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The audiences of generalist television's newscasts reflect that the viewers' interests and loyalties are constantly changing. Research shows that several elements influence the success of programs and formats, but in this paper, we draw attention to the factors that determine the credibility of newscasts. We also want to know how pluralism is safeguarded in newscasts, as we consider that credibility and pluralism are two intertwined values that influence one another. As credibility is a subjective value, it is required to find new information criteria that is suitable and of the utmost rigor. The main aim is to delve into whether there is a consensus on the basic parameters for the definition, identification, and assessment of credibility of nationwide public service media in Spain. Moreover, we are also interested in whether audience figures can be used to determine the degree of trust of newscasts. The analysis brings forward the observations of researchers, scholars and media professionals that offer a vision on the different approaches that integrate the multiple aspects affecting news consumption and interpretation. We conclude that credibility is a concept composed of multidimensional components, resulting from a process where different filters condition fact perception. That is why a story can have different meanings, related to the different point of views of citizens.

Game Learning Analytics can be used to conduct evidence-based evaluations of the effect that serious games produce on their players by combining in-game user interactions and traditional evaluation methods. We illustrate this approach with a case-study where we conduct an evidence-based evaluation of a serious game's effectiveness to increase awareness of bullying. In this paper, we describe: (1) the full process of tracking in-game interactions, analyzing the traces collected using the standard xAPI-SG format, and deriving game learning analytics variables (to be used as "evidences"); and (2) the use of those variables to predict the increase in bullying awareness. We consider that this process can be generalized and replicated to systematize, and therefore simplify, evidence-based evaluations for other serious games based on the interaction data of their players.

Non-hegemonic perspectives on sustainability are grounded in environmental sustainability based on justice. We argue about the potential of co-operatives for learning framed through degrowth epistemological visions promoting pedagogical changes in Higher Education. The context is a public university in Catalonia (Spain) implementing an innovative teaching methodology merging service learning and co-operatives for learning in an Environmental Sciences degree. The research question was: What are the experiences of undergraduate students participating in co-operatives for learning about environmental education? Data collection used focus group interviews and individual reflective narratives. Based on the construct of dialectical tensions, we identify three breaking points for the transition to teaching justice-based environmental sustainability using co-operatives for learning: (1) decommodification of work (tradition/innovation; theory/practice); (2) reconstruction of relationships with 'the other' (individual/collective); and (3) with nature (capitalism/degrowth). We conclude that students' environmental praxis is promoted when addressing new perspectives of development and sustainability in university teaching.

One of the main objectives of the Undergraduate Dissertation is to evaluate the skills associated with a degree. Student satisfaction with the training and skills acquired can be an indicator of the quality of higher education. This paper aims to analyse student satisfaction with Undergraduate Dissertation at the Faculty of Economics of the University of Santiago de Compostela (Spain). Based on a survey conducted among 130 students (75.7% of a total of 172 students who presented their UD during the academic year 2013-2014), structural equation modelling was applied to analyse the influence on satisfaction of aspects related to intellectual curiosity and the perception of acquired skills. The results show that the perception of the skills acquired play a crucial role in students' satisfaction with Undergraduate Satisfaction, conditioned by their perceived future usefulness and backed by personality and motivation elements that encourage their acquisition. The results confirm the significant role played by the tutor, who emerges as an element that boosts the central relations of the model.

Examination of the transition of successful students from university into the labour market reveals a significant gap between the competencies acquired during higher education and those needed in the workplace. In this article, the authors discuss a research study undertaken to analyse the employability traits of engineers who had recently graduated. In order to do this, an estimation was made of both acquired and applied competencies in each area of engineering examined (computer engineers, naval engineers and industrial engineers). This analysis enabled the calculation of a choice model to clarify which competencies act as a stimulus for employment and which discourage recruitment. The results provide clear policy directions both for management teams in each of the three areas of engineering and for universities.

Dental wear arises from mechanical (attrition or abrasion) and chemical (erosion) factors. Despite its prevalence and clinical significance, accurately measuring and understanding its causes remain challenging in everyday practice. This one-year study with 39 participants involved comprehensive examinations and full-arch intraoral scans at the start and after 12 months. Volume loss exceeding 100 µ on each tooth's surfaces (buccal, lingual/palatine and incisal/occlusal) was measured by comparing three-dimensional scans from both time points. This study also assessed factors such as abrasion and erosion through clinical exams and questionnaires. There were no significant differences in dental wear in participants with sleep bruxism. However, noticeable wear occurred in the front teeth of those with waking bruxism and joint-related symptoms. Increased wear was associated with frequent consumption of acidic drinks, regular swimming, dry mouth, nocturnal drooling and heartburn, while no significant wear was found in patients with reflux. The used methodology proved effective in accurately assessing the progression of dental wear, which is important as many patients may initially be asymptomatic. The variability observed in dental wear patterns underscores the need to develop specific software applications that allow immediate and efficient comparison of wear areas based on extensive analysis of patient databases. [ABSTRACT FROM AUTHOR]

In this article, we aim to explore the important role of future teachers in the revitalisation of minoritised languages. In the Spanish autonomous community of Galicia, language legislation stipulates that the minoritised language be supported in educational settings, yet this support has been weak at best, particularly for schools in urban areas. Teacher training colleges and universities are responsible for the preparation of new teachers who are able and willing to contribute to the school-based language revitalisation project. We report on classroom-based research in a university Early Childhood Education program, based on videotapes and written documents produced by students as classroom tasks, as well as a questionnaire they completed after the course. Our conclusions suggest that teacher training can activate teacher agency even before they enter the profession, in two main ways: 1) reflect critically on their own linguistic trajectories and competencies and 2) understand the linguistic realities in Galician society and schools. Using methodologies of guided practice and reflection, teacher education programmes can strengthen the potential of future teachers as agents of language revitalisation.

