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This article provides a comprehensive study of ecosystem rehabilitation methods widely used in the 21st century, focusing on Europe. The review covers the evolution and trends in scientific article publication, identification of European countries demonstrating high publication outputs, collaboration patterns, leading journals, and thematic areas. Additionally, it examines primary stressors in European aquatic ecosystems, and different methods and treatments commonly employed for remediation purposes. The analysis of selected articles revealed a significant increase in studies over time, driven by public awareness and financial incentives from national, European and global organizations. Italy, Portugal and Spain were the leading countries in degraded ecosystem rehabilitation studies, mainly focusing on remediating contaminated areas where metals were identified as the primary stressor (chemical pollution). Chemical remediation method emerged as the most used, closely followed by biological remediation method, which have gained prominence in recent years due to their ecological, economic, and social combined benefits. Furthermore, recent studies demonstrate a growing trend towards the combined use of more than one treatment/method to rehabilitate ecosystems, particularly with biological treatments. This combined approach has the potential for synergistic effects in achieving more effective rehabilitation and their sustainability in the long term, thus, a focus for future research., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Metal mining in the Extremadura region was very important in the 19 th and 20 th centuries. However, due to different reasons the great majority of mines ceased operations, leading to plenty of abandoned mining sites, most of them with on-site waste dumps. Although metal extraction is not radioactive per se, it is considered a NORM activity. In this study, three former mining sites, in which Pb-V-Zn-Ag, Pb-Ag, and Pb-Zn were extracted, were selected to assess the radiological impact on the population and the environment. The external γ exposure was estimated by determining the effective dose and elaborating isodose maps of the sites. The presence of the mining sites increased up to 0.41 mSv/y the effective dose over the surrounding background, which is below the reference value of 1 mSv/y. In only one mining site, the uranium and radium activity concentration of waste dumps were higher than the surrounding soil. The soil to plant (wild grass) transfer factors were similar to other reported values without the influence of NORM activities. So, no enhanced transfer of radionuclides was observed. The radiological impact on the environment was assessed by the risk to non-human biota using the tiered approach developed in ERICA Tool. The sum of the risk quotients of all considered radionuclides in the most conservative Tier 1 was below 1. Total dose rates for several terrestrial Reference Animal and Plants (RAPs) were estimated using Tier 3, obtaining values below 40 µGy/h. Therefore, the impact on non-human biota can be considered as negligible., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The corresponding author (J. Guillen) serves as Assistant Editor to the Journal of Environmental Radioactivity If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Climate change and population ageing are converging challenges that are expected to significantly worsen the health impacts of high temperatures. We aimed to remeasure the implications of ageing for heat-related mortality by comparing time trends based on chronological age (number of years already lived) with those derived from the application of state-of-the-art demographic methodology which better captures the dynamics of evolving longevity: prospective age (number of years still to be lived). We conducted a nationwide time-series analysis of 13 regions in Spain over 1980-2018 using all-cause mortality microdata for people aged 65+ and annual life tables from the Spanish National Institute of Statistics, and daily mean temperatures from E-OBS. Based on confounder-adjusted quasi-Poisson regression with distributed lag non-linear models and multivariate meta-analysis in moving 15-year timeslices, we assessed sex-specific changes in absolute risk and impacts for heat-related mortality at extreme and moderate temperatures, for chronological and prospective age groups. In the conventional chronological age analysis, absolute risk fell over the study period (e.g. females, extreme heat: -54%; moderate heat: -23%); after accounting for rising longevity, the prospective age analysis, however, found a smaller decline in risk for extreme heat (-15%) and a rise for moderate heat (+46%). Additionally, while the chronological age analysis suggested a shift in mortality towards higher ages, the prospective age analysis showed that over the study period, people of largely the same (prospective) age were impacted. Further, the prospective age analysis revealed excess risk in females (compared to males) rose from 20% to 27% for extreme heat, and from 40% to 70% for moderate heat. Assessing the implications of ageing using a prospective age perspective showed the urgency of re-doubling risk reduction efforts, including accelerating healthy ageing programs that incorporate climate considerations. The age patterns of impacts suggested that such actions have the potential to mitigate ageing-related heat-health threats to generate climate change-ready, healthy societies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Data on positive rechallenge in idiosyncratic drug-induced liver injury (DILI) are scarce. We aim to analyse the clinical presentation, outcome and drugs associated with positive rechallenge in two DILI registries., Methods: Cases from the Spanish and Latin American DILI registries were included. Demographics, clinical characteristics and outcome of cases with positive rechallenge according to CIOMS/RUCAM and current definitions were analysed., Results: Of 1418 patients with idiosyncratic DILI, 58 cases had positive rechallenge (4.1%). Patients with positive rechallenge had shorter duration of therapy (p=0.001) and latency (p=0.003). In patients with rechallenge, aspartate transaminase levels were increased (p=0.026) and showed a prolonged time to recovery (p=0.020), albeit no differences were seen in terms of fatal outcomes. The main drug implicated in rechallenge was amoxicillin-clavulanate (17%). The majority of re-exposure events were unintentional (71%). Using both existing definitions of positive rechallenge, there were four cases which exclusively fulfilled the current criteria and five which only meet the historical definition. All cases of positive rechallenge, irrespective of the pattern of damage, fulfilled the criteria of either alanine transaminase (ALT) ≥3 times the upper limit of normal (ULN) and/or alkaline phosphatase (ALP) ≥2 times ULN., Conclusions: Episodes of rechallenge were characterised by shorter duration of therapy and latency, and longer time to resolution, but did not show an increased incidence of fatal outcome. Based on our findings, ALT ≥3 times ULN and/or ALP ≥2 times ULN, regardless of the pattern of damage, is proposed as a new definition of rechallenge in DILI., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In Spain, from October 10th, 2023, the FreeStyle Libre 2 system offers the possibility to automatically changed from isCGM to rtCGM with a system update. Our study aimed to evaluate the glucometric before and after that date. We didn't find significant changes in TIR, however time of use increased and TBR decreased., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal interests' relationship that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The Comprehensive assessment of Acceptance and Commitment Therapy (CompACT) is a 23-item questionnaire measuring psychological flexibility, a quality of life protective factor. An 18-item version was recently produced. We assessed validity and reliability of CompACT, and equivalence of paper and electronic (eCompACT) versions in people with multiple sclerosis (PwMS) in Italy, Germany and Spain., Methods: We used confirmatory factor analysis and assessed CompACT-23 and CompACT-18 measurement invariance between the three language versions. We assessed construct validity (Spearman's correlations) and internal consistency (Cronbach's alpha). Test-retest reliability (intraclass correlation coefficient, ICC) and equivalence of paper and eCompACT (ICC and linear regression model for repeated measures) were assessed in subsamples of PwMS., Results: A total of 725 PwMS completed the study. The three-factor structure of the CompACT-23 showed poor fit (RMSEA 0.07; CFI 0.82; SRMR 0.08), while the fit of the CompACT-18 was good (RMSEA 0.05; CFI 0.93; SRMR 0.05). Configural and partial metric invariance were confirmed, as well as partial scalar invariance (reached when five items were allowed to vary freely). The CompACT-18 showed good internal consistency (all alpha ≥ 0.78); and test-retest reliability (all ICCs ≥ 0.86). Equivalence between paper and eCompACT was excellent (all ICCs ≥ 0.86), with no mode, order, or interaction effects., Conclusion: Results support using the refined CompACT-18 as a three-factor measure of psychological flexibility in PwMS. Paper and eCompACT-18 versions are equivalent. CompACT-18 can be used cross-culturally, but sub-optimal scalar invariance suggests that direct comparison between the three language versions should be interpreted with caution., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications. Design: A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer. Setting: Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023. Subjects: Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription. Interventions: All the patients included in the research were prescribed with their first pair of therapeutic footwear. Main measures: Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day. Results: The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5–8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities. Conclusions: Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations. [ABSTRACT FROM AUTHOR]

