developed, allowing operators to better control traffic distribution across different technologies and maximize aggregated throughput. Our proposal mitigates the impact of limitations on one path affecting others, avoiding the Head-of-Line blocking problem. Performance was tested with real equipment using 5GNR, Wi-Fi, and LiFi —complementary WATs in the 5G-CLARITY project—in both static and dynamic scenarios. The results demonstrate that the proposed scheduler can manage the traffic distribution across different WATs and achieve the combined capacities of these technologies, approximately 1.4 Gbps in our tests, outperforming the other MPTCP schedulers. Recovery times after interruptions, such as coverage loss in one technology, were also measured, with values ranging from 400 to 500 ms.

Background: The mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. Methods: We designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. Results: The evaluated patients’ median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. Conclusions: Self-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

Objective: The objective of this study was to produce a cross-cultural adaptation in Italian of the Agitated Behavior Scale (ABS), originally developed in English, as the first of two stages that also include cross-cultural validation and allow a clinical scale to be used in the proper setting such as rehabilitation units. Methods: In order to adapt the ABS scale to a different cultural environment, five consecutive steps were performed: (1) forward translations (n = 8), (2) synthesis of the 8 forward translations to obtain a first shared italian version (ABS_I_trial), (3) back translations (n = 3), (4) creation of an expert committee to evaluate forward and back translations and finally (5) the cognitive debriefing. Results: After the five steps, including forward translations and back translations, the process of committee verification and judgement and the evaluative step of cognitive debriefing, high comprehensibility of all items was found, resulting in an Italian translation version of ABS suitable for application in a clinical setting. Conclusion: ABS translation was produced by means of a standardized procedure aimed at minimizing cross-cultural gaps. The expert committee evaluated the version produced as highly understandable in Italian. Further steps, such as the subsequent validation of its psychometric properties, are needed to employ this translation in a clinical setting.

Abstract Background Self-efficacy alludes to personal competence in an individual’s effectiveness when facing stressful situations. This construct has been related to different domains of the health field, finding that high levels of self-efficacy benefit human functioning and enhance well-being. Methods The present study aimed to determine the psychometric properties of the self-efficacy scale for managing chronic diseases (SEMCD-S) by assessing factorial, convergent and divergent validity, reliability, and measurement invariance. Likewise, the comparison of self-efficacy according to socio-demographic characteristics was proposed by contrasting latent factors. An instrumental, transactional, descriptive, and non-experimental design study was carried out with the participation of 325 Colombian senior citizens. Results The findings suggest that the scale has appropriate psychometric properties. The one-factor structure exhibited a satisfactory fit, the mean-variance extracted reported acceptable figures and the correlation analysis with other constructs supported this instrument’s convergent and discriminant validity. Likewise, it was invariant to the different socio-demographic aspects examined, while the internal consistency figures were high. Differences in the means of the latent factors were only detected in the academic grade. In this case, older adults with a primary school level attained higher self-efficacy values than those who had completed high school or university studies. Conclusions It is concluded that the self-efficacy scale for chronic disease management is a valid and reliable instrument that can be used in the Colombian context to measure and compare this construct.

People with severe acquired brain injury (pwSABI) frequently experience pulmonary complications. Among these, atelectasis can occur as a result of pneumonia, thus increasing the chance of developing acute respiratory failure. Respiratory physiotherapy contribution to the management of atelectasis in pwSABI is yet poorly understood. We conducted a retrospective analysis on 15 non-cooperative pwSABI with tracheostomy and spontaneously breathing, hospitalized and treated with high-frequency percussion physiotherapy between September 2018 and February 2021 at the Neurological Rehabilitation Unit of the IRCCS “S.Maria Nascente - Fondazione Don Gnocchi”, Milan. Our primary aim was to investigate the feasibility of such a physiotherapy intervention method. Then, we assessed changes in respiratory measures (arterial blood gas analysis and peripheral night-time oxygen saturation) and high-resolution computed tomography lung images, evaluated before and after the physiotherapy treatment. The radiological measures were a modified radiological atelectasis score (mRAS) assigned by two radiologists, and an opacity score automatically provided by the software CT Pneumonia Analysis® that identifies the regions of abnormal lung patterns. Treatment diaries showed that all treatments were completed, and no adverse events during treatment were registered. Among the 15 pwSABI analyzed, 8 were treated with IPV® and 7 with MetaNeb®. After a median of 14 (I-III quartile=12.5-14.5) days of treatment, we observed a statistical improvement in various arterial blood gas measures and peripheral night-time oxygen saturation measures. We also found radiological improvement or stability in more than 80% of pwSABI. In conclusion, our physiotherapy approach was feasible, and we observed respiratory parameters and radiological improvements. Using technology to assess abnormal tomographic patterns could be of interest to disentangle the short-term effects of respiratory physiotherapy on non-collaborating people.

In accordance with the cognitive orientation contemplated in the resolution of complex problems posed in public decision-making using decision support systems and social networks, this work studies the possibility of identifying the state of mind of society through the state of mind of network leaders. Using sentiment and emotion analysis as research techniques and Twitter as a representative social network, the study corpus considers tweets and retweets in Spanish about COVID-19 in the period from February 27, 2020 to December 31, 2021. As cognitive orientation claims, the proposed techniques will allow us to extract the arguments that support the different positions and decisions from the analysis of the tweets issued exclusively by social leaders. In the case study considered, the COVID-19 vaccination process in Spain, the reduction in the number of tweets′ authors (more than 8,000) to the network leaders (just 8) was greater than 99 %; and the subsequent reduction in the number of associated tweets was greater than 88 % from the 18,193 tweets in society to the 2,145 tweets of the eight social leaders. The impressive degree of information compression achieved may be useful to establish new directions of social mood analysis applied to healthcare and business management.