Background and aims: This field-base study evaluates the long-term effectiveness of in-situ remediation measures applied to soils residually polluted by potentially toxic elements (PTEs) in an area affected by a mining spill in SW Spain. Methods: To evaluate the remediation treatments success, their influence on key soil properties and on the development of spontaneous vegetation in the treated soils was investigated. The treatments were based on human derived by-products valorization, and consisted of: biopiles, marble sludge and gypsum mining spoil addition, and their combination with an organic amendment (vermicompost). Results: Amendments application improved the soil properties and reduced PTEs availability. As a result, an enhancement in spontaneous development of vegetation cover and diversity of plant species in the treated soils was followed. Spergularia rubra and Lamarckia aurea, two primary plant species growing in the studied area and that exhibit strong association to soils with the highest levels of pollution, showed high Pb and As accumulation in shoots ande in roots. Exceptionally, accumulation of these pollutants occurred in L. aurea roots, which can explain its high presence in soils with more limited vegetation development and in which no additional plant species can thrive. Conclusions: The occurrence of S. rubra and L. aurea in the amended soils may be indicative of improved soil conditions and reduced toxicity induced by the remediation measures implemented. They may also be considered key species in the area since their presence can promote the recolonization of the degraded soils by species less tolerant to their residual pollution. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis, a chronic inflammatory skin disease, affects 2–10% of the population globally. Bimekizumab (BMK), a monoclonal antibody targeting IL-17, is a dual inhibitor of IL17 A and F that has shown efficacy in treating moderate to severe plaque psoriasis. This real-world evidence (RWE) study aims to assess BMK's efficiency and safety in naïve and refractory patients. Material and methods: A retrospective analysis of a multicenter observational study included 22 patients treated with BMK from April 2023 to February 2023 in five Andalusian hospitals. Ethical approval was obtained, and patients provided informed consent. Assessment criteria encompassed Psoriasis Area and Severity Index (PASI), body surface area (BSA), VAS pruritus, Dermatology Life Quality Index (DLQI), and minimum disease activity (MDA) at 0, 4, 12, and 24 weeks. Results: Patients, predominantly with plaque psoriasis, exhibited significant improvements in PASI (baseline 15.7 to 0.4 at week 16), BSA (baseline 20.7 to 0.43 at week 16), DLQI (baseline 17.93 to 0.43 at week 16), and pruritus (baseline 7.12 to 0.4 at week 16). At week 16, 95.4% achieved MDA. No safety concerns or treatment discontinuations were reported. Discussion: This RWE study aligns with pivotal clinical trials, confirming BMK's efficacy and safety. Notably, BMK demonstrated rapid and sustained psoriasis clearance, even in challenging areas. The study's limitations include a small sample size, suggesting the need for further exploration of patient-reported outcomes. Conclusion: Bimekizumab exhibited optimal efficacy and safety profiles in treating moderate to severe plaque psoriasis in a real-world setting. Rapid response, sustained clearance, and favorable safety outcomes contribute to improved patient experiences. Future research could delve into patient-reported outcomes and expand sample sizes to enhance the understanding of BMK's real-world effectiveness. [ABSTRACT FROM AUTHOR]

Given the sensitivity of mountain biodiversity to human pressure, it is essential to quantify changes in montane biological communities and contrast them with expectations based on potential drivers of change. This need is particularly pressing for biological groups representing important but little‐studied fractions of biodiversity, such as insects. We analyze the temporal changes (between 1998 and 2015) of leaf beetle communities in an altitudinal gradient in the Sierra de Ancares (NW Spain). Our results show temporal changes in the composition of local communities, with a tendency to assemblage thermophilization, as well as a homogenization of the spatial turnover pattern, mostly driven by an increased similarity between communities at the lower and intermediate altitudes. These temporal changes in community composition and in the spatial structure of biodiversity were associated with upward shifts of the upper altitudinal limit of warm‐adapted species and with downward shifts of the lower altitudinal limit of cold‐adapted species. While this upward shift is consistent with expectations of climate change effects, the observed downward shift suggests a land‐use change effect. Our results point to the joint effect of multiple factors (climate and land‐use change) behind temporal changes of these leaf beetle communities, which result in compositional reorganization and biotic homogenization, rather than a mere coherent displacement toward higher altitudes. More generally, we show that understanding temporal change of biodiversity requires assessing multiple community‐level metrics (e.g., variation in assemblage composition and/or changes in spatial turnover) for the detection of tendencies among the species‐specific signals (e.g., altitudinal range shifts). [ABSTRACT FROM AUTHOR]

The aim of this research work is to study the effect of salt mist ageing on the physico-mechanical properties of two ignimbrites from the Canary Islands (Spain). Due to their insular nature and extensive coastlines, these regions are highly susceptible to atmospheric salt aerosols, which is a significant weathering agent for building materials. The ignimbrites analysed are marketed under the names "Azul Lomo Tomás de León" and "Marrón de Abades" and are widely used as building stones. Petrographic, mineralogical and chemical properties were obtained via polarisation microscopy, X-ray diffraction and X-ray fluorescence. The samples were subjected to 60 cycles of a salt mist environment, following relevant European standards. Scanning electron microscopy images of the specimens were analysed along with physical properties, including apparent density, open porosity, water absorption, colourimetry and ultrasound propagation velocity, initially and after every 20 cycles, allowing us to assess their evolution during the ageing test. Mechanical properties were evaluated using uniaxial compressive strength and flexural strength under concentrated load tests on two groups of specimens: one unaged and the other subjected to 60 ageing cycles. With the exception of apparent density, the other properties show a decrease between 5% and 30%. However, open porosity increases and is one of the properties most affected by the ageing test. [ABSTRACT FROM AUTHOR]