Identifying the main drivers of the household carbon footprint (HCF) is a priority to reduce greenhouse gas emissions and move towards a more sustainable economy. Among the multiple factors that explain the HCF, some previous research has confirmed the relevance of gender. In this paper, we calculate the HCF of individual Spanish households using an environmentally extended multi-regional input-output model (EEMRIO) that quantifies the emissions embedded in the supply chain of goods and services that households consume. We assess the differences in consumption and emissions patterns, measuring the gender effect by a new variable, the female share of the household. This represents a remarkable improvement over previous literature that used simpler approaches. Moreover, we assess the partial effect of gender on HCF using multivariate regressions for total and sectoral emissions. Our results show that households with a majority of men have a higher HCF and carbon intensity. Even when controlling for economic, sociodemographic, and regional factors there are differences in the sectoral emissions according to gender. Female households spend more (and generate more emissions) on housing and food products, while male households show that pattern for restaurants and transport. These results can help orientate environmental campaigns and demand-side mitigation policies. • We calculate HCF for individual Spanish households using HBS data and EEMRIO. • We introduce the gender effect through the new indicator "female share in households." • Households with a majority of men have a higher HCF and carbon intensity. • The higher the proportion of women in a household, the higher the HCF in housing and food. • The higher the proportion of women in a household, the lower the carbon footprint in restaurants and transportation. [ABSTRACT FROM AUTHOR]

The increased penetration of renewable energy sources (RESs) as an effective mechanism to reduce carbon emissions leads to an increased weather dependency for power and energy systems. This has created dynamic operation and degradation phenomena, which affect the lifetime estimation of the assets operated with RESs. For the reliable and efficient operation of RES it is crucial to monitor the health of its constituent components and feature selection is a crucial step for building robust and accurate health monitoring approaches. In this context, this paper presents a probabilistic feature selection approach, which probabilistically weights and selects features through a heuristic and iterative process for an improved asset lifetime estimation. Power transformers are key power grid assets and they are used to demonstrate the validity and impact of the proposed approach. The approach is tested on two different photovoltaic power plants operated in Spain and Australia. Results consistently show that the proposed feature-selection approach reduces the prediction error and consistently selects relevant features. The approach has been applied to transformer lifetime estimation, but it can be generally applied to assist in the lifetime estimation of other components operated in RESs. Part of the studies presented here as well as source codes are all open-source under the GitHub repository https://github.com/iramirezg/FeatureSelection. • Probabilistic feature selection approach for improved asset lifetime estimation. • Integration of environmental features for improved renewable-operated asset lifetime. • Systematic and robust feature weighting methodology. • Improved transformer lifetime estimation including sensor and environmental data. • Validated on two real photovoltaic power plant case studies. [ABSTRACT FROM AUTHOR]

The main purpose of this research is to identify the determinants that intervene in the transitional justice choices made in general, and those made in the Spanish case in particular. The construction of a linear regression model containing 83 transitions was developed to identify the significant explanatory factors in the transitional justice choices. The analysis enabled us to place Spain at some distance from the countries considered as successful in terms of transitional justice to classify it as an exception that is not adequately explained by the general model, while also identifying the main reasons for this. [ABSTRACT FROM AUTHOR]

Aim: To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain. Design: A three round online Delphi survey and focus group. Methods: An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio‐health care and manager nurses. Results: On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes. Conclusion: Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare. Implications for the Profession and/or Patient Care: Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non‐medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it. Impact: What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician‐led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process.What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks.Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process. Reporting Method: Standards for reporting qualitative research: a synthesis of recommendations. SRQR. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Under the current pattern of climate change, mountain bird populations are generally shifting their ranges to higher elevations, tracking their climatic optima. Nevertheless, space limitations at high altitudes constrain mountain species' resilience to climatic change, making them particularly vulnerable. In extreme cases, the climatic niche of some species can move beyond mountaintops, ultimately driving such species to extinction. This study presents the case of the northern wheatear Oenanthe oenanthe in mainland Spain and compares its breeding distribution from 2003 to 2022. Spain, where the species mostly occupies mountain areas, represents its southernmost distribution limit in Europe. We built environmental favourability models using information from the two most recent Spanish bird atlases and a set of climatic, topographic, human activity and lithological variables to determine the factors affecting the occurrence of the species. The influence of climate compared to all other factors was obtained using variation partitioning analysis. The northern wheatear has suffered a strong reduction (67%) in occupied areas and also in favourability throughout mainland Spain (especially in the south) where climate change may have far‐reaching consequences, including local extinctions. Climate explained more than 90% of the variation in the model obtained for 2022. Interestingly, the occupied areas were, on average, 100 m higher in 2022 than in 2003. If the effects of climate warming persist, the northern wheatear will likely disappear in its southernmost distribution limit, being the Sierra de las Nieves National Park population the most vulnerable in mainland Spain. For this reason, it is necessary to implement monitoring programmes for northern wheatear populations, with priority for mountain systems wherein they already occupy higher elevations, as well as further studies on other mountain species. [ABSTRACT FROM AUTHOR]

Background: The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission. Aim: To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days). Research Design and Setting: A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR. Results: A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital‐acquired pressure ulcers. Conclusions: Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital‐acquired ulcers at hospital discharge. Relevance to Clinical Practice: Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation. No Patient or Public Contribution: No direct patient contact was made during the data collection. [ABSTRACT FROM AUTHOR]