Multicriteria sorting involves assigning the objects of decisions (actions) into $a$ priori known ordered classes considering the preferences of a decision maker (DM). Two new multicriteria sorting methods were recently proposed by the authors. These methods are based on a novel approach called interval-based outranking which provides the methods with attractive practical and theoretical characteristics. However, as is well known, defining parameter values for methods based on the outranking approach is often very difficult. This difficulty arises not only from the large number of parameters and the DM’s lack of familiarity with them, but also from imperfectly known (even missing) information. Here, we address: i) how to elicit the parameter values of the two new methods, and ii) how to incorporate imperfect knowledge during the elicitation. We follow the preference disaggregation paradigm and use evolutionary algorithms to address it. Our proposal performs very well in a wide range of computational experiments. Interesting findings are: i) the method restores the assignment examples with high effectiveness using only three profiles in each limiting boundary or representative actions per class; and ii) the ability to appropriately assign unknown actions can be greatly improved by increasing the number of limiting profiles.

Abstract Complex abdominal wall defects are important conditions with high morbidity, leading to impairment of patients' physical condition and quality of life. In the last decade, the abdominal wall reconstruction paradigm has changed due to the formation of experienced and excellence groups, improving clinical outcomes after surgery. Therefore, our study shows the perspective and outcomes of an abdominal wall reconstruction group (AWRG) in Colombia, focused on the transverse abdominis release (TAR) procedure. A retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent TAR procedures between January 2014–December 2020 were included. Analysis and description of postoperative outcomes (recurrence, surgical site infection (SSI), seroma, hematoma, and re-intervention) were performed. 47 patients underwent TAR procedure. 62% of patients were male. Mean age was 55 ± 13.4 years. Mean BMI was 27.8 ± 4.5 kg/m2. Abdominal wall defects were classified with EHS ventral Hernia classification having a W3 hernia in 72% of all defects (Mean gap size of 11.49 cm ± 4.03 cm). Mean CeDAR preoperative risk score was 20.5% ± 14.5%. Preoperative use of BOTOX Therapy (OR 1.0 P 0.00 95% CI 0.3–1.1) or pneumoperitoneum (OR 0.7 P 0.04 95% CI 0.3–0.89) are slightly associated with postoperative hematoma. In terms of hernia relapse, we have 12% of cases; all of them over a year after the surgery. TAR procedure for complex abdominal wall defects under specific clinical conditions including emergency scenarios is viable. Specialized and experienced groups show better postoperative outcomes; further studies are needed to confirm our results.

KV7 channels exert a pivotal role regulating vascular tone in several vascular beds. In this context, KV7 channel agonists represent an attractive strategy for the treatment of pulmonary arterial hypertension (PAH). Therefore, in this study, we have explored the pulmonary vascular effects of the novel KV7 channel agonist URO-K10. Consequently, the vasodilator and electrophysiological effects of URO-K10 were tested in rat and human pulmonary arteries (PA) and PA smooth muscle cells (PASMC) using myography and patch-clamp techniques. Protein expression was also determined by Western blot. Morpholino-induced knockdown of KCNE4 was assessed in isolated PA. PASMC proliferation was measured by BrdU incorporation assay. In summary, our data show that URO-K10 is a more effective relaxant of PA than the classical KV7 activators retigabine and flupirtine. URO-K10 enhanced KV currents in PASMC and its electrophysiological and relaxant effects were inhibited by the KV7 channel blocker XE991. The effects of URO-K10 were confirmed in human PA. URO-K10 also exhibited antiproliferative effects in human PASMC. Unlike retigabine and flupirtine, URO-K10-induced pulmonary vasodilation was not affected by morpholino-induced knockdown of the KCNE4 regulatory subunit. Noteworthy, the pulmonary vasodilator efficacy of this compound was considerably increased under conditions mimicking the ionic remodelling (as an in vitro model of PAH) and in PA from monocrotaline-induced pulmonary hypertensive rats. Taking all together, URO-K10 behaves as a KCNE4-independent KV7 channel activator with much increased pulmonary vascular effects compared to classical KV7 channel activators. Our study identifies a promising new drug in the context of PAH.

Diabetes mellitus (DM) is a highly prevalent disease worldwide, estimated to affect 1 in every 11 adults; among them, 90–95% of cases are type 2 diabetes mellitus. This is partly attributed to the surge in the prevalence of obesity, which has reached epidemic proportions since 2008. In these patients, cardiovascular (CV) risk stands as the primary cause of morbidity and mortality, placing a substantial burden on healthcare systems due to the potential for macrovascular and microvascular complications. In this context, leptin, an adipocyte-derived hormone, plays a fundamental role. This hormone is essential for regulating the cellular metabolism and energy balance, controlling inflammatory responses, and maintaining CV system homeostasis. Thus, leptin resistance not only contributes to weight gain but may also lead to increased cardiac inflammation, greater fibrosis, hypertension, and impairment of the cardiac metabolism. Understanding the relationship between leptin resistance and CV risk in obese individuals with type 2 DM (T2DM) could improve the management and prevention of this complication. Therefore, in this narrative review, we will discuss the evidence linking leptin with the presence, severity, and/or prognosis of obesity and T2DM regarding CV disease, aiming to shed light on the potential implications for better management and preventive strategies.

