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Abstract Background The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention “EspaiJove.net” in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity. Methods A clustered school-based randomised controlled trial (cRCT) design. Subjects: 1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018. Intervention: Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list. Outcome measures: 1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ. Analysis: The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling. Results One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p

Predictive biomarkers of trabectedin represent an unmet need in advanced soft‐tissue sarcomas (STS). DNA damage repair (DDR) genes, involved in homologous recombination or nucleotide excision repair, had been previously described as biomarkers of trabectedin resistance or sensitivity, respectively. The majority of these studies only focused on specific factors (ERCC1, ERCC5, and BRCA1) and did not evaluate several other DDR‐related genes that could have a relevant role for trabectedin efficacy. In this retrospective translational study, 118 genes involved in DDR were evaluated to determine, by transcriptomics, a predictive gene signature of trabectedin efficacy. A six‐gene predictive signature of trabectedin efficacy was built in a series of 139 tumor samples from patients with advanced STS. Patients in the high‐risk gene signature group showed a significantly worse progression‐free survival compared with patients in the low‐risk group (2.1 vs 6.0 months, respectively). Differential gene expression analysis defined new potential predictive biomarkers of trabectedin sensitivity (PARP3 and CCNH) or resistance (DNAJB11 and PARP1). Our study identified a new gene signature that significantly predicts patients with higher probability to respond to treatment with trabectedin. Targeting some genes of this signature emerges as a potential strategy to enhance trabectedin efficacy.

The present research consisted in determining α-linolenic acid (ALA, ω-3) and linoleic acid (LA, ω-6) in vegetable oils with ultrasound-assisted extraction. The analytical method was validated by high performance liquid chromatography (HPLC) for the quantification of both polyunsaturated fatty acids (PUFA). The determination was made at a wavelength of 205 nm, mobile phase composed of acetonitrile: methanol: acetic acid 1% (85:5:10), with a flow of 1 mL min-1 and during 5 min. The calibration graph data (50 to 300 mg L-1) adjusted to the linear regression model with a coefficient of determination (R2) of 0.99914 and 0.99986 for ALA and LA, respectively. The repeatability, reproducibility, accuracy and percentage of recovery complied with international guidelines for analytical methods. The proposed method is simple, fast, linear, precise and accurate for the quantitative determination of ALA and LA in vegetable oils. The previous ultrasound application during 10 min achieves significantly higher concentrations (p 0.05) when ultrasound is not applied. In conclusion, the present method can serve as a useful alternative for routine determinations of ALA and LA in vegetable oils, as it proved to be an easy, fast and reliable method.

Background: Heart failure (HF) diagnosis as reported in primary care medical records is not always properly confirmed and could result in over-registration. Objectives: To determine the proportion of registered HF that can be confirmed with information from primary care medical records and to analyse related factors. Methods: A cross-sectional study. The medical records of 595 HF patients attended in two primary healthcare centres in Barcelona (Spain) were revised and validated by a team of experts who classified diagnosis into confirmed, unconfirmed, and misdiagnosis. Variables potentially related to the confirmation of the diagnosis were analysed. The revision of medical records and data collection took place from 15 January to 31 March 2014. Results: Mean (standard deviation) age was 78 (10) years and 58% were women. The diagnosis could be confirmed in 53.6% of patients. Factors associated with a greater probability of having a confirmed diagnosis were age (yearly OR: 0.97, 95%CI: 0.95–0.99), cardiologist follow-up (OR: 3.66, 95%CI: 2.46–5.48), history of ischaemic heart disease (OR: 2.18, 95%CI: 1.36–2.48), atrial fibrillation (OR: 2.01, 95%CI: 1.34–3.03), and prescription of loop diuretics (OR: 3.24, 95%CI: 2.14–4.89). Conclusion: Only in half of the patients labelled as HF in primary care medical records could this diagnosis be further confirmed. Variables regularly registered in clinical practice could help general practitioners identify those patients requiring a revision of their HF diagnosis.