• Significant reduction (18.44%) in overall Spanish GHG emissions from 2008 to 2018, highlighting some differences depending on the considered phase of the crisis. • The total intensity effect has been noticeable negative, especially in Agriculture, Transport, and Other Services. • The total carbonization effect has contributed to increase GHG emissions by 5.86%, being particularly negative in the case of Industry. • Per capita production effect was strongly negative in Industry and slightly positive in the rest of the economic sectors. • R&D, more eco-friendly technologies, green energies, circular economy and consumer green attitudes: the best strategies to reduce GHG emissions. The reduction of GHG emissions to reverse the greenhouse effect is one of the main challenges in this century. In this paper we pursue two objectives. First, we analyze the evolution of GHG emissions in Spain in 2008–2018, at both the global and sectoral levels, with the variation in emissions decomposed into a set of determining factors. Second, we propose several actions specifically oriented to more tightly controlling the level of emissions. Our results showed a remarkable reduction (18.44%) in GHG emissions, mainly due to the intensity effect, but also to the production-per-capita effect. We detected somewhat different patterns among the various sectors analyzed. While the intensity effect was the most influential one in the agricultural, transport, and others sectors, the production-per-capita effect was predominant in the case of industry. The carbonization effect was revealed as crucial in the commerce sector. The above findings highlight the importance of the energy efficiency measures taken in recent years in the Spanish economy, also pointing to the need to deepen those strategies and to propose new measures that entail greater efficiency in emissions. Additional efforts in areas like innovation, R&D, diffusion of more eco-friendly technologies, and a greater use of greener energies all prove to be essential reduction actions to fight the greenhouse effect. [ABSTRACT FROM AUTHOR]

Clint Eastwood's American Sniper (2014) and Alba Sotorra's Game Over (2015) explore the inculcating pull of pop myths on soldiers. Eastwood's biopic focuses on Chris Kyle, American military history's most lethal sniper. Sotorra's documentary Game Over considers Djalal, an Iranian Catalan youth who moves from being an America-idolizing gamer to a sniper in Afghanistan. Initially, they see themselves as Western cowboys and perfect soldiers. War, however, leaves them disillusioned and traumatized. Via distinct generic formats (documentary v. feature film) and nationally determined political frameworks (US v. Spain), they ask: can mythologies fueling the post-9/11 war machine empty it of its force? Mobilizing postcolonial, disability, and trauma studies, this comparative analysis theorizes how objects of soft power can both harden a soldier's mind and liberate it from the battlefield's thrall. Ultimately, the article reveals contrasting, potentially limited strategies subjects across cultures deploy to break the hold of American visions of power. [ABSTRACT FROM AUTHOR]

The present study uses the apparent-time construct to analyze cross-generational variability of word order in unergative and unaccusative constructions in Basque (e.g., negar ein 'to cry' and heldu 'to arrive', respectively). It considers the results of an acceptability judgment as well as elicitation tasks carried out among two generations of Basque native speakers (55–75 years old, and 35–45 years old). Unlike the younger participants, the older participants lack the syntactic focus strategy. It is proposed that this lack among the older participants was conditioned by the socially restricted bilingualism that they experienced during the dictatorship of Francisco Franco (1939–1975), while the younger participants appeared to have acquired (i.e. recovered) the syntactic focus strategy because they experienced the legitimacy and vitality of Basque in public life and in formal education following the Normalization Law of 1982. Studies in Basque sociolinguistics have identified language changes through feature loss, dialectal leveling and contact-induced change, but no studies to date have identified the recovery of a previously lost syntactic structure. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents are particularly vulnerable to suicide attempts, which is a major risk factor for completed suicide in this age group. However, most research on suicide prevention interventions comes from high-income countries with predominantly white participants and English protocols. This study examines interventions that have been tested in Latin America and Spain. Methods: A systematic review was conducted to include interventions aimed at reducing suicide ideation, attempts, and increasing knowledge about it in these regions. Results: Sixteen articles were selected, and Dialectical Behaviour Therapy, Problem Solving Therapy, and Trauma-Focused Cognitive Behavioural Therapy were found to be more effective than standard treatments or wait-list conditions in reducing the outcomes. Discussion: This review highlights the need for more research on preventive interventions in Latin America and Spain. While all interventions evaluated were effective, further research and replication studies are necessary to strengthen the evidence base for these interventions. [ABSTRACT FROM AUTHOR]

This paper presents the results of the explorations carried out in the western sector of the Iberian Central System (western Gredos, Béjar, Gata and Estrela mountain ranges). The macroremains found allow detailing the model of the landscape transformation, the composition and extension of their vegetal formations throughout the Holocene. Ninety-nine woody macroremains, 3 bark remains and 8 pinecones were located from eight sites between 875 and 1860 m above sea level, among which 15 radiocarbon dates were made. The taxonomic identification of two trunks found in Estrela allows us to document the local presence of Pinus cf. sylvestris ca. 6600 cal BP in this site. The same taxon also appears at the western end of Gredos between ca. 1700–2800 cal BP at approximately 1300 m. These remains expand the Holocene distribution of P. cf. sylvestris in the Central System known to date, both temporally and geographically. In parallel, the macroremains analysed document the composition of high mountain scrub (Cytisus type, Erica cf. arborea) in Béjar (ca. 1860 m), as well as mixed scrub-woodland formations in Gata (975–1180 m), which included deciduous Quercus , Betulaceae and Ericaceae. The presence of P. pinaster at ca. 6200 cal BP and 1180 m in this mountain range constitutes the earliest palaeobotanical evidence of this species recorded in Gata. The main results support the continuous persistence of plant formations in which P. sylvestris , P. nigra , and P. pinaster would have formed part throughout the Iberian Central System during the Holocene in a wide altitudinal range (1100–1840 m). • Above one hundred Holocene macrofossils from eight different sites were analysed. • Pinus sylvestris recently disappeared from the western Central System. • P. gr. sylvestris remained in Serra da Estrela until ˜6650 years ago. • First evidence of Pinus pinaster has been found in Gata ˜6200 years ago. • Betula , Quercus , Alnus and Ericaceae Holocene macroremains were found in Gata. [ABSTRACT FROM AUTHOR]