Although the 6-Minute Walk Test (6MWT) is among the recommended clinical tools to assess gait impairments in individuals with Parkinson’s disease (PD), its standard clinical outcome consists only of the distance walked in 6 min. Integrating a single Inertial Measurement Unit (IMU) could provide additional quantitative and objective information about gait quality complementing standard clinical outcome. This study aims to evaluate the test–retest reliability, validity and discriminant ability of gait parameters obtained by a single IMU during the 6MWT in subjects with mild PD. Twenty-two people with mild PD and ten healthy persons performed the 6MWT wearing an IMU placed on the lower trunk. Features belonging to rhythm and pace, variability, regularity, jerkiness, intensity, dynamic instability and symmetry domains were computed. Test–retest reliability was evaluated through the Intraclass Correlation Coefficient (ICC), while concurrent validity was determined by Spearman’s coefficient. Mann–Whitney U test and the Area Under the receiver operating characteristic Curve (AUC) were then applied to assess the discriminant ability of reliable and valid parameters. Results showed an overall high reliability (ICC ≥ 0.75) and multiple significant correlations with clinical scales in all domains. Several features exhibited significant alterations compared to healthy controls. Our findings suggested that the 6MWT instrumented with a single IMU can provide reliable and valid information about gait features in individuals with PD. This offers objective details about gait quality and the possibility of being integrated into clinical evaluations to better define walking rehabilitation strategies in a quick and easy way.

Elevated blood pressure (EBP), hypertension (HT), and prehypertension (PHT), along with the rising prevalence of overweight/obesity in children, correlate with a heightened risk of cardiovascular complications. This study focuses on assessing the prevalence of overweight/obesity and EBP and identifying potential indicators for effective early screening and detection of EBP in children aged 6 to 9 years old. This cross-sectional study was conducted with 1142 students from different schools across the Valencian Community in Spain. Data collection involved administering a questionnaire alongside direct anthropometric measurements of each student. The collected data underwent comprehensive statistical analysis, including frequencies, percentages, means, and chi-square automatic interaction detector (CHAID) analysis. In the sample, 7.5% of the children had HT and 6.8% had PHT, meaning 14.3% presented with EBP. Additionally, 17.0% of the children were classified as overweight and 3.9% as obese. Body mass index >23.1, body fat percentage >20.79%, and Kidmed scores

The content, management, and implementation of social skills have been developed since the end of the 20th century as a model of capabilities. Thus, as human beings develop and train their basic cognitive and perceptual–motor functions, they increase their ability to solve and cope with difficulties. This article aims to present a bibliometric and systematic review of social skills, using query sources in databases such as Web of Science (WoS) and Scopus between the years 2000 and 2022, with platforms such as Bibliometrix and Gephi. This search yielded a total of 233 records in WoS and 250 records in Scopus that were merged and, after eliminating 143 duplicate data, were consolidated into 340 records that enclose the academic production of 20 years. Through scientific mapping, the main authors, journals, and countries in this field were determined; similarly, the most relevant studies were classified into three categories, namely, classic, structural, and perspectives, which were represented by means of the metaphor of the tree of science. In addition, a program for further studies was planned, such as in-depth qualitative research measuring observationally and directly taking into account emotional expressiveness, emotional understanding, emotion regulation, and behavior, and the impact of social skills training on social problem-solving. Finally, another important aspect to mention is that this research work is useful for the scientific academic community in many areas of knowledge such as psychology, education, and managers of educational institutions.

The early differential diagnosis of Parkinson's disease (PD) and atypical Parkinsonian syndromes (APS), including corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP), is challenging because of an overlap of clinical features and the lack of reliable biomarkers. Neural-derived extracellular vesicles (NDEVs) isolated from blood provide a window into the brain's biochemistry and may assist in distinguishing between PD and APS. We verified in a case-control study whether oligomeric α-Synuclein and Tau aggregates isolated from NDEVs could allow the differential diagnosis of these conditions.Blood sampling and clinical data, including disease duration, motor severity, global cognition, and levodopa equivalent daily dose (LEDD), were collected from patients with a diagnosis of either PD (n = 70), PSP (n = 21), or CBD (n = 19). NDEVs were isolated from serum by immunocapture using an antibody against the neuronal surface marker L1CAM; oligomeric α-Synuclein and aggregated Tau were measured by ELISA.NDEVs analyses showed that oligomeric α-Synuclein is significantly augmented in PD compared to APS, whereas Tau aggregates are significantly increased in APS compared to PD (p

Develar las representaciones sociales asociadas a la salud mental en el contexto de la vivencia de COVID-19 en estudiantes universitarios.

Resumen: Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC), para la prevención de las enfermedades cardiovasculares (CV). Se incluyen los siguientes apartados: revisión epidemiológica, donde se describe la morbimortalidad CV actual en España y su evolución y los principales factores de riesgo; riesgo CV y recomendaciones para el cálculo del riesgo CV; factores de riesgo mayores como hipertensión arterial, dislipidemia y diabetes mellitus, describiendo el método para su diagnóstico, los objetivos terapéuticos y las recomendaciones de medidas de estilo de vida y de tratamiento farmacológico; indicaciones de antiagregación y recomendaciones para el cribado de la fibrilación auricular y recomendaciones para el manejo del paciente crónico. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación. Abstract: The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.

Complexity analysis of electroencephalogram (EEG) signals has emerged as a valuable tool for characterizing Parkinson’s disease (PD). Fractal dimension (FD) is a widely employed method for measuring the complexity of shapes with many applications in neurodegenerative disorders. Nevertheless, very little is known on the fractal characteristics of EEG in PD measured by FD. In this study we performed a spatio-temporal analysis of EEG in PD using FD in four dimensions (4DFD). We analyzed 42 resting-state EEG recordings comprising two groups: 27 PD patients without dementia and 15 healthy control subjects (HC). From the original resting-state EEG we derived the cortical activations defined by a source reconstruction at each time sample, generating point clouds in three dimensions. Then, a sliding window of one second (the fourth dimension) was used to compute the value of 4DFD by means of the box-counting algorithm. Our results showed a significantly higher value of 4DFD in the PD group (p < 0.001). Moreover, as a diagnostic classifier of PD, 4DFD obtained an area under curve value of 0.97 for a receiver operating characteristic curve analysis. These results suggest that 4DFD could be a promising method for characterizing the specific changes in the brain dynamics associated with PD.