Introduction: The cognitive safety of monoclonal antibody proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has been established in clinical trials, but not yet in real-world observational studies. We assessed the cognitive function in patients initiating PCSK9i, and differences in cognitive function domains, to analyze subgroups by the low-density lipoprotein cholesterol (LDL-C) achieved, and differences between alirocumab and evolocumab. Methods: This has a multicenter, quasi-experimental design carried out in 12 Spanish hospitals from May 2020 to February 2023. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Results: Among 158 patients followed for a median of 99 weeks, 52% were taking evolocumab and 48% alirocumab; the mean change from baseline in MoCA score at follow-up was + 0.28 [95% CI (− 0.17 to 0.73; p = 0.216)]. There were no significant differences in the secondary endpoints—the visuospatial/executive domain + 0.04 (p = 0.651), naming domain − 0.01 (p = 0.671), attention/memory domain + 0.01 (p = 0.945); language domain − 0.10 (p = 0.145), abstraction domain + 0.03 (p = 0.624), and orientation domain − 0.05 (p = 0.224)—but for delayed recall memory the mean change was statistically significant (improvement) + 0.44 (p = 0.001). Neither were there any differences in the three stratified subgroups according to lowest attained LDL-C level—0–54 mg/dL, 55–69 mg/dL and ≥ 70 mg/dL; p = 0.454—or between alirocumab and evolocumab arms. Conclusion: We did not find effect of monoclonal antibody PCSK9i on neurocognitive function over 24 months of treatment, either in global MoCA score or different cognitive domains. An improvement in delayed recall memory was shown. The study showed no differences in the cognitive function between the prespecified subgroups, even among patients who achieved very low levels of LDL-C. There were no differences between alirocumab and evolocumab. Registration: ClinicalTtrials.gov Identifier number NCT04319081. [ABSTRACT FROM AUTHOR]

Background: Recent years have seen an increase in the use of social media, by the healthcare sector, including dentistry. Indeed, social media may now be important communication tools for dental practices and patients. This work analyzes the influence of patient (male and female) use of dental practice social media on their decision to change practice. The results also provide insight into the factors patients considered important when choosing a dental practice. Methods: This study was approved by the Ethics Committee of the Universidad Europea de Madrid (No. CIPI/22.022). Using a web-based questionnaire, a cross-sectional study was undertaken involving a Spanish population that made use of dental services. The questionnaire consisted of four parts covering provision of informed consent, the collection of sociodemographic data, patient use of dental practice social media, and the factors considered important when changing dental practice. Results: All participants gave their informed consent regarding inclusion. No compensation was provided for participation. 588 people responded to the questionnaire, of whom 503 were eligible for inclusion. Most respondents were female (312/503; 62%). Most (151/503; 30%) last changed dental practice during the previous 2–5 years. 208/503 (41.4%) indicated that they had visited dental practice social media. 118/503 (23.5%) indicated that they had made use of such the last time they changed dental practice; 102 of these 118 (85.6%) reported their experience to have influenced their decision to change. Respondents who had changed practice in the last 5 years had interacted with dental practice social media more than those who changed over 11 years ago (p <.05), and those who changed practice in the present/past year were more influenced by these media (p <.05). The factor considered most important was 'Facilities and technology'. No gender-based differences were seen for any measured variable (p <.05). Conclusions: Different factors affect the selection of a new dental practice, but respondents who changed practice in the last few years were more likely to have made use of dental practice social media, which, for some, influenced their final decision to change. Dental practices might do well to consider using social media as communication and marketing tools. [ABSTRACT FROM AUTHOR]

Copyright of Spanish Journal of Disability Studies / Revista Española de Discapacidad is the property of Centro Espanol de Documentacion sobre Discapacidad and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adaptation techniques can be applied not only to the multimedia contents or navigational possibilities of a course, but also to the assessment. In order to facilitate the authoring of adaptive free-text assessment and its integration within adaptive web-based courses, Adaptive Hypermedia techniques and Free-text Computer Assisted Assessment are combined in what could be called Adaptive Computer Assisted Assessment of Free-text Answers. This paper focuses on the integration of this type of assessment within adaptive courses, as well as on the presentation of an authoring tool able to manage the insertion and modification of different question statements and reference answers for open-ended questions. The results of the evaluation of this tool with course authors show the feasibility of proposing and evaluating open-ended questions adapted to each student, as well as that of getting a better model of the student's progress. (Contains 1 table and 8 figures.)

Driving under the influence of alcohol or drugs is a very common behavior in our environment and a serious problem for public health. On the one hand, in 2016, 400,000 people died in the world in traffic accidents in which ethanol was involved. On the other hand, traffic accidents in which the use of drugs of abuse other than ethyl alcohol accounted for more than 160,000 deaths worldwide in 2017. The objective of this work is to carry out a review of the 710 cases of people who died in traffic accidents received at the forensic toxicology service of the Institute of Forensic Sciences of the University of Santiago de Compostela (Galicia-Spain) over a period of 10 years (2009–2019). We performed an observational study of period prevalence, in which the following data were collected: age, sex, year, and analytical results in plasma, in the case of being positive. The data collected was subjected to statistical treatment. Of the 710 cases analyzed, 123 correspond to pedestrians and 587 to occupants of vehicles or motorcycles. A total of 77.6% of the deceased were men. At least one psychotropic substance was found in the blood of almost 40% of the victims. The most frequently found substance was ethyl alcohol, which appeared in 231 cases, more frequently in males. The second place is occupied by benzodiazepines, which appeared in 43 cases, followed by cocaine, which was detected in 25 cases. Polydrug use was found in only 44 cases, with the association of ethanol and cocaine being the most commonly found, followed by that of ethanol and benzodiazepines. Only in 5 of the cases analyzed there were 3 or more substances present. With the data obtained in this study, it is shown that in traffic accidents, the finding of different toxic or medicinal substances is frequent. Ethyl alcohol continues to be very present in road accidents (most detected substance), with the great impact that this implies. Secondly, the presence of benzodiazepines stands out, and cocaine is the third most detected toxic in this study. These results allow to obtain a profile of the substances most frequently involved in traffic accidents. Despite the surveillance, control, and information campaigns that the Spanish Government regularly carries out, the results are far from satisfactory. [ABSTRACT FROM AUTHOR]