Light cuts from fluid catalyst cracking (FCC) units are commonly used as feedstocks for etherification units in oil refineries. These feedstocks contain nitriles and diolefins that poison the etherification catalyst. PDVSA Intevep has developed several methods for removing these nitriles. An adsorption-based option is discussed in this paper; two other options reported recently were based on catalytic conversions (Ramírez-Corredores et al. 2002, 2003). The oligomerization tendencies of the diolefins dictated the use of a rather inert adsorbent. Some of the critical features of this adsorbent and the adsorption process are discussed. The adsorbent design was based on a geometrical premise and on active non-acid sites to achieve a highly selective adsorbent with a high adsorption capacity for nitriles. Chemical shift was selected for the desorption stage of the removal process to preserve the active lifetime of the adsorbent in the treatment of reactive feedstocks. This was demonstrated to be both effective and beneficial.

Introduction: Clear cell sarcoma (CCS) is a rare and aggressive soft tissue sarcoma. CCS is characterized by the translocation t(12;22) (q13;q12), involving the fusion of EWSR1 and ATF1 genes, and less frequently the fusion gene EWSR1-CREB1. Usually, CCSs are considered poorly responsive to conventional chemotherapy. However, trabectedin has shown activity against translocation-related sarcomas. Furthermore, preclinical results suggest that trabectedin is a promising antitumor agent for CCS, potentially inducing melanocytic differentiation. Case Presentation: We report the case of a challenging anatomopathological diagnosis in a patient with an aggressive metastatic CCS. Following the diagnosis of CCS, the patient experienced a clinical and radiological tumor response to trabectedin after four lines of treatment. Conclusion: This is a novel report of CCS treated with trabectedin that resulted in a partial response and suggests the need for further research on trabectedin as a therapeutic option for CCS.

Introduction: In recent years, target therapies to specific molecular alterations in advanced non–small cell lung cancer (NSCLC) have been identified and have shown superior efficacy compared to non-targeted treatments. Anaplastic lymphoma kinase (ALK) is one of the therapeutic targets; nevertheless, ALK diagnosis is not performed in all NSCLC patients in Spain. The objective of this study is to estimate in monetary terms the benefit for the Spanish society of ALK diagnosis in advanced NSCLC patients. Methods: A cost-benefit analysis of ALK diagnosis vs. non-diagnosis in advanced NSCLC patients was carried out from the Spanish social perspective, with a time horizon of 5 years. Costs, benefits and the cost-benefit ratio weremeasured. The analysis has considered the overall survival in advanced NSCLC patients treated with the ALKtyrosine kinase inhibitor (TKI) alectinib. The natural history of NSCLC was simulated using a Markov model. A 3% discount rate was applied to both costs and benefits. The result was tested using a deterministic sensitivity analysis. Results: The cost of ALK diagnosis vs. non-diagnosis in the base case would be €10.19 million, generating benefits of €11.71 million. The cost-benefit ratio would be €1.15. In the sensitivity analysis, the cost-benefit ratio could range from €0.89 to €2.10. Conclusions: The results justify the universal application of ALK diagnosis in advanced NSCLC, which generates a benefit for Spanish society that outweighs its costs and allows optimal treatment with targeted therapies for these patients.

Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10–15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS.