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Background: Disease penetrance in genotype-positive (G+) relatives of families with dilated cardiomyopathy (DCM) and the characteristics associated with DCM onset in these individuals are unknown., Objectives: This study sought to determine the penetrance of new DCM diagnosis in G+ relatives and to identify factors associated with DCM development., Methods: The authors evaluated 779 G+ patients (age 35.8 ± 17.3 years; 459 [59%] females; 367 [47%] with variants in TTN) without DCM followed at 25 Spanish centers., Results: After a median follow-up of 37.1 months (Q1-Q3: 16.3-63.8 months), 85 individuals (10.9%) developed DCM (incidence rate of 2.9 per 100 person-years; 95% CI: 2.3-3.5 per 100 person-years). DCM penetrance and age at DCM onset was different according to underlying gene group (log-rank P = 0.015 and P <0.01, respectively). In a multivariable model excluding CMR parameters, independent predictors of DCM development were: older age (HR per 1-year increase: 1.02; 95% CI: 1.0-1.04), an abnormal electrocardiogram (HR: 2.13; 95% CI: 1.38-3.29); presence of variants in motor sarcomeric genes (HR: 1.92; 95% CI: 1.05-3.50); lower left ventricular ejection fraction (HR per 1% increase: 0.86; 95% CI: 0.82-0.90) and larger left ventricular end-diastolic diameter (HR per 1-mm increase: 1.10; 95% CI: 1.06-1.13). Multivariable analysis in individuals with cardiac magnetic resonance and late gadolinium enhancement assessment (n = 360, 45%) identified late gadolinium enhancement as an additional independent predictor of DCM development (HR: 2.52; 95% CI: 1.43-4.45)., Conclusions: Following a first negative screening, approximately 11% of G+ relatives developed DCM during a median follow-up of 3 years. Older age, an abnormal electrocardiogram, lower left ventricular ejection fraction, increased left ventricular end-diastolic diameter, motor sarcomeric genetic variants, and late gadolinium enhancement are associated with a higher risk of developing DCM., Competing Interests: Funding Support and Author Disclosures This study was funded by the Spanish Society of Cardiology (Grant in Inherited Cardiac Diseases 2022) and the Instituto de Salud Carlos III through the projects “PI18/0004, PI20/0320” (Co-funded by European Regional Development Fund/European Social Fund “A way to make Europe”/“Investing in your future”). The CNIC is supported by the ISCIII, MCIN, the Pro-CNIC Foundation, and the Severo Ochoa Centers of Excellence program (CEX2020-001041-S). The Hospital Universitario Puerta de Hierro, Hospital Clínic, Hospital Vall Hebron, Hospital Virgen del Rocío, Hospital Universitario Gregorio Marañon, and the Hospital Universitario Virgen de la Arrixaca are members of the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Breast-feeding is associated with fewer comorbidities in very-low-birth-weight (VLBW) preterm infants. Bronchopulmonary dysplasia (BPD) of VLBW infants is a multifactorial pathology in which nutritional aspects may be of special importance. The aim of this study is to determine, in a cohort of VLBW infants, whether breast milk nutrition is associated with a reduced prevalence and severity of BPD. A retrospective study was conducted to record the intake of mother's own milk (MOM), pasteurised donor human milk or preterm formula milk in the first 2 weeks of postnatal life of 566 VLBW newborns at our hospital during the period January 2008–December 2021. After applying the relevant exclusion criteria, data for 489 VLBW infants were analysed; 195 developed some degree of BPD. Moderate or severe BPD is associated with less weight gain. Moreover, the preferential ingestion of breast milk in the first and second postnatal weeks had effects associated with lower OR for BPD, which were statistically demonstrable for mild (OR 0·16; 95 % CI 0·03, 0·71) and severe (OR 0·08; 95 % CI 0·009, 0·91) BPD. Breast-feeding during the first weeks of postnatal life is associated with a reduced prevalence of BPD, which is frequently associated with less weight gain as a result of greater respiratory effort with greater energy expenditure. [ABSTRACT FROM AUTHOR]

Objective: Several studies stated greater impact on mental health among psychiatric population during the first wave of the COVID-19 pandemic. The aim of this paper was to study the pandemic effects more than a year after its outbreak on the mental state of adult patients with pre-existing psychopathology attending a Mental Health Center in Madrid (Spain)., Methods: A cross-sectional observational study was carried out with a sample of fifty-eight patients using a questionnaire that collected different descriptive variables. Results of the PHQ-9 Depression Scale, the GAD-7 Anxiety Scale, the IES-R Impact of Event Scale-Revised, the Clinical Global Impression scale CGI-GI, and the assessment of the professionals responsible for the patients about their clinical state were also collected. A descriptive analysis and binary logistic regression models were performed., Results: There was a prevalence of 70% anxiety, 76% depression and 57% stress due to a stressful event more than one year after the start of the pandemic. Likewise, associations were found between the symptoms and certain clinical, mediating variables and gender., Conclusions: The psychological state of patients with pre-existing psychopathology attended at the Mental Health Center is negatively affected by the COVID-19 pandemic up to a year and a half after its onset., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Decision making is a pivotal component of nursing education worldwide. This study aimed to accomplish objectives: (1) Cross-cultural adaptation and psychometric validation of the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale from English to Spanish; (2) Comparison of nursing student groups by academic years; and (3) Analysis of the impact of work experience on decision making. Methods: Cross-sectional comparative study. A convenience sample comprising 301 nursing students was included. Cultural adaptation and validation involved a rigorous process encompassing translation, back-translation, expert consultation, pilot testing, and psychometric evaluation of reliability and statistical validity. The NASC-CDM© scale consists of two subscales: self-confidence and anxiety, and 3 dimensions: D1 (Using resources to gather information and listening fully), D2 (Using information to see the big picture), and D3 (Knowing and acting). To assess variations in self-confidence and anxiety among students, the study employed the following tests: Analysis of Variance tests, homogeneity of variance, and Levene's correction with Tukey's post hoc analysis. Results: Validation showed high internal consistency reliability for both scales: Cronbach's α = 0.920 and Guttman's λ2 = 0.923 (M = 111.32, SD = 17.07) for self-confidence, and α = 0.940 and λ2 = 0.942 (M = 80.44, SD = 21.67) for anxiety; and comparative fit index (CFI) of: 0.981 for self-confidence and 0.997 for anxiety. The results revealed a significant and gradual increase in students' self-confidence (p =.049) as they progressed through the courses, particularly in D2 and D3. Conversely, anxiety was high in the 1st year (M = 81.71, SD = 18.90) and increased in the 3rd year (M = 86.32, SD = 26.38), and significantly decreased only in D3. Work experience positively influenced self-confidence in D2 and D3 but had no effect on anxiety. Conclusion: The Spanish version (NASC-CDM-S©) was confirmed as a valid, sensitive, and reliable instrument, maintaining structural equivalence with the original English version. While the students' self-confidence increased throughout their training, their levels of anxiety varied. Nevertheless, these findings underscored shortcomings in assessing and identifying patient problems. [ABSTRACT FROM AUTHOR]

Background: In line with WHO guidelines for the implementation of public health prevention plans targeted at the impacts of high temperatures, a heat wave definition temperature (Tthreshold) was calculated for 182 so-called "isoclimatic zones" (IZ) in Spain. As the dependent variable for determining this Tthreshold, we analysed daily all-cause mortality data (ICD-10: A00-R99) for each IZ across the period 2009–2018. The independent variable used was the mean value of the maximum daily temperature of the summer months recorded at meteorological observatories in each IZ. We used Box–Jenkins models to ascertain mortality anomalies, and scatterplots to link these anomalies to the temperatures at which they occurred, thereby determining the Tthreshold for each IZ. We then calculated how many heat waves had occurred in each IZ, as well as their intensity, and analysed their time trend over this period. Results: The results showed that in 52.5% of the IZ, the percentile of the maximum temperatures series of the summer months to which Tthreshold corresponded was below the 95th percentile of the meteorological heat wave definition in Spain: indeed, it only coincided in 30.7% of cases. The geographical distribution of these percentiles displayed great heterogeneity as a consequence of the local factors that influence the temperature–mortality relationship. The trend in the number of heat waves analysed indicated an overall increase in Spain at a rate of 3.9 heat waves per decade, and a similar rise in mean annual intensity of 9.5 °C/decade. These time-trend values were higher than those yielded by analysing the trend in meteorological heat waves based on the 95th percentile. Conclusions: The results obtained in this study indicate the need to use a heat wave definition based on epidemiological temperature–mortality studies, rather than on values based on meteorological percentiles. This could be minimising estimated health impacts in analyses of future impacts attributable to heat. [ABSTRACT FROM AUTHOR]