Skin diseases can be the cause of a significant psychosocial burden. However, tools to screen for social interaction difficulties and diminished social networks that affect the wellbeing and mental health of the individual have not been sufficiently developed. This study is based on the sociotype approach, which has recently been proposed as a new theoretical construct implemented in the form of an ad hoc questionnaire that examines the social bonding structures and relational factors. A pilot study was conducted in Alcañiz Hospital (Spain), with a study population of 159 dermatology patients. The results showed that in both subjective estimates concerning family, friends, work, and acquaintances, and in quantitative aspects, such as social contacts, duration of conversations, and moments of laughter, there were significant differences between the sample regarding diagnostic severity, dermatological diseases, and gender. The sociotype questionnaire (SOCQ) is a useful tool to screen for social difficulties in dermatological patients.

Background and ObjectivesSubstantial evidence shows that diagnostic inertia leads to failure to achieve screening and diagnosis objectives for arterial hypertension (AHT). In addition, different studies suggest that the results may differ between men and women. This study aimed to evaluate the differences in diagnostic inertia in women and men attending public primary care centers, to identify potential gender biases in the clinical management of AHT.Study Design/Materials and MethodsCross-sectional descriptive and analytical estimates were obtained nested on an epidemiological ambispective cohort study of patients aged ≥30 years who attended public primary care centers in a Spanish region in the period 2008–2012, belonging to the ESCARVAL-RISK cohort. We applied a consistent operational definition of diagnostic inertia to a registry- reflected population group of 44,221 patients with diagnosed hypertension or meeting the criteria for diagnosis (51.2% women), with a mean age of 63.4 years (62.4 years in men and 64.4 years in women).ResultsOf the total population, 95.5% had a diagnosis of hypertension registered in their electronic health record. Another 1,968 patients met the inclusion criteria for diagnostic inertia of hypertension, representing 4.5% of the total population (5% of men and 3.9% of women). The factors significantly associated with inertia were younger age, normal body mass index, elevated total cholesterol, coexistence of diabetes and dyslipidemia, and treatment with oral antidiabetic drugs. Lower inertia was associated with age over 50 years, higher body mass index, normal total cholesterol, no diabetes or dyslipidemia, and treatment with lipid-lowering, antiplatelet, and anticoagulant drugs. The only gender difference in the association of factors with diagnostic inertia was found in waist circumference.ConclusionIn the ESCARVAL-RISK study population presenting registered AHT or meeting the functional diagnostic criteria for AHT, diagnostic inertia appears to be greater in men than in women.

REM sleep behavior disorder (RBD) has a tighter link with synucleinopathies than other neurodegenerative disorders. Parkinson’s Disease (PD) patients with RBD have a more severe motor and cognitive impairment; biomarkers for RBD are currently unavailable. Synaptic accumulation of α-Syn oligomers and their interaction with SNARE proteins is responsible for synaptic dysfunction in PD. We verified whether oligomeric α-Syn and SNARE components in neural-derived extracellular vesicles (NDEVs) in serum could be biomarkers for RBD. Forty-seven PD patients were enrolled, and the RBD Screening Questionnaire (RBDSQ) was compiled. A cut-off score > 6 to define probable RBD (p-RBD) and probable non-RBD (p non-RBD) was used. NDEVs were isolated from serum by immunocapture, and oligomeric α-Syn and SNARE complex components VAMP-2 and STX-1 were measured by ELISA. NDEVs’ STX-1A resulted in being decreased in p-RBD compared to p non-RBD PD patients. A positive correlation between NDEVs’ oligomeric α-Syn and RBDSQ total score was found (p = 0.032). Regression analysis confirmed a significant association between NDEVs’ oligomeric α-Syn concentration and RBD symptoms (p = 0.033) independent from age, disease duration, and motor impairment severity. Our findings suggest that synuclein-mediated neurodegeneration in PD-RBD is more diffuse. NDEVs’ oligomeric α-Syn and SNARE complex components’ serum concentrations could be regarded as reliable biomarkers for the RBD-specific PD endophenotype.

Two multicriteria-sorting methods that generalize the relational paradigm have been recently presented in the literature. One uses objects representative of classes, the other uses objects in the limiting boundaries of classes; both can use either a reflexive or an asymmetric preference relation. However, defining the parameters of relation-based methods is not straightforward. The present work operationalizes those methods with a methodology that takes examples provided by the decision-maker and, using an accuracy measure that specifically fits the characteristics of the methods, exploits an evolutionary algorithm to determine the parameters that best reproduce such examples. The assessment of the proposal showed that (i) it can achieve considerably high levels of out-of-sample effectiveness with only a few decision examples; (ii) the inference process is more effective learning the parameters of the method based on representative objects; (iii) it tends to be more effective with a reflexive relation; (iv) the effectiveness decreases while increasing the number of classes, which is not always the case when increasing the number of criteria. Theoretical properties of the proposed methodology will be investigated in future works.