BackgroundWe have defined a project to develop a mobile app that continually records smartphone parameters which may help define the Eastern Cooperative Oncology Group performance status (ECOG-PS) and the health-related quality of life (HRQoL), without interaction with patients or professionals. This project is divided into 3 phases. Here we describe phase 1. The objective of this phase was to develop the app and assess its usability concerning patient characteristics, acceptability, and satisfaction.MethodsThe app eB2-ECOG was developed and installed in the smartphone of cancer patients who will be followed for six months. Criteria inclusion were: age over 18-year-old; diagnosed with unresectable or metastatic lung cancer, gastrointestinal stromal tumor, sarcoma, or head and neck cancer; under systemic anticancer therapies; and possession of a Smartphone. The app will collect passive and active data from the patients while healthcare professionals will evaluate the ECOG-PS and HRQoL through conventional tools. Acceptability was assessed during the follow-up. Patients answered a satisfaction survey in the app between 3-6 months from their inclusion.ResultsThe app developed provides a system for continuously collecting, merging, and processing data related to patient’s health and physical activity. It provides a transparent capture service based on all the available data of a patient. Currently, 106 patients have been recruited. A total of 36 patients were excluded, most of them (21/36) due to technological reasons. We assessed 69 patients (53 lung cancer, 8 gastrointestinal stromal tumors, 5 sarcomas, and 3 head and neck cancer). Concerning app satisfaction, 70.4% (20/27) of patients found the app intuitive and easy to use, and 51.9% (17/27) of them said that the app helped them to improve and handle their problems better. Overall, 17 out of 27 patients [62.9%] were satisfied with the app, and 14 of them [51.8%] would recommend the app to other patients.ConclusionsWe observed that the app’s acceptability and satisfaction were good, which is essential for the continuity of the project. In the subsequent phases, we will develop predictive models based on the collected information during this phase. We will validate the method and analyze the sensitivity of the automated results.

Abstract Background Improved point-of-care diagnostic tests for tuberculosis (TB) in severe immune suppressed people living with HIV (PLWH) are needed to decrease morbidity and mortality outcomes. The aim of the study is to evaluate the performance of the lipoarabinomannan antigen test (LAM-test) with and without α-mannosidase pre-treated urine in a cohort of PLWH in primary care clinics in Guatemala. We further determined TB incidence, and mortality rates and its risk factors in PLWH with TB symptoms. Methods Prospective longitudinal study of PLWH with TB symptoms. Urine samples were collected at 2 HIV sites to test the sensitivity of the LAM-test in urine with and without α-mannosidase pre-treatment. A composite reference standard of either a positive Mycobacterium tuberculosis complex culture and/or GeneXpert® MTB/RIF (Xpert, Cepheid, Sunnyvale, CA, USA) results was used in the LAM-test diagnostic accuracy studies. Cox proportional hazards regression was used to study mortality predictors. Results The overall sensitivity of the LAM-test was of 56.1% with 95% CI of (43.3–68.3). There were no differences in the LAM-test sensitivity neither by hospital nor by CD4 T cell values. LAM-test sensitivity in PLWH with

Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization. Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples. Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0–1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047). Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

Finding angiogenic prognostic markers in advanced non-small-cell lung cancer is still an unmet medical need. We explored a set of genetic variants in the VEGF-pathway as potential biomarkers to predict clinical outcomes of patients with non-small-cell lung cancer treated with chemotherapy plus bevacizumab. We prospectively analyzed the relationship between VEGF-pathway components with both pathological and prognostic variables in response to chemotherapy plus bevacizumab in 168 patients with non-squamous non-small-cell lung cancer. Circulating levels of VEGF and VEGFR2 and expression of specific endothelial surface markers and single-nucleotide polymorphisms in VEGF-pathway genes were analyzed. The primary clinical endpoint was progression-free survival. Secondary endpoints included overall survival and objective tumor response. VEGFR-1 rs9582036 variants AA/AC were associated with increased progression-free survival (p = 0.012 and p = 0.035, respectively), and with improved overall survival (p = 0.019) with respect to CC allele. Patients with VEGF-A rs3025039 harboring allele TT had also reduced mortality risk (p = 0.049) compared with the CC allele. The VEGF-A rs833061 variant was found to be related with response to treatment, with 61.1% of patients harboring the CC allele achieving partial treatment response. High pre-treatment circulating levels of VEGF-A were associated with shorter progression-free survival (p = 0.036). In conclusion, in this prospective study, genetic variants in VEGFR-1 and VEGF-A and plasma levels of VEGF-A were associated with clinical benefit, progression-free survival, or overall survival in a cohort of advanced non-squamous non-small-cell lung cancer patients receiving chemotherapy plus antiangiogenic therapy.