The prominence of the figure of Don Juan marks the Spanish literature on masculinities which will be analyzed in this article. This distinctive trait, obvious when comparing it to English-speaking masculinity studies, is responsible for the highest achievements of masculinity studies in Spain. Those studies benefit from the fact that the figure of Don Juan is a stylization of modern masculinity. Other historiographies could also benefit from it, but for that to happen, Spanish scholars must intensify their dialogue with those historiographies. A critical thinking on masculinities based on Don Juan will not be beneficial, however, if Don Juan is taken as a description of a specific territory, whether it be Castile, Spain or Latin America. Beyond Don Juan, the relation between masculinity and nation and with other phenomena on the process of modernization has concentrated a good deal of effort among Spanish scholars; this article contends that the figure of Don Juan could shed new light on that field of research. [ABSTRACT FROM AUTHOR]

The purpose of this research was to perform an exploratory factorial analysis of the digital competencies questionnaire in students. A cross-sectional observational design was applied to 322 students of the Tecnológico Superior Universitario España from the 4th and 5th cycles of the Business Administration career. It was obtained that the basic assumption of the factor analysis of the Kaiser-Meyer-Olkin Measure was 0.778 and Bartlett's sphericity test had a significant value p<0.000 On the other hand, the variance of the first component was 28%, component 2 had a percentage of almost 12% as explained variance, and finally the third component had a variance percentage representation of 10%. This means that the percentage of accumulated variance of the three components was 50.5%. [ABSTRACT FROM AUTHOR]

Tildrakizumab (TIL) binds selectively to the p19 subunit of interleukin 23. Its introduction has managed to increase the levels of efficacy, safety (improving that previously presented by the anti-IL-12/23 class) and survival. Retrospective analysis of a multicenter, observational study of real clinical practice including patients with moderate-to-severe plaque psoriasis in treatment with TIL. This cross-sectional analysis includes information of patients between February 2019 to February 2022. A total of three tertiary hospitals in Andalusia (Spain) participated in this study. Analyses were performed "as observed" using IBM SPSS v28 for Windows. A total of 61 patients were included in the analysis. The mean age of our patients was 49.5 years; 50.18% of the patients were female and 34.42% of the patients had a BMI greater than 30. It was notable that 44.26% of our patients had scalp involvement. Almost 35% of the patients had psoriatic arthropathy, although skin involvement was predominant. At week 52 (n = 34), 68% of the patients presented an absolute PASI equal to or less than 1. Regarding the drug survival, eight patients discontinued treatment due to inefficacy: five primary and three secondary failures, and one death due to causes not drug related showing survival of 86% at week 52. In the analysis of subgroups of patients, we found that scalp involvement determined greater survival (94%), as well as a shorter duration of the disease (91.7% vs. 84.4% in those with less than 10 years versus more than 15 years of evolution) and with a lower number of previous biological therapies (100% naïve, 90% in those who have used one line of biological therapy and 82.1% in those who have completed two or more lines of biological treatment. Tildrakizumab showed excellent results in the control of psoriasis in the mid-term with an elevated number of patients maintaining treatment after 52 weeks. There were no statistically significant differences in the efficiency, safety or survival results of TIL between patients coming from previous therapies. [ABSTRACT FROM AUTHOR]

Background: Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain.Methods: This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR).Results: Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3-89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57-0.79).Conclusions: Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out. [ABSTRACT FROM AUTHOR]

• Circular economy strategies can be fostered with the use of waste taxation. • We assess the economic and environmental effects of landfill and incineration taxes. • An energy-environment-economy dynamic CGE model for Spain is developed. • The model provides high detail, with 19 different waste treatment industries. • We find a low economic impact and a reduction of all the environmental impacts. Economic theory states that incineration and landfill taxation can effectively diminish the environmental impacts of pollution and resource use by reducing their associated pollutants while stimulating the reuse and recycling of materials, and therefore, fostering a circular economy. The aim of this research is to assess the economic and environmental effects of these taxes in Spain in different scenarios with a detailed dynamic computable general equilibrium (CGE) model, as there are no studies analyzing this in detail. We focus on the economic impact on GDP and sectorial production and the environmental impact on different categories: global warming potential, marine eutrophication potential, photochemical ozone formation potential, particulate matter, human toxicity (cancer and noncancer), ecotoxicity, and depletion of fossil resources. We find in all scenarios that these taxes have a limited economic impact while reducing all of the environmental impact categories analyzed. The study reinforces the theory that policy makers need to impose taxes on landfill and incineration to reinforce the circularity of the economy and reduce environmental burdens, but also demonstrates that they can improve their design without additional costs. [ABSTRACT FROM AUTHOR]