The presence of involuntary, non-functional jaw muscle activity (NFJMA) has not yet been assessed in patients with disorders of consciousness (DOC), although the presence of bruxism and other forms of movement disorders involving facial muscles is probably more frequent than believed. In this work, we evaluated twenty-two prolonged or chronic DOC patients with a long-lasting polygraphic recording to verify NFJMA occurrence and assess its neurophysiological patterns in this group of patients. A total of 5 out of 22 patients showed the presence of significant NFJMA with electromyographic patterns similar to what can be observed in non-DOC patients with bruxism, thus suggesting a disinhibition of masticatory motor nuclei from the cortical control. On the other hand, in two DOC patients, electromyographic patterns advised for the presence of myorhythmia, thus suggesting a brainstem/diencephalic involvement. Functional, non-invasive tools such as long-lasting polygraphic recordings should be extended to a larger sample of patients, since they are increasingly important in revealing disorders potentially severe and impacting the quality of life of DOC patients.

Carbon footprint and nonrenewability are among the motives to mitigate dependence on oil resources. On the other hand, palm trees exceeded 100 million around globe, which poses enormous amount of biowastes to get exploited per annum. Moreover, nanocellulose is emerging as efficient low cost material, which shows increasing versatility throughout time. In this investigation we will attempt to extract nanocellulose from palm wastes (fronds, leaves, and coir), and characterize them. Dry biomass was pulped by being subjected to 10% (wt/wt) NaOH alkaline treatment at 160 °C for 2 h. Pulped non-bleached biomass underwent acidic hydrolysis by mechanical stirring in 20% H2SO4 (v/v) and heating to 120 °C for 30 min. After filtration, neutralization, and centrifugion, resultant particles were characterized to assess their morphology, size, particle charge, existing chemical groups, and crystallinity. For the three types of palm residues, our preparation technique was successful to isolate lignin containing nanocellulose particles. However, coir was more recalcitrant to acidic hydrolysis than fronds and leaves. Our palm residues yielded 42–82 nm spherical particles, and zeta potential ranging between −11 and −19 mV. Crystallinity was higher after pulping, and lower after hydrolysis, which suggests promotion of amorphous content of cellulose. Lignin-containing nanocellulose prepared in this study initiates promising horizon especially in heavy metal (cations) removal from water in environmental applications and sustained drug delivery for medical applications.

Resumen: Se presentan las recomendaciones del Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) de la semFYC, para la prevención de las enfermedades cardiovasculares (CV). Se incluyen los siguientes apartados: Revisión epidemiológica, donde se describe la morbimortalidad CV actual en España y su evolución y los principales factores de riesgo; Tablas de riesgo CV y recomendaciones para el cálculo del riesgo CV; Factores de riesgo mayores como hipertensión arterial, dislipidemia y diabetes mellitus, describiendo el método para su diagnóstico, los objetivos terapéuticos y las recomendaciones de medidas de estilo de vida y de tratamiento farmacológico; Indicaciones de antiagregación, y Recomendaciones para el cribado de la fibrilación auricular. Para las principales recomendaciones se incluyen tablas específicas que recogen la calidad de la evidencia y la fuerza de la recomendación. Abstract: The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: Epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; Cardiovascular (CV) risk tables and recommendations for the calculation of CV risk; Main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; Indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation. The quality of testing and the strength of the recommendation are included in the main recommendations.

The new fifth generation (5G) era has transformed previous mobile generations into fast, smart networks that will be more responsive and customizable. With network slicing, 5G networks can be dynamically adapted to the different needs of specific vertical industries. This capability has opened the opportunity to new business models whereby infrastructure owners can monetize their investment by leasing resources to third parties (i.e. tenants). In this respect, a challenging task for the owner of the radio access network infrastructure (i.e. the network provider) is the spectrum planning of multi-tenant scenarios. This paper proposes different alternatives of hiring capacity to the provider as well as a set of spectrum planning strategies, each giving a certain degree of flexibility to allocate resources per tenant. These strategies are evaluated in a 5G small cell multi-tenant network through snapshot-based simulations. The performance of the strategies is assessed in terms of scalability, spectrum isolation, utilization and efficiency.

Background. Very few studies have analyzed early histologic lesions of diabetic nephropathy (DN) in patients without signs of clinical involvement (microalbuminuria). In this study, we analyzed renal histologic lesions in necropsies of diabetic patients with or without previous signs of DN. Methods. Histological material was analyzed from 21 autopsies of type 2 diabetes mellitus (T2DM) patients (9 with albuminuria and 12 without albuminuria) and 4 controls. Histologic lesions were evaluated according to the Tervaert classification. Results. Kidneys of diabetic patients presented significantly higher scores in most histologic indices analyzed (glomerular basal membrane thickening, mild and severe mesangial expansion, nodular sclerosis, interstitial fibrosis, and tubular atrophy) than in nondiabetic controls (p

The retina is among the highest organized tissues of the central nervous system. To achieve such organization, a finely tuned regulation of developmental processes is required to form the retinal layers that contain the specialized neurons and supporting glial cells to allow precise phototransduction. MicroRNAs are a class of small RNAs with undoubtful roles in fundamental biological processes, including neurodevelopment of the brain and the retina. This review provides a short overview of the most important findings regarding microRNAs in the regulation of retinal development, from the developmental-dependent rearrangement of the microRNA expression program to the key roles of particular microRNAs in the differentiation and maintenance of retinal cell subtypes.