Background: Cancer patients represent a vulnerable population for COVID-19 illness. We aimed to analyze outcomes of lung cancer patients affected by COVID-19 in a tertiary hospital of a high-incidence region during the pandemic.Methods: We annotated 23 lung cancer patients consecutively diagnosed with COVID-19 at our institution (HGUGM; Madrid, Spain) between March 4th, 2020 and May 12th, 2020. Only patients with a confirmatory SARS-CoV-2 RT-PCR were included in the study.Results: All patients had at least 1 COVID-19 related symptom; cough (48%), shortness of breath (48%), fever (39%), and low-grade fever (30%) were the most common. Time from symptoms onset to first positive SARS-CoV-2 PCR was 5.5 days (range 1–17), with 13% of cases needed from a 2nd PCR to confirm diagnosis. There was a high variability on thoracic imaging findings, with multilobar pneumonia as the most commonly found pattern (74%). Main lab test abnormalities were low lymphocytes count (87%), high neutrophil to lymphocyte ratio -NLR- (78%), and elevated inflammatory markers: fibrinogen (91%), c-reactive protein -CRP- (87%), and D-dimer (70%). In our series, hospitalization rate was 74%, 39% of patients developed acute respiratory distress syndrome (ARDS), and the case-fatality rate was 35% (8/23). 87% of patients received anti-viral treatment (87% hydroxychloroquine, 74% lopinavir/ritonavir, 13% azithromycin), 43% corticosteroids, 26% interferon-β, 4% tocilizumab, and 82% of hospitalized patients received anticoagulation. High-oxygen requirements were needed in 39% of patients, but only 1 pt was admitted for invasive MV and was discharged 42 days after admission. Multiple variables related to tumor status, clinical baseline conditions, and inflammation markers were associated with mortality but did not remain statistically significant in a multivariate model. In patients with lung cancer receiving systemic therapy (n = 242) incidence and mortality from COVID-19 were 4.5, and 2.1%, respectively, with no differences found by type of treatment.Conclusions: Lung cancer patients represent a vulnerable population for COVID-19, according to the high rate of hospitalization, onset of ARDS, and high mortality rate. Although larger series are needed, no differences in mortality were found by type of cancer treatment. Measures to minimize the risk of SARS-CoV-2 infection remain key to protect lung cancer patients.

Background: Approximately 15% of patients infected by SARS-CoV-2 develop a distress syndrome secondary to a host hyperinflammatory response induced by a cytokine storm. Myelosuppression is associated with a higher risk of infections and mortality. There are data to support methods of management for neutropenia and COVID-19. We present a multicenter experience during the first COVID-19 outbreak in neutropenic cancer patients infected by SARS-CoV-2. Methods: Clinical retrospective data were collected from neutropenic cancer patients with COVID-19. Comorbidities, tumor type, stage, treatment, neutropenia severity, G-CSF, COVID-19 parameters, and mortality were analyzed. A bivariate analysis of the impact on mortality was carried out. Additionally, we performed a multivariable logistic regression to predict respiratory failure and death. Results: Among the 943 cancer patients screened, 83 patients (11.3%) simultaneously had neutropenia and an infection with COVID-19. The lungs (26%) and breasts (22%) were the primary locations affected, and most patients had advanced disease (67%). In the logistic model, as adjusted covariates, sex, age, treatment (palliative vs. curative), tumor type, and the lowest level of neutrophils were used. A significant effect was obtained for the number of days of G-CSF treatment (OR = 1.4, 95% CI [1,1,03,92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with infections by COVID-19, with a higher probability of worse outcome.

Presents abstracts of plenary lectures at the Second Scientific Conference "Restauración Neurologica 2004". Use of growth factor gene therapy in the central nervous system; Details of the development and function of mammalian motoneurons; Report on the involvement of DNA damage and repair systems in neurodegenerative process; Declaration of results of LEIS evaluation on patients with multiple sclerosis after a neurorestorative treatment.