Data on the effectiveness and safety of a drug in real‐world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice. The ojective of this study was to assess the effectiveness and safety of guselkumab at 24 weeks in patients with moderate to severe plaque psoriasis in routine clinical practice. A retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks was carried out in Spain. We studied 343 patients, 249 of whom were followed for 24 weeks. By week 24, the mean (SD) psoriasis area severity index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (−9.3; [−10.2;‐8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI‐90 response and 49.0% a PASI‐100 response. On multivariate analysis, two factors reduced the probability of a PASI of 2 or less at 24 weeks: a BMI ≥30 (OR, 0.44; 95% CI, 0.22–0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, [0.56–0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only nine patients (2.6%) by the end of the follow‐up period. The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value. [ABSTRACT FROM AUTHOR]

El uso de cohortes de osteoartritis bien caracterizadas es obligatorio para estudiar y profundizar en el conocimiento en esta enfermedad. En España no existe actualmente ninguna cohorte prospectiva en este ámbito; por ello, el objetivo de este trabajo es describir la primera cohorte de osteoartritis en España: la PROCOAC (PROspective COhort of A Coruña). El Servicio de Reumatología del Hospital Universitario de La Coruña inició un estudio de seguimiento prospectivo en el año 2006. Los criterios de inclusión fueron: a) pacientes mayores de 55 años a los que se les realizó una radiografía abdominal que permitiese estudiar ambas caderas; b) pacientes diagnosticados de osteoartritis radiográfica de mano según los criterios ACR; c) pacientes diagnosticados de osteoartritis radiográfica de rodilla o cadera según los criterios ACR. Se realizó seguimiento cada 2 años y se recogió información clínica, analítica, genética y radiográfica. La cohorte consta de 937 individuos; 873 tienen osteoartritis radiográfica de rodilla, 783 de cadera y 679 de mano. La edad media de la población es 63,9 ± 8,9 años y el IMC promedio de 29,6 ± 5,1. Más de la mitad de la población tiene hipertensión arterial y el 17%, diabetes. La osteoartritis predominante en la mano es la nodular (78,1%), seguida de la rizartrosis (55,3%) y la erosiva (18,4%). El 21,4% y el 43,1% tienen sanas la rodilla y la cadera, respectivamente. Se observa un grado 1 en el 26% y 37%; un grado 2 en el 26,7% y 11,5%; un grado 3 en el 14,9% y 4%; y un grado 4 en el 9,4% y 3,7%, respectivamente. El 44,1% de la población tiene una articulación afectada, el 39,9% tiene 2 y el 13,4% tiene las 3 articulaciones afectadas. La edad (OR = 1,11; p < 0,001), el IMC (OR = 1,11; p = 0,002) y el WOMAC total (OR = 1,03; p = 0,005) son los únicos factores de riesgo si comparamos la afectación de una sola ubicación frente a 3. También se detectó una discrepancia entre el dolor y el daño radiográfico articular en pacientes con grado KL ≤ 2, de modo que un porcentaje significativamente mayor de pacientes con osteoartritis de rodilla experimentaron dolor (66,1%) en comparación con los pacientes de cadera (21,1%) (p < 0,001). La cohorte PROCOAC es un instrumento que permite realizar estudios de incidencia y progresión en la osteoartritis de mano, rodilla y cadera, así como conocer factores que se asocian con los diferentes fenotipos de osteoartritis. The use of well characterized osteoarthritis cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). The Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: a) patients older than 55 years who underwent an abdominal x-ray to study both hips; b) patients diagnosed with radiographic hand osteoarthritis according to ACR criteria; c) patients diagnosed with radiographic knee or hip osteoarthritis according to ACR criteria. Follow-up was performed every 2 years collecting clinical, analytical, genetic and radiographic information. The cohort consists of 937 patients, 873 have radiographic knee osteoarthritis, 783 hip osteoarthritis and 679 hand osteoarthritis. The mean age of the population is 63.9 ± 8.9 years and the average BMI is 29.6 ± 5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Of them, 21.4% and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7%, respectively. Of the population, 44.1% has only one joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR = 1.11; P <.001), BMI (OR = 1.11; P =.002) and total WOMAC (OR = 1.03; P =.005) are the only risk factors if we compare the involvement of a single location versus 3. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL ≤ 2 grade, and therefore a significantly higher percentage of patients with knee osteoarthritis experienced pain (66.1%) compared to patients with osteoarthritis hip (21.1%) (P <.001). The PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip osteoarthritis; as well as determining factors that are associated with the different osteoarthritis phenotypes. [ABSTRACT FROM AUTHOR]

Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140–180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140–180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31–1.73) (BG 140–180 mg/dL; HR 1.48; 95%CI: 1.29–1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Historia y Comunicación Social is the property of Universidad Complutense de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To assess pain management nursing practice in older adults with dementia through electronic health records (EHR). Design: Retrospective study. Methods: Data were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018. Results: EHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients' care plans, and non‐pharmacological interventions were recorded in 12%. In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations. [ABSTRACT FROM AUTHOR]

Context: It has been more than 10 years since the human papillomavirus (HPV) vaccination program was initiated in most advanced countries. Thus, it seems necessary to change the uterine cervical cancer screening strategy. Molecular-based tests are considered essential in this scenario. Objective: We aimed to review the distribution of the HPV genotypes after the introduction of the vaccination program with Cervarix® and Gardasil 4® in two autonomous communities in Spain, looking for possible changes in distribution and the occurrence of a herd effect. Design: A cross-sectional study was performed in 45,362 samples that were processed in the Cantabria and Aragon communities during the period from 2002 to 2016. We compared the genotype distribution before and after the vaccination program was initiated. Results: Genotypes HPV6 and HPV11 have decreased significantly after the introduction of the vaccine. HPV16 has had a decrease, but not a significant one in the statistical analysis. However, HPV31, HPV52, and HPV45 have increased in percentage. A replacement phenomenon with other genotypes not included in the vaccine has been observed in our population. Conclusions: Continued surveillance is needed to provide further indication of any changes over time in the genotypes in circulation. This will be facilitated by monitoring the genotyping results from the new model of cervical screening using primary HPV DNA testing. [ABSTRACT FROM AUTHOR]