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain's healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients' rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied. [ABSTRACT FROM AUTHOR]

Background: The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness. Methods: A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson's r) and logistic regression analyses. Results: The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced. Conclusion: Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults. [ABSTRACT FROM AUTHOR]

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Background: Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed., Objective: The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up., Methods: This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app., Results: Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025., Conclusions: This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs., Trial Registration: ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306., International Registered Report Identifier (irrid): PRR1-10.2196/55829., (©Marta Novella-Navarro, Jose M Iniesta-Chamorro, Diego Benavent, Javier Bachiller-Corral, Enrique Calvo-Aranda, Helena Borrell, Laura Berbel-Arcobé, Victoria Navarro-Compan, Xabier Michelena, Leticia Lojo-Oliveira, Jaime Arroyo-Palomo, Mariana Diaz-Almiron, Verónica García García, Irene Monjo-Henry, Claudia María Gómez González, Enrique J Gomez, Alejandro Balsa, Chamaida Plasencia-Rodríguez. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 22.04.2024.)

Over the years, different solutions were developed and tested to reduce the emissions of ammonia and particulate matter from the livestock facilities. The environmental performances of these solutions were not always evaluated in detail. This study examines the environmental footprint of pig production at farm gate, with a focus on emissions from housing. Using Life Cycle Assessment, the environmental impact of pig production in a transition farm in Spain and in two finishing farms in Italy was evaluated considering three scenarios (one baseline and two of them involving an air treatment technology: wet scrubber or dry scrubber). The study goal was to quantify the environmental footprint of pig production in different scenarios, identify key environmental hotspots, and to assess impact reduction efficiency due to the two assessed technologies, analyze the environmental trade-offs that come with the use of these technologies, and identify potential for improvements. Both wet and dry scrubbers showed potential for reducing emissions in pig housing, affecting environmental impact categories related to air pollutants such as particulate matter, acidification and eutrophication. However, there were trade-offs between emissions reduction and categories related to energy and resource use. The infrastructure and consumables required to operate the scrubber added to the impacts compared to the baseline. The dry scrubber showed a more favorable balance between emission reduction and trade-offs. In this regard, results were similar for the Spanish and Italian farms, although there were slight variations. Scrubbers had a greater effect in the Italian farms due to their use along longer periods of the pig fattening (closed cycle farms) compared to the Spanish farm (transition farm). Scrubbers are environmentally promising, especially where acidification, eutrophication and particulate matter are local problems. However, they alone cannot fully address the complex environmental impacts of pig production, which require comprehensive interventions across the supply chain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Rapid urbanisation exacerbates health and wellbeing disparities in vulnerable contexts and underscores the imperative need to develop innovative and participatory co-creation approaches to understand and address the specificities of these contexts. This paper presents a method to develop an assessment framework that integrates top-down dimensions with bottom-up perspectives to monitor the impact of inclusive health and wellbeing interventions tailored to the neighbourhood's needs in Las Palmeras, a vulnerable neighbourhood in Cordoba (Spain). Drawing upon studies in the literature examining urban health and wellbeing trends, it delineates a participatory and inclusive framework, emphasising the need for context-specific indicators and assessment tools. Involving diverse stakeholders, including residents and professionals, it enriches the process and identifies key indicators and assessment methods. This approach provides valuable insights for managing innovative solutions, aligning them with local expectations, and measuring their impact. It contributes to the discourse on inclusive urban health by advocating for participatory, context-specific strategies and interdisciplinary collaboration. While not universally applicable, the framework offers a model for health assessment in vulnerable contexts, encouraging further development of community-based tools for promoting inclusive wellbeing.

Background: Maternal pertussis vaccination during the third trimester of pregnancy was implemented in 2015 in Spain, reaching a national coverage of 84% in 2019. In this ecological study, we investigated whether there was a change in the disease severity for pertussis in infants upon introduction of prenatal pertussis vaccination., Methods: We performed a time-trend analysis of infant pertussis hospitalizations during 2005-2019 in Spain using national register data. Annual hospitalization rates per 100,000 population and the mean length of hospitalization were calculated for infants < 3 months of age (target group benefiting from the prenatal vaccination) and a reference group aged 3-11 months. We compared overall rates and annual percent changes of the above variables in both groups for the time period before (2005-2014) and after vaccination introduction (2015-2019), using segmented Poisson regression., Results: During the pre-vaccination period, infants aged 0-2 months had a 5-times higher rate of pertussis hospitalization and spent on average 50 % longer in hospital than the reference group. After the maternal vaccination introduction, the hospitalization rate decreased more rapidly in infants aged 0-2 months than in infants aged 3-11 months: annual reduction of 34 % (95 % CI: 31-38) versus 26 % (95 % CI: 21-31) in the hospitalization rate and 13 % (95 % CI: 11-15) versus 6 % (95 % CI: 2-9) in the mean hospital stay, respectively. In 2019, the mean hospital stay for pertussis was about 4.5 days in both groups., Conclusions: Maternal pertussis vaccination in Spain led to a reduction in disease severity in the target group as compared to older infants, highlighting the need for increased efforts on educating healthcare professionals on the importance of maternal vaccinations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This paper discusses recent archaeological fieldwork conducted at El Castillejo, a medieval Islamic settlement in Los Guájares, Granada, southern Spain. Results from combined archaeological excavation and archaeoseismological assessment of standing structures suggest that the site was affected by a destructive earthquake during its occupation. Radiocarbon samples and OSL analysis point to a seismic event in the period CE 1224-1266. The earthquake occurred within an area marked by a 'seismological gap' in terms of historic seismicity and the causative fault has been tentatively identified in the Nigüelas-Padul Fault System which lies north of the settlement. This event is not recorded by national or European seismic catalogues and represents the oldest historic earthquake in the Granada area. Our work stresses the significant impact that targeted archaeological investigations can generate in our understanding of the local historic seismicity, thus providing clear implications for seismic disaster prevention and reduction., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Forlin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A flood event affecting Pindal Cave, a UNESCO World Heritage site, introduced a substantial amount of external sediments and waste into the cave. This event led to the burial of preexisting sediments, altering the biogeochemical characteristics of the cave ecosystem by introducing heightened levels of organic matter, nitrogen compounds, phosphorus, and heavy metals. The sediments included particulate matter and waste from a cattle farm located within the water catchment area of the cavity, along with diverse microorganisms, reshaping the cave microbial community. This study addresses the ongoing influence of a cattle farm on the cave ecosystem and aims to understand the adaptive responses of the underground microbial community to the sudden influx of waste allochthonous material. Here, we show that the flood event had an immediate and profound effect on the cave microbial community, marked by a significant increase in methanogenic archaea, denitrifying bacteria, and other microorganisms commonly associated with mammalian intestinal tracts. Furthermore, our findings reveal that one year after the flood, microorganisms related to the flood decreased, while the increase in inorganic forms of ammonium and nitrate suggests potential nitrification, aligning with increased abundances of corresponding functional genes involved in nitrogen cycling. The results reveal that the impact of pollution was neither recent nor isolated, and it was decisive in stopping livestock activity near the cave. The influence of the cattle farm has persisted since its establishment over the impluvium area, and this influence endures even a year after the flood. Our study emphasizes the dynamic interplay between natural events, anthropogenic activities, and microbial communities, offering insights into the resilience of cave ecosystems. Understanding microbial adaptation in response to environmental disturbances, as demonstrated in this cave ecosystem, has implications for broader ecological studies and underscores the importance of considering temporal dynamics in conservation efforts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