Glioblastoma (GB) is the most prevalent primary brain cancer and the most aggressive form of glioma because of its poor prognosis and high recurrence. To confirm the importance of epigenetics in glioma, we explored The Cancer Gene Atlas (TCGA) database and we found that several histone/DNA modifications and chromatin remodeling factors were affected at transcriptional and genetic levels in GB compared to lower-grade gliomas. We associated these alterations in our own cohort of study with a significant reduction in the bulk levels of acetylated lysines 9 and 14 of histone H3 in high-grade compared to low-grade tumors. Within GB, we performed an RNA-seq analysis between samples exhibiting the lowest and highest levels of acetylated H3 in the cohort; these results are in general concordance with the transcriptional changes obtained after histone deacetylase (HDAC) inhibition of GB-derived cultures that affected relevant genes in glioma biology and treatment (e.g., A2ML1, CD83, SLC17A7, TNFSF18). Overall, we identified a transcriptional signature linked to histone acetylation that was potentially associated with good prognosis, i.e., high overall survival and low rate of somatic mutations in epigenetically related genes in GB. Our study identifies lysine acetylation as a key defective histone modification in adult high-grade glioma, and offers novel insights regarding the use of HDAC inhibitors in therapy.

Las técnicas de autotransfusión, conocidas con anterioridad, se han convertido en la actualidad en la principal alternativa del empleo de sangre homóloga, debido a los altos riesgos que esta práctica conlleva y a los elevados costos que genera. La hemodilución normovolémica aguda, procedimiento en el que se le extrae al paciente sangre en el preoperatorio inmediato y se le remplaza el volumen con coloides o cristaloides para luego reinfundirla, constituye la técnica más ampliamente usada con estos fines, con reconocida seguridad y eficacia. Se informa nuestra experiencia inicial con esta técnica en un grupo de 10 pacientes con resultados comparables a los de la literatura médica, destacando un ahorro de sangre homóloga del orden del 65%, y la necesidad de ceñirse estrictamente a los criterios de selección de los pacientes.

Background: Nowadays, the increase in life expectancy needs to be matched by an increase in the wellbeing of older adults. A starting point is the definition of what is understood by health-related quality of life and its measurement in different contexts. Our research translates these international priorities to a local base. Objective: To evaluate the psychometric characteristics of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) in a sample of older adults from a Spanish urban community (Casablanca). Methods: In collaboration with the local health centre, we designed and implemented the health neighbourhood survey. Interviews took place at subjects’ homes with 212 women and 135 men over the age of 60, who were residents in Casablanca. With the results, we evaluated the psychometric characteristics of WHOQOL-BREF and tested its reliability and validation. Results: The instrument has a high internal consistency with a Cronbach’s Alpha of 0.9. The items with higher correlation value were: ability to carry out activities in daily life, enough energy for daily life. The scale contributions of Physical Health dimension (0.809) and Psychological Health dimension (0.722) were notable. Conclusions: As with other studies, the instrument proved to be an integral evaluation of the diverse domains that condition the wellbeing of older adults.

The application of enzymatic kinetics theory on the nutrition of horticultural species is scarce. Imax and Km describe the kinetics of nutrient absorption by the plant. Imax and Km are necessary to predict phosphorus (P) uptake from soil using mathematical models, and their estimation gives information about the efficient use of P in plants. Imax and Km for habanero pepper (Capsicum chinense Jacq. cv. Mayapán) were determined using the modified exhaustion method. Depletion of P by the roots was obtained with 0.01, 0.125, 0.25, 0.50, and 1.00 mM P L−1. P-depletion data over time were fitted to an exponential-regression model to obtain the initial P-uptake rates by the roots. Initial P-uptake rates were significantly different (p < 0.001) depending on the levels of P in the solution. Imax and Km were predicted by iteratively fitting the initial P-absorption rates in terms of the concentration of P to the Michaelis–Menten model. The average Imax was 3.49 × 10−7 mM cm2 s−1 and Km was 2.59 × 10−2 mM P L−1. These results show that the habanero pepper root can uptake 1.08 × 10−5 mg P L−1 per cm2 in the soil solution per second and P transporters are saturated with 2.59 × 10−2 mM P L−1.

Resumen: El adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo 2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia. Abstract: Treatment of diabetes mellitus type 2 (DM2) includes healthy eating and exercise (150 minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type 4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used. Palabras clave: Diabetes tipo 2, Hiperglucemia, Fármacos antidiabéticos, Keywords: Type 2 diabetes, Hyperglycemia, Antidiabetic drugs

Although calcium signals are known to be critical for many cellular processes, how signaling elicits specific functions remains unclear. In visually striking work, Duan et al. reveal that networks of cytoplasmic nanocourses orchestrate cell activity by directing site-specific calcium signals.

Resumen: Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2. Abstract: The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.

To investigate whether different forms of α-synuclein (α-syn) proteins can induce inflammation and activate the NLRP3 inflammasome, we stimulated with monomeric or aggregated α-syn peripheral blood mononuclear cells of Parkinson disease (PD) patients and age- and sex-matched healthy controls (HC). ASC-speck formation, i.e., the intracellular generation of functionally active inflammasome complexes, as well as the production of inflammasome-related [caspase-1, interleukin 1β (IL-18), and IL-1β], and pro–IL-6, or anti–IL-10 inflammatory cytokines were evaluated. Gastrointestinal permeability, suggested to be altered in PD, was also investigated by measuring plasma concentration of lipopolysaccharide (LPS) and I-FABP (fatty acid–binding protein). ASC-speck expression, as well as IL-18 and caspase-1 production and LPS and I-FABP plasma concentration, was comparable in PD and HC, indicating that α-syn does not stimulate the NLRP3 inflammasome and that PD does not associate with alterations of intestinal permeability. Interestingly, though, IL-1β and IL-6 production was increased, whereas that of IL-10 was reduced in α-syn–stimulated cells of PD compared to HC, suggesting that PD-associated neuroinflammation is not the consequence of the activation of the NLRP3 inflammasome but rather of an imbalance between proinflammatory and anti-inflammatory cytokines.