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades. Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed. [ABSTRACT FROM AUTHOR]

Objectives This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the level of agreement between cardiologists regarding the management of oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) in Spain. Materials and methods: A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with the questionnaire items on a 9-point Likert scale. Item selection was based on acceptance by ≥66.6% of panellists and the agreement of the scientific committee. In round 2, the same panellists evaluated those items that did not meet consensus in round 1. Results: A total of 238 experts participated in round 1; of these, 217 completed the round 2 survey. In round 1, 111 items from 4 dimensions (Thromboembolic and bleeding risk evaluation for treatment decision-making: 18 items; Choice of OAC: 39 items; OAC in specific cardiology situations: 12 items; Patient participation and education: 42 items) were evaluated. Consensus was reached for 92 items (83%). Over 80% of the experts agreed with the use of DOACs as the initial anticoagulant treatment when OAC is indicated. Panellists recommended the use of DOACs in patients at high risk of thromboembolic complications (CHA2DS2-VASc ≥3) (83%), haemorrhages (HAS-BLED ≥3) (89%) and poor quality of anticoagulation control (SAMe-TT2R2 >2) (76%), patients who fail to achieve an optimal therapeutic range after 3 months on VKA treatment (93%), and those who are to undergo cardioversion (80%). Panellists agreed that the efficacy and safety profile of each DOAC (98%), the availability of a specific reversal agent (72%) and patient's preference (85%) should be considered when prescribing a DOAC. A total of 97 items were ultimately accepted after round 2. Conclusions: This Delphi panel study provides expert-based recommendations that may offer guidance on clinical decision-making for the management of OAC in NVAF. The importance of patient education and involvement has been highlighted. [ABSTRACT FROM AUTHOR]

Serious games have proven to be a powerful tool in education to engage, motivate, and help students learn. However, the change in student knowledge after playing games is usually measured with traditional (paper) prequestionnaires–postquestionnaires. We propose a combination of game learning analytics and data mining techniques to predict knowledge change based on in‐game student interactions. We have tested this approach in a case study for which we have conducted preexperiments–postexperiments with 227 students playing a previously validated serious game on first aid techniques. We collected student interaction data while students played, using a game learning analytics infrastructure and the standard data format Experience API for Serious Games. After data collection, we developed and tested prediction models to determine whether knowledge, given as posttest results, can be accurately predicted. Additionally, we compared models both with and without pretest information to determine the importance of previous knowledge when predicting postgame knowledge. The high accuracy of the obtained prediction models suggests that serious games can be used not only to teach but also to measure knowledge acquisition after playing. This will simplify serious games application for educational settings and especially in the classroom easing teachers' evaluation tasks. Lay Description: What is currently known about the subject matter Serious games are a powerful tool to engage, motivate, and help students learn.Pre‐post experiments are commonly used to measure knowledge acquisition.Game learning analytics can be applied to interaction data from games. What this paper adds We present a two‐step approach combining game learning analytics and data mining to predict players' performance in serious games based on their interactions.The approach is tested in a case study with pre‐post experiments collecting interaction data with 227 students playing a serious game to determine if performance can be accurately predicted.The comparison of prediction models has helped to determine if pretest information is essential.The highly accurate prediction models obtained suggest that games can be used to teach and measure knowledge acquisition after playing. Implications of study findings for practitioners The approach aims to simplify the measurement of players' learning with serious games.It may be generalized at least to similar scenarios (e.g., games for procedural learning or game‐likesimulations) where similar interaction data are feasible.Game mechanics and educational design should define the interaction data to capture.Using an accepted standard tracking profile is a clear recommendation. [ABSTRACT FROM AUTHOR]

Doubly uniparental inheritance (DUI) is a particular mitochondrial DNA inheritance mode reported in a number of bivalves. DUI species show two types of mtDNA, one transmitted from females to daughters and sons (F mitotype) and another one from males to sons (M mitotype). In Veneridae, the existence of DUI has been investigated in several species but it was found in only two of them. In this study, we obtained partial sequences of rrnL, cytb and cox1 genes of males and females of Polititapes rhomboides from NW Spain and we demonstrated the existence of heteroplasmy in males, as expected under DUI. F and M mitotypes showed a taxon‐specific phylogenetic pattern and similar evolutionary rates. We focused on cox1 for population genetic analysis, examining separately F and M mitotypes, but also F mitotypes from females (F♀) and males (F♂). In all cases, cox1 bears signs of strong purifying selection, with no apparent evidence of relaxed selection in the M genome, while the divergence between F and M genomes is in agreement with the neutral model of evolution. The cox1 polymorphism, higher at the M than at the F genome, also shows clear footprints of genetic hitchhiking with favourable mutations at other mtDNA loci, except for F♂. In terms of population structure, results suggest that the pattern depends on the examined mitotype (F, F♀, F♂ or M). [ABSTRACT FROM AUTHOR]