In this paper, a climatological study focused on the analysis of atmospheric aerosols properties over Burjassot and Aras de los Olmos AERONET sites, located at Eastern Spain, is performed. Computed mean values for Aerosol Optical Depth (AOD 440), Ångström exponent (α 440 − 870) and columnar water vapor (w) in Burjassot (Aras de los Olmos) are 0.19 ± 0.08 (0.10 ± 0.02), 1.21 ± 0.16 (1.18 ± 0.25) and 1.87 ± 0.68 cm (0.94 ± 0.10 cm), respectively. From the monthly statistics of w and AOD , it is concluded that summer months are characterised by higher humidity and turbidity, being the latter favoured by particle stagnation, recirculation, secondary aerosol formation, hygroscopic processes and North African dust intrusions. Regarding the volume size distribution, well developed fine and coarse modes are found in summer. On the other hand, the spectral dependence of the asymmetry parameter (g) describes a decrease in λ up to 870 nm , and then a slight increase due to the influence of dust particles. The computed mean values for the asymmetry parameter (g 440) are 0.700 ± 0.013 (0.709 ± 0.016) for Burjassot (Aras de los Olmos). With respect to the Single Scattering Albedo (SSA) and the complex refractive index, an additional analysis using Level 1.5 data is performed, as relatively few data points pass the filters imposed by the Level 2.0 conditions. In the case of SSA, which is found to be larger in spring and summer months, the obtained mean annual values at 440 nm are 0.94 ± 0.03 (0.95 ± 0.03) for Burjassot (Aras de los Olmos). Finally, regarding the complex refractive index, the mean values of the real part (m 440) are 1.50 ± 0.03 (1.49 ± 0.03), and for the imaginary part (∣ k 440 ∣) are 0.007 ± 0.004 (0.004 ± 0.003) in Burjassot (Aras de los Olmos). The present study is complemented with three analyses based on the distinction between the different aerosol types. To begin with, these are classified according to their nature, being the most abundant continental clean aerosols. Next, Gobbi diagrams are plotted for both sites, depicting a clustered region of coarse aerosols, as well as particle growth traces. Finally, the different air masses affecting the measurement sites are studied, reaching to the conclusion that these originated in the European and the African continents are the most turbid ones. To conclude this study, a seasonal Mann-Kendall test is applied to AOD, α , w and SSA measurements in order to study possible trends. Hence, a statistically significant (> 80 %) decreasing trend in AOD is observed for most months; whereas α , w and SSA do not show statistically significant long-term trends, only for a few months of the year. • 20 (6) years AERONET data studied for Burjassot (Aras de los Olmos) in Eastern Spain. • Continental clean aerosols are dominant over Burjassot and Aras de los Olmos. • AOD, α and ω higher at Burjassot than Aras de los Olmos due to its urban character. • European and African air masses are responsible for high turbidity measurements. • AOD decreases with 80% confidence level; but α and SSA trends are not statistically significant. [ABSTRACT FROM AUTHOR]

CrossFit is characterized by being a standardized training program that improves physical performance through the provision of several stimuli regardless of the participant's strength level. This study aimed to compare the acute response in total repetitions as a measurement of performance, jump ability, physiological demand (heart rate and blood lactate), and perceived effort considering the participants' strength level with individualized intensity in CrossFit. Thirty-five participants were assessed and asked to participate on two separate days in a standardized and relative 'As Many Repetitions As Possible' (AMRAP) CrossFit circuit. Both AMRAPs comprised strength, gymnastic and aerobic exercises, although only strength was individualized according to the participant's level. Before the statistical analysis, participants were allocated to higher- or lower-strength groups following the one-repetition maximum-bodyweight ratio in the push press exercise. Results support the existence of a strong relationship between strength level and total repetitions in both AMRAPs. In addition, differences in total repetitions and rate of perceived exertion between strength groups are discarded when AMRAP intensity is individualized while physiological demand and jump ability are maintained. Thus, the higher-strength participants may benefit from similar responses with a lower number of repetitions. Therefore, CrossFit trainers should be encouraged to prescribe strength tasks based on the percentage of 1RM for every training. [ABSTRACT FROM AUTHOR]

Elevated atmospheric nitrogen (N) deposition on terrestrial ecosystems has become one of the most important drivers of microbial diversity loss on a global scale, and has been reported to alter the soil function of nutrient-poor, montane Calluna vulgaris heathlands in the context of global change. In this work we analyze for the first time the shifts of bacterial communities in response to experimental addition of N in Calluna heathlands as a simulation of atmospheric deposition. Specifically, we evaluated the effects of five N addition treatments (0, 10, 20, and 50 kg N ha -1  yr -1 for 3-years; and 56 kg N ha -1  yr -1 for 10-years) on the resistance of soil bacterial communities as determined by changes in their composition and alpha and beta diversities. The study was conducted in montane Calluna heathlands at different development stages (young and mature phases) in the southern side of the Cantabrian Mountains (NW Spain). Our results evidenced a substantial increase of long-term (10-years) N inputs on soil extractable N-NH 4 + , particularly in young Calluna stands. The alpha diversity of soil bacterial communities in mature Calluna stands did not show a significant response to experimental N addition, whereas it was significantly higher under long-term chronic N addition (56 kg N ha -1  yr -1 for 10-years) in young Calluna stands. These bacterial community shifts are mainly attributable to a decrease in the dominance of Acidobacteria phylum, the most representative in montane Calluna ecosystems, in favor of copiotrophic taxa such as Actinobacteria or Proteobacteria phyla, favored under increased N availability. Future research should investigate what specific ecosystem functions performed by soil bacterial communities may be sensitive to increased nitrogen depositions, which may have substantial implications for the understanding of montane Calluna ecosystems' stability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Diabetes mellitus is a chronic disease with high morbidity and mortality, affecting 537 million adults worldwide. Spain is the second European country in prevalence, with 14.8% in the population aged twenty/seventy-nine years; with 11.6 cases per 1,000 people/year. Diabetic retinopathy (DR) is the fifth cause of vision loss worldwide and the seventh cause of blindness/visual impairment among members of the National Organization of the Blind in Spain (ONCE). Early detection of DR prevents blindness in diabetics and is conditioned by glycosylated hemoglobin. The aim of this paper was to analyze the management of diabetic patients in Aljarafe region (Seville) and identify opportunities for improvement in the coordination of their follow-up between the Primary Care physician and the ophthalmologist., Methods: A retrospective observational study (2016-2019) was carried out, with patients registered in the diabetic census of the twenty-eight municipalities of Aljarafe. The primary care and hospital health history, and telemedicine program were consulted. About statistical analysis, for qualitative variables, totals and percentages were calculated; for quantitative variables, mean and standard deviation (if normally distributed) and median and quartiles (if non-normally distributed)., Results: There were 17,175 diabetics registered in Aljarafe (5.7% of the population); 14,440 patients (84.1%) had some determination of hemoglobin during the period, 9,228 (63.9%) had all of them in the appropriate range. Fundoscopic control was performed on 12,040 diabetics (70.1%), and of those who did not, 346 (10.6%) had all of them out of range. There were 1,878 (10.9%) patients without fundoscopic or metabolic control, 1,019 (54.3%) were women, 1,219 (64.9%) were under sixty-five years of age, 1,019 (54.3%) had severe comorbidity., Conclusions: Most patients have adequate screening, and more than half have determinations within range. However, a significant percentage with no glycated hemoglobin within range lack fundoscopic control, and another smaller group lack fundoscopic or metabolic control, with inter-municipal variability. We propose to improve communication channels between levels.