In mammals, glucosensing markers reside in brain areas known to play an important role in the control of food intake. The best characterized glucosensing mechanism is that dependent on glucokinase (GK) whose activation by increased levels of glucose leads in specific hypothalamic neurons to decreased or increased activity, ultimately leading to decreased food intake. In fish, evidence obtained in recent years suggested the presence of GK-like immunoreactive cells in different brain areas related to food intake control. However, it has not been established yet whether or not those neuronal populations having glucosensing capacity are the same that express the neuropeptides involved in the metabolic control of food intake. Therefore, we assessed through dual fluorescent in situ hybridization the possible expression of GK in the melanocortinergic neurons expressing proopiomelanocortin (POMC) or agouti-related protein (AGRP). POMC and AGRP expression localized exclusively in the rostral hypothalamus, in the ventral pole of the lateral tuberal nucleus, the homolog of the mammalian arcuate nucleus. Hypothalamic GK expression confined to the ependymal cells coating the ventral pole of the third ventricle but some expression level occurred in the AGRP neurons. GK expression seems to be absent in the hypothalamic POMC neurons. These results suggest that AGRP neurons might sense glucose directly through a mechanism involving GK. In contrast, POMC neurons would not directly respond to glucose through GK and would require presynaptic inputs to sense glucose. Ependymal cells could play a critical role relying glucose metabolic information to the central circuitry regulating food intake in fish, especially in POMC neurons.

The aim of this study was to identify an easily reliable prognostic score that selects the subset of advanced soft tissue sarcoma (ASTS) patients with a higher benefit with trabectedin in terms of time to progression and overall survival. A retrospective series of 357 patients with ASTS treated with trabectedin as second- or further-line in 19 centers across Spain was analyzed. First, it was confirmed that patients with high growth modulation index (GMI > 1.33) were associated with the better clinical outcome. Univariate and multivariate analyses were performed to identify factors associated with a GMI > 1.33. Thus, GEISTRA score was based on metastasis free-interval (MFI ≤ 9.7 months), Karnofsky < 80%, Non L-sarcomas and better response in the previous systemic line. The median GMI was 0.82 (0–69), with 198 patients (55%) with a GMI < 1, 41 (11.5%) with a GMI 1–1.33 and 118 (33.1%) with a GMI > 1.33. The lowest GEISTRA score showed a median of time-to-progression (TTP) and overall survival (OS) of 5.7 and 19.5 months, respectively, whereas it was 1.8 and 3.1 months for TTP and OS, respectively, for the GEISTRA 4 score. This prognostic tool can contribute to better selecting candidates for trabectedin treatment in ASTS.

Objective: To evaluate the incidence of risky consumption (RC) and heavy episodic drinking (HED) in the Cohort of Spanish university students at two-year follow-up and to identify predictors of these patterns of alcohol consumption and the association between these patterns and academic achievement. Method: We carried out a cohort study. Alcohol consumption was measured with the AUDIT. The following variables were collected by questionnaire: place of residence, parents' education, alcohol consumption in the family, age of onset of use, alcohol expectancies, and the academic achievement. We constructed logistic regression models using three dependent variables: RC, HED, and academic achievement. Results: The response rate at two-year follow-up was 64.1%. The incidence of RC and HED at two-year follow-up were 24.92% and 4.01% respectively. The prevalence of RC rose from 37.1% to 54.6%. On the contrary, HED dropped from 12.2% to 8.7%. In relation to incidence of RC, being male (OR=2.77), medium (OR=1.59) or high expectancies (OR=2.24), and early age of onset of use (OR=2.26) constituted risk factors. In contrast, living with parents constituted a protective factor (OR=0.48). For HED, being male (OR=1.92) and high expectancies (OR=2.96) were risk factors. RC and HED were risk factors for low academic achievement. Conclusions: HED is a pattern of alcohol consumption mainly associated with adolescence, while RC is associated with youth. Both patterns are predictors of academic achievement. Public Health strategies should focus on modifying expectancies and limit access to alcohol at young ages.Objetivo: Determinar la incidencia del consumo de riesgo de alcohol (CR) y del consumo intensivo (CI) en una cohorte de estudiantes universitarios a los 2 años de seguimiento e identificar los factores de estas pautas de consumo de alcohol y su asociación con el redimiento académico. Método: Se ha realizado un estudio de cohortes. El consumo de alcohol se ha medido con el AUDIT. Las siguientes variables se han medido mediante cuestionario: lugar de residencia, educación parental, consumo de alcohol en la familia, edad de inicio de uso, expectativas sobre alcohol y rendimiento académico. Para el análisis de datos se han construido modelos de regresión logística con las tres variables dependientes consideradas: CR, CI y rendimiento académico. Resultados: La tasa de respuesta en el seguimiento se situó en el 64,1%. La incidencia de CR y CI a los 2 años fue del 24,92% y el 4,01%. La prevalencia de CR aumentó del 37,1% al 54,6%. Por el contrario, el CI disminuyó del 12,2% al 8,7%. Con relación a la incidencia de CR, el ser varón (OR=2,77), las medias (OR=1.59) y altas expectativas (OR=2.24), y la edad temprana de inicio de uso (OR=2,26) son factores de riesgo. Por el contrario, el vivir con los padres muestra un factor protector (OR=0,48). Para el CI, ser varón (OR=1,92) y las altas expectativas (OR=2,96) son también factores de riesgo. Ambos patrones de consumo constituyen factores de riesgo del bajo rendimiento académico. Conclusiones: El CI es un patrón de consumo principalmente asociado con la adolescencia, mientras que el CR se asocia con la juventud. Ambos patrones son predictores del rendimiento académico. Las estrategias de salud pública deberían centrarse en la modificación de expectativas y en limitar el acceso al alcohol de los más jóvenes.

