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Clinical simulation as a teaching methodology allows the student to train and learn technical abilities and/or non-technical abilities. One of the key elements of this teaching methodology is the debriefing, which consists of a conversation between several people, in which the participants go over a real or simulated event in order to analyze their actions and reflect on the role that thought processes, psychomotor skills and emotional states can play in maintaining, or improving their performance in the future. The Debriefing Experience Scale allows the experience of students in debriefing to be measured. The objective of this study is to translate the Debriefing Experience Scale (DES) into Spanish and analyze its reliability and validity to measure the experience of nursing students during the debriefing. The study was developed in two phases: One: the adaption of the instrument to Spanish, two: a transversal study carried out in a sample of 290 nursing students. The psychometric properties were analyzed in terms of reliability and construct validity using confirmatory factorial analysis (CFA). Cronbach's alpha was adequate for all the scales and for each one of the dimensions. The confirmatory factorial analysis showed that the 4-dimensional model is acceptable for both scales (experience and opinion). The Spanish version Debriefing Experience Scale questionnaire is useful, valid and reliable for use to measure the debriefing experience of university students in a simulation activity.

The European Higher Education Area (EHEA) recommends the use of new educational methodologies and the evaluation of student satisfaction. Different instruments have been developed in Spain to evaluate different aspects such as clinical decisions and teamwork, however no instruments have been found that specifically evaluate student self-confidence and satisfaction during clinical simulation. The aim was to translate the Student Satisfaction and Self-Confidence in Learning Scale (SCLS) questionnaire into Spanish and analyse its reliability and validity and understand the level of satisfaction and self-confidence of nursing students with respect to learning in clinical simulations. The study was carried out in two phases: (1) adaptation of the questionnaire into Spanish. (2) Cross-sectional study in a sample of 489 nursing students. The reliability and exploratory and confirmatory factorial analyses were performed. To analyse the relationship of the scale scores with the socio-demographic variables, the Fisher Student T-test or the ANOVA was used. The scale demonstrated high internal consistency reliability for the total scale and each of its dimensions. Cronbach's alpha was 0.88 (0.83 to 0.81) for each of the dimensions. The exploratory and confirmatory factor analysis showed that both the one-dimensional and two-dimensional models were acceptable. The results showed average scores above 4 for both dimensions. The SCLS-Spanish translation demonstrated evidence of its validity and reliability for use to understand the level of satisfaction and self-confidence of nursing students in clinical simulation. Clinical simulations help students to increase their levels of confidence and satisfaction, enabling them to face real scenarios in clinical practice.

The Educational Practices Questionnaire is an instrument for assessing students perceptions of best educational practices in simulation. As for other countries, in Spain, it is necessary to have validated rubrics to measure the effects of simulation. The objective of this study was to carry out a translation and cultural adaptation of the Educational Practices Questionnaire into Spanish and analyze its reliability and validity. The study was carried out in two phases: (1) adaptation of the questionnaire into Spanish. (2) Cross-sectional study in a sample of 626 nursing students. Psychometric properties were analyzed in terms of reliability and construct validity by confirmatory and exploratory factor analysis. The exploratory and confirmatory factor analyses showed that the one-dimensional model is acceptable for both scales (presence and importance). The results show that the participants' scores can be calculated and interpreted for the general factor and also for the four subscales. Cronbach's alpha and the Omega Index were also suitable for all the scales and for each of the dimensions. The Educational Practices Questionnaire is a simple and easy-to-administer tool to measure how nursing degree students perceive the presence and importance of best educational practices.