Background: The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context. Methods: Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses. Results: The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions. Conclusions: The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain. Key points: • This paper provides a culturally translated, adapted, and validated version of the Caring Behaviors Assessment tool in the Spanish context, which can be used to obtain reliable and culturally adapted data on essential aspects of patient care. • The findings of this study contribute to the wider global clinical community by demonstrating the importance of considering cultural factors when assessing and evaluating patient care from patients' own perspective, and also emphasizes the need for culturally sensitive approaches in healthcare settings. • This validated instrument facilitates the measurement of caring behaviors in the Spanish context, allowing for objective evaluation and improvement. Use of the Caring Behaviors Assessment tool could thus serve as a valuable resource for both future research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: The growing use of cannabis in adolescence is a public health problem that must be addressed through prevention. In Spain, the average age of initiation of cannabis use in the adolescent population is 14.8 years. At 14 years, the lifetime prevalence of cannabis use is 11.7%, which increases to 51.,5% at the age of 18; the prevalence of cannabis use in the population aged 14 to 18 years is 28.6%, a figure that must be tried to reduce, that is why this school prevention program is proposed: Alerta Cannabis. Methods: The Alerta Cannabis research project consists of design, implementation, and evaluation. In the first phase, a computer-tailored eHealth program (Alerta Cannabis) is developed based on the I-Change Model, an integrated model based on three main behavioral change processes: awareness, motivation, and action. This program consists of four 30-minute sessions that will provide culturally adapted and personalized advice to motivate students not to use cannabis through text feedback, animations, and gamification techniques. This phase will also include usability testing. In the implementation phase, secondary school students from Western Andalusia, Spain (Seville, Cádiz, Huelva, and Córdoba) and Eastern Andalusia (Jaén, Málaga, and Granada) will be randomized to an experimental condition (EC) or a control condition (CC) for a cluster randomized clinical trial (CRCT). Each condition will have 35 classes within 8 schools. GI will receive the online intervention Alerta Cannabis. EC and CC will have to fill out a questionnaire at baseline, six months, and twelve months of follow-up. In the last phase, the effect of Alerta Cannabis is evaluated. The primary outcomes are the lifetime prevalence of cannabis use and its use in the last 30 days and at 6 months. At 12 months of follow-up, the prevalence in the last 12 months will also be assessed. The secondary outcome is the intention to use cannabis. Discussion: The study tests the effect of the innovative program specifically aimed to reduce the use of cannabis in the adolescent population through eHealth in Spain. The findings aim to develop and implement evidence-based cannabis prevention interventions, which could support school prevention, for instance, the assistance of school nurses. If the program proves to be effective, it could be useful to prevent cannabis use on a national and international scale. Trial registration: NCT05849636. Date of registration: March 16, 2023. [ABSTRACT FROM AUTHOR]

Background: The development of cities and transport infrastructure produces a large volume of mineral waste (e.g. excavated earth material). At the same time, cities are increasingly trying to develop green infrastructures, given the ecosystem services they provide to people, but this comes with considerable economic and environmental costs associated with the transfer of fertile soil from rural areas to cities. In a circular economy approach, the reuse of mineral waste to build fertile soil is a substantial opportunity to reduce the economic and environmental costs of both mineral waste management and green infrastructure development. Soils constructed from these materials (constructed Technosols) must be able to support vegetation growth and become a suitable living environment for soil organisms. This requires ecological engineering to maximise the potential of constructed soils for biodiversity, both from a taxonomic and functional perspective. In this context, we systematically mapped the evidence related to the ability of soils constructed from mineral wastes to support biodiversity. Methods: We gathered published and grey literature through searches in two publications databases (Scopus and Web of Science Core Collection), one search engine (Google Scholar), nine organisational websites and through a call for literature. Titles, abstracts, and full-texts were successively screened using eligibility criteria. All included studies were described with coded variables and a database was produced. The extent of evidence was assessed and knowledge clusters and gaps were identified. Review findings: The searches yielded 9265 articles, and 153 articles were retained after the screening process. More than half of these articles were from European countries, with France leading the field with 40 articles, followed by Spain (15 articles) and Italy (10 articles). Most of the articles (75%) were produced after 2015. The main reasons for constructing soils from mineral waste were for mine rehabilitation (35%), waste recycling (16%) and experimental purpose (15%). The 153 articles were divided into 1962 studies, a study being a combination of a taxon, an intervention (i.e. soil construction) and a measured outcome. Among these studies, the most studied biological group is plants (69% of studies) and especially herbaceous species (32%), followed by microorganisms (17%) and invertebrates (14%). The most used type of mineral waste is mine waste (31% of studies) followed by excavated soil (16%) and demolition waste (14%). Finally, the most frequently measured outcome is plant growth (42% of studies), followed by organism abundance (16%) and diversity (10%). Conclusions: Three main knowledge clusters were identified which could be addressed in the future for full synthesis of the results: (1) How well do plants grow in soils constructed from mineral wastes? (2) What is the potential of soils constructed from mineral wastes to support biodiversity? and (3) How do microbial communities develop in soils constructed from mineral wastes? There is a lack of studies investigating several biological groups at the same time: only 6 articles out of 153 investigated the response of both plants, invertebrates and microorganisms to soil construction. More research is therefore needed on the ability to support a diversity of organisms. [ABSTRACT FROM AUTHOR]