HLA allelic distribution was analysed in a cohort of 96 Northern Italian subjects (53M/43F) (mean age 59.9 ± 13.3 years) from Lombardy who developed COVID-19 during the first two pandemic waves to investigate possible correlations between HLA molecules and disease severity. An important role of HLA- B and HLA-C loci in modulating the clinical severity of COVID-19 disease was identified. In particular, the HLA-B07 supertype was observed to be associated with a significant risk for severe disease; conversely, the HLA-B27 supertype and C*12:02 allele played a protective role as they were associated with milder disease. These associations were confirmed after applying a multinomial regression analysis to adjust the correlation for age, gender and comorbidities with COVID-19 severity. Though the power of results is limited by the small sample size, data herein contribute to shedding light on the role played by genetic background in COVID-19 infection.

A “triune approach” to the three main domains of intelligence is advocated. It would be the most cogent way to understand the uses and impact of artificial intelligence in its intrinsic relation with human nature and social structures. The enormous technological success of artificial intelligence and the widespread social applications, impinging both in individual lives and in multiple economic and social structures, are making necessary a reflection on the wider dynamics of intelligence, interconnecting the artificial information pathways with the natural information flows and the social structural substrates. As a telling instance, the traditional poor understanding and management of “social emotions” is dangerously amplified in today’s social networks, contributing to unrest, polarization, and widespread desocialization processes. In contemporary societies, the essential link between intelligence and life has to be plainly revealed as a counterpoint to the link between artificial intelligence and computation.

Background Intravenous ferric carboxymaltose (FCM) improves symptoms, functional capacity, and quality of life in heart failure and iron deficiency. The mechanisms underlying these effects are not fully understood. The aim of this study was to examine changes in myocardial iron content after FCM administration in patients with heart failure and iron deficiency using cardiac magnetic resonance. Methods and Results Fifty‐three stable heart failure and iron deficiency patients were randomly assigned 1:1 to receive intravenous FCM or placebo in a multicenter, double‐blind study. T2* and T1 mapping cardiac magnetic resonance sequences, noninvasive surrogates of intramyocardial iron, were evaluated before and 7 and 30 days after randomization using linear mixed regression analysis. Results are presented as least‐square means with 95% CI. The primary end point was the change in T2* and T1 mapping at 7 and 30 days. Median age was 73 (65–78) years, with N‐terminal pro‐B‐type natriuretic peptide, ferritin, and transferrin saturation medians of 1690 pg/mL (1010–2828), 63 ng/mL (22–114), and 15.7% (11.0–19.2), respectively. Baseline T2* and T1 mapping values did not significantly differ across treatment arms. On day 7, both T2* and T1 mapping (ms) were significantly lower in the FCM arm (36.6 [34.6–38.7] versus 40 [38–42.1], P=0.025; 1061 [1051–1072] versus 1085 [1074–1095], P=0.001, respectively). A similar reduction was found at 30 days for T2* (36.3 [34.1–38.5] versus 41.1 [38.9–43.4], P=0.003), but not for T1 mapping (1075 [1065–1085] versus 1079 [1069–1089], P=0.577). Conclusions In patients with heart failure and iron deficiency, FCM administration was associated with changes in the T2* and T1 mapping cardiac magnetic resonance sequences, indicative of myocardial iron repletion. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03398681.

Background: The relationship between self-rated health and gender differs across countries and generations. The aim of this study is to analyze the effect of socioeconomic conditions on self-rated health from a generational perspective, its differential effect on gender, and its influence on the gender gap in order to explore health diversity using a multidisciplinary approach and considering policy implications in Eastern European countries. Methods: We used data drawn from the European Health Interview Survey for eight Eastern European countries and EUROSTAT from 2006 through to 2009. We conducted multilevel analyses to understand the individual and national health determinants of self-rated health by gender and to determine whether national differences remain after controlling for micro variables. In order to analyze the role of equity (Gini quartile) in gender differences, Oaxaca analyses were used. Results: The self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking, influence citizens’ perceived health, and have a stronger effect on women than on men. Knowing both the characteristics (endowment effects) and the effects of individual characteristics (coefficient effects) on health is important in order to understand gender gaps among people from the silent generation. Conclusions: Our research indicates that random effects are greater for men than for women. Moreover, random effects might be explained to a certain extent by economic equity (Gini index). The combined effects of gender, cohort, and geographical differences on self-rated health have to be taken into account to develop public health policies.

In this paper, a method to classify behavioural patterns of cattle on farms is presented. Animals were equipped with low-cost 3-D accelerometers and GPS sensors, embedded in a commercial device attached to the neck. Accelerometer signals were sampled at 10 Hz, and data from each axis was independently processed to extract 108 features in the time and frequency domains. A total of 238 activity patterns, corresponding to four different classes (grazing, ruminating, laying and steady standing), with duration ranging from few seconds to several minutes, were recorded on video and matched to accelerometer raw data to train a random forest machine learning classifier. GPS location was sampled every 5 min, to reduce battery consumption, and analysed via the k-medoids unsupervised machine learning algorithm to track location and spatial scatter of herds. Results indicate good accuracy for classification from accelerometer records, with best accuracy (0.93) for grazing. The complementary application of both methods to monitor activities of interest, such as sustainable pasture consumption in small and mid-size farms, and to detect anomalous events is also explored. Results encourage replicating the experiment in other farms, to consolidate the proposed strategy.