From January 2020, COVID-19 is spreading around the world producing serious respiratory symptoms in infected patients that in some cases can be complicated by the severe acute respiratory syndrome, sepsis and septic shock, multiorgan failure, including acute kidney injury and cardiac injury. Cost and time efficient approaches to reduce the burthen of the disease are needed. To find potential COVID-19 treatments among the whole arsenal of existing drugs, we combined system biology and artificial intelligence-based approaches. The drug combination of pirfenidone and melatonin has been identified as a candidate treatment that may contribute to reduce the virus infection. Starting from different drug targets the effect of the drugs converges on human proteins with a known role in SARS-CoV-2 infection cycle. Simultaneously, GUILDify v2.0 web server has been used as an alternative method to corroborate the effect of pirfenidone and melatonin against the infection of SARS-CoV-2. We have also predicted a potential therapeutic effect of the drug combination over the respiratory associated pathology, thus tackling at the same time two important issues in COVID-19. These evidences, together with the fact that from a medical point of view both drugs are considered safe and can be combined with the current standard of care treatments for COVID-19 makes this combination very attractive for treating patients at stage II, non-severe symptomatic patients with the presence of virus and those patients who are at risk of developing severe pulmonary complications.

Human aldo-keto reductase 1B15 (AKR1B15) is a newly discovered enzyme which shares 92% amino acid sequence identity with AKR1B10. While AKR1B10 is a well characterized enzyme with high retinaldehyde reductase activity, involved in the development of several cancer types, the enzymatic activity and physiological role of AKR1B15 are still poorly known. Here, the purified recombinant enzyme has been subjected to substrate specificity characterization, kinetic analysis and inhibitor screening, combined with structural modeling. AKR1B15 is active towards a variety of carbonyl substrates, including retinoids, with lower kcat and Km values than AKR1B10. In contrast to AKR1B10, which strongly prefers all-trans-retinaldehyde, AKR1B15 exhibits superior catalytic efficiency with 9-cis-retinaldehyde, the best substrate found for this enzyme. With ketone and dicarbonyl substrates, AKR1B15 also shows higher catalytic activity than AKR1B10. Several typical AKR inhibitors do not significantly affect AKR1B15 activity. Amino acid substitutions clustered in loops A and C result in a smaller, more hydrophobic and more rigid active site in AKR1B15 compared with the AKR1B10 pocket, consistent with distinct substrate specificity and narrower inhibitor selectivity for AKR1B15.

BACKGROUND: Modeling count and binary data collected in hierarchical designs have increased the use of Generalized Linear Mixed Models (GLMMs) in medicine. This article presents a systematic review of the application and quality of results and information reported from GLMMs in the field of clinical medicine. METHODS: A search using the Web of Science database was performed for published original articles in medical journals from 2000 to 2012. The search strategy included the topic "generalized linear mixed models","hierarchical generalized linear models", "multilevel generalized linear model" and as a research domain we refined by science technology. Papers reporting methodological considerations without application, and those that were not involved in clinical medicine or written in English were excluded. RESULTS: A total of 443 articles were detected, with an increase over time in the number of articles. In total, 108 articles fit the inclusion criteria. Of these, 54.6% were declared to be longitudinal studies, whereas 58.3% and 26.9% were defined as repeated measurements and multilevel design, respectively. Twenty-two articles belonged to environmental and occupational public health, 10 articles to clinical neurology, 8 to oncology, and 7 to infectious diseases and pediatrics. The distribution of the response variable was reported in 88% of the articles, predominantly Binomial (n = 64) or Poisson (n = 22). Most of the useful information about GLMMs was not reported in most cases. Variance estimates of random effects were described in only 8 articles (9.2%). The model validation, the method of covariate selection and the method of goodness of fit were only reported in 8.0%, 36.8% and 14.9% of the articles, respectively. CONCLUSIONS: During recent years, the use of GLMMs in medical literature has increased to take into account the correlation of data when modeling qualitative data or counts. According to the current recommendations, the quality of reporting has room for improvement regarding the characteristics of the analysis, estimation method, validation, and selection of the model.