Individuals who reside in a country without regular authorisation generally find it difficult to access public medical services beyond emergency treatment. Even in countries with universal healthcare, there is often a gap between rights on paper and their implementation. Civil society organisations (CSOs) fill this gap by providing medical services to vulnerable populations, including irregular migrants. What, if any, are the ethical dilemmas that arise for CSO staff when delivering such services in countries with universal healthcare? Under what conditions do these dilemmas arise? And what strategies do CSO staff use to mitigate them? We answer these questions using 40 semi-structured interviews with CSO staff working in two European countries with high levels of irregularity, universal healthcare provisions on paper, and significant differences in approaches and availability of public services for irregular migrants: Italy and Spain. We show that CSO staff providing medical services to irregular migrants in places with universal healthcare coverage face a fundamental dilemma between humanitarianism and equity. CSO staff respond to the humanitarian belief in the value of taking all possible steps to prevent or alleviate human suffering, thus promoting a decent quality of life that includes access to both emergency and non-emergency care. In doing so, however, they run the risk of substituting rather than complementing public provisions, thereby preventing governments from assuming responsibility for these services in the long term. Individuals who acknowledge the existence of this dilemma generally oppose the creation of parallel structures; that is, services specifically developed for irregular migrants outside the public system; while those who ignore it essentially subscribe to a tiered system, giving up on considerations of equity. We argue that CSOs involved in the provision of healthcare to irregular migrants do not simply provide services; they also play an inherently political role. [ABSTRACT FROM AUTHOR]

In August 2021, the Mar Menor, a saltwater lagoon located in the Region of Murcia (Spain), suffered a tragic environmental episode of dystrophic crisis and anoxia. The appearance of numerous dead fish in different areas of the lagoon over the course of days put all the authorities and the population of the area on alert. This paper shows a case study of what happened in the lagoon in terms of the presence of the most common inorganic pollutants. Measurements of the concentration of nitrogen species, phosphates and main heavy metals were carried out at different sampling sites in the Mar Menor from May 2021 to November 2022. Chemical analyses were carried out for each of the species under study. These analyses provide valuable information about the dystrophic crisis caused by a classic eutrophication process that began with the excessive nutrient input into the Mar Menor. Ion chromatography and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) were used as instrumentation for the quantification of these samples. The species whose values were greatly increased after the tragic episode described above were nitrates. The concentration varied significantly at the different sampling sites throughout the study. On the last sampling date, decreased concentrations of all the species were measured at each of the sampling sites, coinciding with the apparent good state of the lagoon., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals. Methods: Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital. Results: Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK). Conclusion: Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained. Trial registration: NCT04678310. Registered 21/12/2020. [ABSTRACT FROM AUTHOR]

Background: Shortages of mechanical ventilation have become a constant problem in Emergency Departments (EDs), thereby affecting the timely deployment of medical interventions that counteract the severe health complications experienced during respiratory disease seasons. It is then necessary to count on agile and robust methodological approaches predicting the expected demand loads to EDs while supporting the timely allocation of ventilators. In this paper, we propose an integration of Artificial Intelligence (AI) and Discrete-event Simulation (DES) to design effective interventions ensuring the high availability of ventilators for patients needing these devices. Methods: First, we applied Random Forest (RF) to estimate the mechanical ventilation probability of respiratory-affected patients entering the emergency wards. Second, we introduced the RF predictions into a DES model to diagnose the response of EDs in terms of mechanical ventilator availability. Lately, we pretested two different interventions suggested by decision-makers to address the scarcity of this resource. A case study in a European hospital group was used to validate the proposed methodology. Results: The number of patients in the training cohort was 734, while the test group comprised 315. The sensitivity of the AI model was 93.08% (95% confidence interval, [88.46 − 96.26%]), whilst the specificity was 85.45% [77.45 − 91.45%]. On the other hand, the positive and negative predictive values were 91.62% (86.75 − 95.13%) and 87.85% (80.12 − 93.36%). Also, the Receiver Operator Characteristic (ROC) curve plot was 95.00% (89.25 − 100%). Finally, the median waiting time for mechanical ventilation was decreased by 17.48% after implementing a new resource capacity strategy. Conclusions: Combining AI and DES helps healthcare decision-makers to elucidate interventions shortening the waiting times for mechanical ventilators in EDs during respiratory disease epidemics and pandemics. [ABSTRACT FROM AUTHOR]

Flow regulation in gravel-bed rivers impacts the hydrology, sediments and morphology, riparian vegetation, and vertical connectivity with the hyporheic zone. In this context, previous works have suggested that flood events may have riverine morphological and ecological benefits. In a Mediterranean-climate river system, we analyzed the impact of a 18-year return period flood on river morphology, riparian vegetation, fish aquatic habitat quality, and hyporheic exchange in a dam-regulated gravel-bed river, Serpis River (Spain). We collected pre- and post-flood riparian vegetation distributions and bathymetries, which were used to develop two-dimensional surface and three-dimensional subsurface numerical models to map surface and hyporheic hydraulics. Results show that the large flood removed the invasive giant reed from large areas, reshaped the in-channel morphology by forming new bars and pools, and enhanced the complexity of the flow field and the hydro-morphological diversity. The habitat availability for the endemic Eastern Iberian chub (Squalius valentinus) and invasive bleak (Alburnus alburnus) increased. Hyporheic exchange showed limited change under losing conditions, but noticeable under neutral ambient groundwater condition. This study corroborates the beneficial effects that flood events or high flow releases may have on regulated streams and the potential use of high flow pulse as a restoration tool., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Nitrate pollution in aquifers is a global concern. Spain has developed a national strategy to recover nitrate polluted aquifers aligned with the European Union (EU) policies, specifically through the water planning under the EU Water Framework Directive. River basin management plans use PATRICAL model results to define the maximum nitrogen surplus in each polluted aquifer for the first time. The maximum nitrogen surplus allows to reach the good status in each aquifer and the model provides the number of years required. Around 30% of the aquifers in Spain is currently heavily polluted by nitrates. Model results show that 90% of these aquifers can be recovered in next 6-12 years by increasing nitrogen use efficiency and reducing nitrogen losses around 50%, which is in line with the EU Farm to Fork Strategy. The remaining aquifers require additional reductions to achieve the good status. In Spain this increase in nitrogen efficiency can be obtained with different measures including 30% reduction of current fertilization., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Miguel Angel Perez Martin reports financial support was provided by Government of Spain Ecological Transition Ministry. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The seafloor is recognised as a major sink for marine litter. However, studies conducted in this compartment addressing marine litter densities and its interactions with fauna are scarce, mainly due to sampling constraints. In this paper, we assess marine litter density, composition and interactions with marine communities and evaluate its relationship with fishing activities at the "Banco de la Concepción" seamount (Canary Islands, Spain). We took advantage of underwater video records taken with a Remotely Operated Towed Vehicle in the framework of the LIFE IP INTEMARES project. A total of 56 video transects were analysed covering about 9 km with 19 h of video recording. Transects were categorised as high, low, and null fishing effort based on the Vessel Monitoring System (VMS) positional data registered between 2009 and 2017. Litter items were recorded in 70% of the transects with a mean density of 2122 (±2464) items km -2 . There were significant differences in litter densities over the three levels of fishing pressure, with a density decrease from stations of high to stations of null fishing pressure. Regarding categories, plastic was by far the most abundant category found (83.1%), mainly consisting of fishing lines, both monofilaments and entangled longlines. The study of the interactions of marine litter with fauna showed that less than 20% of the items presented an interaction with benthic organisms either by causing or not a visible impact. The sponge Asconema setubalense accounted for more than half (57.4%) of all interactions, but only 5% of all A. setubalense specimens showed physical damage., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)