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Introduction: The purpose of this article is to propose the reform of the regulation in force in Spain on the coverage and treatment of information in the audiovisual media during electoral campaigns, in relation to the mandatory transposition into Spanish legislation, before the end of 2020, of Directive 1808/2018 of audiovisual communication. Methodology: For this, a review of the most relevant legislation in the field is carried out, including the Organic Law of Electoral Regime (LOREG by its acronym in Spanish) of 1985, the different laws of creation of public and private media, General 7/2010 Law of Audiovisual (LGA by its acronym in Spanish), the European Audiovisual Services Directive approved in 2018 and the regulation in other European countries on the organization of electoral debates and disinformation campaigns. Results: Although the 35 years of validity of the LOREG and its jurisprudence condition the legal framework of the audiovisual coverage of the electoral campaigns, it is possible to include in the transposition and reform of the LGA 7/2010 the regulation of the debates and new measures on the protection of pluralism, independence, and verification against fake news, issues that a group of Spanish academics raised during the public consultation of the Secretary of State for Digital Advancement (SEAD by its acronym in Spanish) of the Ministry of Economy and Business (MEE by its acronym in Spanish) on the transposition of Directive 1808/2018. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives: This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods: This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results: A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)). Conclusion: SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal. [ABSTRACT FROM AUTHOR]

Objective: Monotherapy is an option as first-line therapy for pulmonary arterial hypertension (PAH). However, combination therapy is a beneficial alternative. Our objective was to evaluate the efficacy of monotherapy versus combination therapy in patients with systemic sclerosis (SSc)-associated PAH.Methods: All patients with SSc-associated PAH from the Spanish Scleroderma Registry (RESCLE) were reviewed. Patients were split into 3 groups: monotherapy versus sequential combination versus upfront combination therapy. The primary endpoint was death from any cause at 1, 3, and 5 years from PAH diagnosis.Results: Seventy-six patients (4.2%) out of 1817 had SSc-related PAH. Thirty-four patients (45%) were receiving monotherapy [endothelin receptor antagonist (n = 22; 29%) or phosphodiesterase-5 inhibitors (n = 12; 16%)], 25 (33%) sequential combination, and 17 (22%) upfront combination therapy. A lower forced vital capacity/DLCO in the sequential combination group was reported (2.9 ± 1.1 vs 1.8 ± 0.4 vs 2.3 ± 0.8; p = 0.085) and also a higher mean pulmonary arterial pressure in combination groups (37.2 ± 8.7 mmHg vs 40.8 ± 8.8 vs 46 ± 15.9; p = 0.026) at baseline. Treatment regimen (p = 0.017) and functional class (p = 0.007) were found to be independent predictors of mortality. Sequential combination therapy was found to be an independent protective factor (HR 0.11, 95% CI 0.03-0.51; p = 0.004), while upfront combination therapy showed a trend (HR 0.68, 95% CI 0.23-1.97; p = 0.476). Survival from PAH diagnosis among monotherapy, sequential, and upfront combination groups was 78% versus 95.8% versus 94.1% at 1 year, 40.7% versus 81.5% versus 51.8% at 3 years, and 31.6% versus 56.5% versus 34.5% at 5 years (p = 0.007), respectively. Side effects were not significantly different among groups.Conclusion: Combination sequential therapy improved survival in our cohort. [ABSTRACT FROM AUTHOR]

BACKGROUND: Newborns in neonatal intensive care units (NICUs) are in contact with a variety of medical products whose production might include synthetic chemicals with hormonal activity. OBJECTIVES: Our aim was to assess the content of bisphenol A (BPA) and parabens (PBs) and the hormone-like activities of a subset of medical products commonly used in NICUs in prolonged intimate contact with NICU newborns. METHODS: Fifty-two NICU items were analyzed, determining the concentrations of BPA and PBs [methyl- (MeP), ethyl- (EtP), propyl- (PrP), and butylparaben (BuP)] and using the E-Screen and PALM-luciferase assays to measure the in vitro (anti-)estrogenic and (anti-)androgenic activity, respectively, of the extracts. Items found to have elevated BPA/PB content or hormone-like activities were further extracted using leaching methodologies. RESULTS: BPA was found in three-fifths and PBs in four-fifths of tested NICU items, and ~25% and ~10% of extracts evidenced estrogenic and anti-androgenic activity, respectively. The highest BPA content was found in the three-way stopcock (>7.000 ng/g), followed by patterned transparent film dressing, gastro-duodenal feeding tubes, sterile gloves, single-lumen umbilical catheters, and intravenous (IV) infusion extension sets (concentrations ranged from 100 to 700 ng/g BPA). A total PB concentration (?PPBs) >100 ng/g was observed in several items, including light therapy protection glasses, patterned transparent film dressing, winged IV catheters, IV infusion extension sets, and textile tape. The highest estrogenic activity [>450 pM estradiol equivalent (E2eq)] was found in small dummy nipples, three-way stopcocks, and patterned transparent film dressing and the highest anti-androgenic activity [>5 mM procymidone equivalent units per gram (Proceq/g)] in small dummy nipples and three-way stopcocks. DISCUSSION: According to these findings, neonates might be exposed to multiple sources of BPA and PBs in NICUs via inhalation, dermal, oral, and IV/parenteral routes. There is a need to address the future health implications for these extremely vulnerable patients and to adopt precautionary preventive measures as a matter of urgency. [ABSTRACT FROM AUTHOR]

Decadal predictions bridge the gap between the short-term weather/seasonal forecasts and the long-term climate projections. They target the reproduction of large-scale weather patterns at multi-year time scales by both recognizing the long memory of some components of the climate system, and explicitly including the evolution of greenhouse gas concentrations as an external forcing. This study illustrates the use of decadal predictions to determine the near-future storminess at regional scales. Specifically, the evolution of extreme storm surges and sea levels along the Atlantic Iberian coast is assessed. Present (1980–2016) and near-future (2021–2024) storm surges are simulated over the northeast Atlantic, forced by atmospheric reanalyses (ERA-Interim) and decadal predictions (MiKlip), respectively. Results are then statistically analyzed to investigate the short-term effects of climate change and climate variability on extreme surges and extreme sea levels. Surges will increase mostly in early winter, while tides are largest in late winter. As a result, the impact of the increase in storminess on the extreme sea levels and coastal flooding will be modest, and the growth in extreme sea levels will be dominated by the contribution of mean sea level rise. [ABSTRACT FROM AUTHOR]