This study investigates the predation of P. noctiluca ephyrae on Atlantic Bluefin tuna (ABFT) eggs under different experimental conditions. The specific factors considered in the experimental design were: a) water mix conditions to explore predation under two-dimensional (2D) and three-dimensional (3D) prey distributions, b) prey density to investigate the ingestion rate capacity, and c) incubation time to inspect gut saturation. The eggs and jellyfish ephyrae were collected during the 2012 ABFT spawning survey off Ibiza (Balearic Isl., Western Mediterranean). The results showed that the proportion of feeding ephyrae increased with size. The mean clearance rate of feeding ephyrae, 4.14 L h(-1), was the highest ever recorded for ephyrae. Under calm conditions the eggs floated at the surface (2D spatial arrangement) and the clearance rates, at low prey densities, were at least twice those under mixed conditions (3D spatial arrangement). At high prey density, clearance rate did not differ between mix conditions, probably due to the fast gut saturation, which was reached in c.a. 15 min, as revealed by time series observations of gut contents. The fast saturation of ephyrae and their slow digestion time of approximately 18 h suggest the existence of a diel feeding periodicity. We conclude that in the Western Mediterranean, P. noctiluca ephyrae are capable of predating on ABFT eggs, a highly pulsed and spatially restricted resource that potentially switches from a 3D to a 2D configuration in the absence of wind-generated turbulence. The P. noctiluca and Atlantic Bluefin tuna egg system might represent an example of a general mechanism linking pelagic and neustonic food webs.

BackgroundAdherence to interferon β-1b (INFβ-1b) therapy is essential to maximize the beneficial effects of treatment in multiple sclerosis (MS). For that reason, the main objectives of this study are to assess adherence to INFβ-1b in patients suffering from MS in Spain, and to identify the factors responsible for adherence in routine clinical practice.Methodology/principal findingsThis was an observational, retrospective, cross-sectional study including 120 Spanish patients with MS under INFβ-1b treatment. Therapeutic adherence was assessed with Morisky-Green test and with the percentage of doses received. The proportion of adherent patients assessed by Morisky-Green test was 68.3%, being indicative of poor adherence. Nevertheless, the percentage of doses received, which was based on the number of injected medication, was 94.3%. The main reason for missing INFβ-1b injections was forgetting some of the administrations (64%). Therefore, interventions that diminish forgetfulness might have a positive effect in the proportion of adherent patients and in the percentage of doses received. In addition, age and comorbidities had a significant effect in the number of doses injected per month, and should be considered in the management of adherence in MS patients.Conclusion/significanceAmong all the available methods for assessing adherence, the overall consumption of the intended dose has to be considered when addressing adherence.

This study investigates the predation of P. noctiluca ephyrae on Atlantic Bluefin tuna (ABFT) eggs under different experimental conditions. The specific factors considered in the experimental design were: a) water mix conditions to explore predation under two-dimensional (2D) and three-dimensional (3D) prey distributions, b) prey density to investigate the ingestion rate capacity, and c) incubation time to inspect gut saturation. The eggs and jellyfish ephyrae were collected during the 2012 ABFT spawning survey off Ibiza (Balearic Isl., Western Mediterranean). The results showed that the proportion of feeding ephyrae increased with size. The mean clearance rate of feeding ephyrae, 4.14 L h-1, was the highest ever recorded for ephyrae. Under calm conditions the eggs floated at the surface (2D spatial arrangement) and the clearance rates, at low prey densities, were at least twice those under mixed conditions (3D spatial arrangement). At high prey density, clearance rate did not differ between mix conditions, probably due to the fast gut saturation, which was reached in c.a. 15 min, as revealed by time series observations of gut contents. The fast saturation of ephyrae and their slow digestion time of approximately 18 h suggest the existence of a diel feeding periodicity. We conclude that in the Western Mediterranean, P. noctiluca ephyrae are capable of predating on ABFT eggs, a highly pulsed and spatially restricted resource that potentially switches from a 3D to a 2D configuration in the absence of wind-generated turbulence. The P. noctiluca and Atlantic Bluefin tuna egg system might represent an example of a general mechanism linking pelagic and neustonic food webs. [ABSTRACT FROM AUTHOR]