El fenomen de les narratives transmedia, producte de l'experimentació de la ficció televisiva en un marc multimèdia i multiplataforma, planteja nombrosos desafiaments que no només concerneixen a decisions de la indústria i les seves línies de producció sinó també a la reflexió i anàlisi que estableixen com a objecte d'estudi aquestes noves formes. L'aparell metodològic-conceptual aplicat i assajat amb mitjans i formes d'expressió de l'era predigital és posat a prova constantment en l'actualitat per les narratives desplegables. En aquest text, i recolzant-nos en la nostra experiència sobre la producció ficcional més recent, ens referirem a un concepte clau pel desenvolupament de la narració transmediática: la serialitat, en especial com les formes d'estructurar i organitzar la narració són reformulades en el nou i complex context mediàtic, i en aquesta direcció, quines són les tensions generades entorn d'aquestes narratives entre, d'una banda, les demandes que s'associen a modalitats de consum pròpies d'un mitjà tradicional que no ha canviat bàsicament els seus protocols consolidats en l'era analògica, i de l'altre, les noves formes d'accés i ús dels continguts propiciats per les noves tecnologies.

Los indicadores de la calidad de la prescripción de grado potencial de uso (IGPU) se definen como la proporción que representa el consumo de determinados principios activos frente al consumo total de su categoría anatómica terapéutica. En los últimos años, los IGPU que se han ido definiendo en nuestro país utilizan la dosis diaria definida (DDD) como unidad de medida. Y aunque la DDD no es necesariamente igual a la dosis terapéutica equivalente (DTE), se ha argumentado que es una unidad de medida estándar y, por tanto, válida. Esto podría no ser correcto, ya que las relaciones entre DTE y DDD son distintas en los diferentes fármacos, incluso dentro de la misma categoría anatómica terapéutica. Por ello, la utilización de las DDD en los IGPU puede llevar a incentivar o desincentivar la prescripción de un fármaco en función de su relación DTE/DDD.Quality prescription indicators of use potential level (UPLI) are defined as the proportion that represents consumption of specific active principles as opposed to the total consumption of the anatomical therapeutic category. The UPLIs that have gradually been defined in Spain employ the defined daily dose (DDD) as the unit of measurement. Although the DDD is not necessarily the same as the therapeutic equivalent dose (TED), some authors have argued that the DDD is a standard unit of measurement and is therefore valid. However, this view may not be correct, given that the relationships between the TED and the DDD differ, depending on the drug, even within the same anatomical therapeutic category. Therefore, the use of DDDs in UPLI s may lead to prescription of a medicine being encouraged or discouraged depending on its TED/DDD ratio.