Abstract Background Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization. Methods Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008–2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care. Results A total of 11,003 (57%) patients had uncontrolled diabetes defined as HbA1c ≥6.5%, and, among those, 5325 participants had HbA1c ≥7.5%. During an average follow-up time of 3.3 years, 499 deaths, 912 hospitalizations for coronary heart disease (CHD) and 786 hospitalizations for stroke were recorded. We observed a linear and increasingly positive dose-response of HbA1c levels and CHD hospitalization. The relative risk for all-cause mortality and CHD and stroke hospitalization comparing patients with and without uncontrolled diabetes was 1.29 (95 CI 1.08,1.55), 1.38 (95 CI 1.20,1.59) and 1.05 (95 CI 0.91, 1.21), respectively. The population attributable risk (PAR) associated with uncontrolled diabetes was 13.6% (95% CI; 4.0–23.9) for all-cause mortality, 17.9% (95% CI; 10.5–25.2) for CHD and 2.7% (95% CI; − 5.5-10.8) for stroke hospitalization. Conclusions In a large general-practice cohort of patients with diabetes, uncontrolled glucose levels were associated with a substantial mortality and cardiovascular disease burden.

Resumen: Es objetivo de este artículo mostrar una experiencia de práctica novedosa implementada por la dirección de un departamento de salud. Se expone un modelo organizativo de coordinación sociosanitaria entre los diferentes niveles asistenciales y sectores, estableciendo sinergias de los recursos sociales y sanitarios comunes del Departamento de Salud Clínico-Malvarrosa (Valencia). Tras un año, se han constituido cinco consejos de salud de zona básica en atención primaria y una comisión de coordinación sociosanitaria integrada por tres subcomisiones: 1) de atención asistencial social y sanitaria, 2) de asociacionismo y voluntariado hospitalario, y 3) de acción comunitaria y participación ciudadana. La estructura organizativa propuesta se ha consolidado y las acciones realizadas se han valorado de manera positiva por las diferentes personas implicadas. Se ha generado una red de comunicación social y sanitaria: interdepartamental, extradepartamental y extrahospitalaria. Abstract: The objective of this article is to show an experience of new practice as implemented by the management of a Department of Health. An organisational model is shown of sociosanitary coordination between the different levels of care and sectors, establishing synergies of the common social and health resources of the Clínico-Malvarrosa Department of Health (Valencia, Spain). After one year, five basic health councils have been set up in Primary Care and a Sociosanitary Coordination Commission composed of three subcommittees: 1) socio and health care, 2) associationism and hospital volunteering, and 3) community action and citizen participation. The proposed organisational structure has been consolidated, the actions carried out have been valued positively by the different agents involved. It has generated a network of social and health communication: interdepartmental, extra-departmental and out-of-hospital. Palabras clave: Coordinación sociosanitaria, Vulnerabilidad, Acción comunitaria, Keywords: Sociosanitary coordination, Vulnerability, Community action

Este ensayo aborda la necesidad imperiosa de que los estrategas de la Secretaría de Relaciones Exteriores de México, que pretenden mejorar la imagen del país, utilicen las herramientas de la nueva diplomacia pública a través de los miembros del servicio exterior mexicano. Pero hasta el momento no se ha logrado el objetivo de mejorar la imagen de México debido a que las acciones de difusión son escasas, aisladas y esporádicas. Se indica que para lograr el objetivo los encargados del manejo de las redes sociales y estrategias de la nueva diplomacia pública debieran ser capacitados y contar con la experiencia para hacerlo. Deben tener esta responsabilidad aquellos que son experimentados, han sido capacitados y tienen una vocación en materia de comunicación, con transparencia, veracidad y lucidez. Estos responsables de la instrumentación de la nueva diplomacia deben manejarse en una interlocución multinivel y asimétrica, maniobrar bien las redes sociales y dialogar con los diversos actores de la sociedad internacional. Se concluye que si se utilizan eficientemente estas herramientas y se operan con profesionalismo; la imagen de México en el exterior mejorará sustancialmente, se incrementarán las inversiones, el comercio y los flujos de turistas extranjeros.

Countless informational proposals and models have explored the singular characteristics of biological systems: from the initial choice of information terms in the early days of molecular biology to the current bioinformatic avalanche in this “omic” era. However, this was conducted, most often, within partial, specialized scopes or just metaphorically. In this paper, we attempt a consistent informational discourse, initially based on the molecular recognition paradigm, which addresses the main stages of biological organization in a new way. It considers the interconnection between signaling systems and information flows, between informational architectures and biomolecular codes, between controlled cell cycles and multicellular complexity. It also addresses, in a new way, a central issue: how new evolutionary paths are opened by the cumulated action of multiple variation engines or mutational ‘vehicles’ evolved for the genomic exploration of DNA sequence space. Rather than discussing the possible replacement, extension, or maintenance of traditional neo-Darwinian tenets, a genuine informational approach to evolutionary phenomena is advocated, in which systemic variation in the informational architectures may induce differential survival (self-construction, self-maintenance, and reproduction) of biological agents within their open ended environment.

Utility-scale hybrid wind–solar PV power plants (which might include some storage as well) are an attractive option for the transition of conventional grids to incorporate high renewable energy (RE) shares. Along with lower generation costs, they offer increased dispatch capabilities and flexible operation. However, when assessing their potential, they present higher needs in terms of input data, as they are forced to consider both spatial and temporal variations to evaluate their techno-economic viability, as well as other common inputs such as economic, social or environmental data. The availability of the different data influences the type of analysis to be implemented. The microgrid approach of segmenting the information into layers will be adopted for the classification of data. Three different levels of analysis are sought: long-term energy scenarios, geo-spatial planning, and production cost estimation. The analysis of necessary data for each planning stage, and the available data sources for the assessment of utility-scale hybrid power plants, under this microgrid approach, is the main focus of this review.