Introduction: Etanercept (ETN), a highly effective biological agent for the treatment of psoriasis (PSO) and psoriatic arthritis (PsA), is widely used in Spain. However, evidence of its economic impact is limited, indicating the need for a systematic review of the economic assessments conducted on the use of ETN in the treatment of both PSO and PsA in Spain. Methods: A systematic review was carried out in PubMed, Embase, Cochrane Library, Health Technology Assessment reports and not indexed sources up to November 2018. The inclusion criteria were economic evaluations (total and partial) and dose optimization studies published in English or Spanish on the use of ETN to treat PSO and PsA for ETN in Spain. Results: A total of 402 publications were identified, of which 32 were selected for inclusion in the review; of these 32 publications, 81.3% analyzed PSO (14 full economic evaluations, 5 partial economic evaluations and 7 dose optimization studies) and 18.8% analyzed PsA (1 economic analysis and 5 dose optimization studies). The perspective of the Spanish National Health Service (NHS) was used in 90.0% (n = 18) of the full and partial economic evaluations. The time horizons ranged from 12 weeks to 2 years. Reductions in the Psoriasis Area and Severity Index (PASI) of 50, 75 and 90% (PASI 50, 75 and 90, respectively) were most commonly used as efficacy outcomes in the complete evaluations. The economic impact of ETN ranged from €9110–14,337/PASI 75 at 12 weeks (50 mg/week) to €82,279/PASI 90 at 2 years, depending on the health outcome, time horizon and ETN dose used. Only one study determined the cost of using ETN for the treatment of PSO (€29,430–52,367/QALY for dose 2 × 25 mg/week or 50 mg/week, respectively). Only one partial economic evaluation on PSA was identified (NHS perspective), resulting in an ETN annual cost of €8585/patient-year. Conclusion: Consistent evidence on the economic impact of ETN for the treatment of PSO and PSA in Spain is lacking, mainly due to the highly heterogeneous methodology used and the broad range of outcomes found in the economic evaluations published to date. Funding: Pfizer S.L.U. [ABSTRACT FROM AUTHOR]

Little information is available on the content of bisphenol A (BPA) and other endocrine-disrupting chemicals (EDCs) such as parabens in infant textiles and clothes. 1) To determine the concentrations of BPA and parabens in socks for infants and young children purchased in Spain, 2) to assess the (anti-)estrogenicity and (anti-)androgenicity of extracts from the socks, and 3) to estimate dermal exposure doses to these chemicals. Thirty-two pairs of socks for infants and young children (1–48 months) were purchased from 3 stores in Granada (Spain). Textile material was cut from the foot, toe, and leg of each sock (n = 96 samples) for chemical analysis. Hormone-like activities were determined in foot sections (n = 32 samples) by using the E-Screen assay for (anti-)estrogenicity and PALM luciferase assay for (anti-)androgenicity. BPA was present in 90.6% of samples at concentrations ranging from <0.70 to 3736 ng/g. BPA levels were around 25-fold higher in socks from store 1, which had a higher cotton content compared to stores 2 and 3. Ethyl-paraben was found in 100% of samples, followed by methyl-paraben (81.0%), and propyl-paraben (43.7%). No butyl-paraben was detected in any sample. Estrogenic activity was detected in 83.3% of socks from store 1 (range = 48.2–6051 pM E 2 eq/g) but in only three socks from stores 2 and 3. Anti-androgenic activity was detected in six of the 32 socks studied (range = 94.4–2989 μM Proceq/g), all from store 1. Estimated dermal exposure to BPA was higher from socks for children aged 36–48 months (median = 17.6 pg/kg/day), and dermal exposure to parabens was higher from socks for children aged 24–36 months (median = 0.60 pg/kg/day). This is the first report in Europe on the wide presence of BPA and parabens in socks marketed for infants and children. BPA appears to contribute to the hormone-like activity observed in sock extracts. Unlabelled Image • BPA was present in 91% of socks at concentrations ranging from <0.70 to 3736 ng/g. • Ethyl-paraben was found in 100% of socks, followed by methyl- and propyl-paraben. • Around 41% of socks extracts were estrogenic and 19% were anti-androgenic. • Hormone-like activities were higher in socks with higher BPA content. • The median estimated dermal exposure dose to BPA was 19.6 pg/kg/day. [ABSTRACT FROM AUTHOR]

Cultural landscapes are multi-layered entities that constantly endure changes and transformations, especially in Europe due to its ancient history and anthropized nature, which reveals itself not only in physical elements, but also through immaterial heritage. This paper aims to analyse the connection between sacred landscapes, small religious architecture and folklore, focusing on the origin and transformations of several places in Galicia (northwest of Spain). Galicia is defined by its rich flora and fauna, a management of its land based on smallholding and the social idiosyncrasy of its people, defined by strong symbolism and the religious tradition that is reflected in a great amount of small sacred architecture. All this provide a paradigmatic territory for this research, allowing an approach to the case studies from the point of view of landscape architecture, assessing the small sacred architecture elements, their background, symbolism and associated vegetation. It is worth mentioning that, although vegetation had a very strong meaning and symbolism in the sacred history of Galicia, nowadays it only appears in 26% of the analysed case studies. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of placental levels of arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb), manganese (Mn), and chromium (Cr) with birth outcomes (birth weight, length, and head circumference, low birth weight [LBW], gestational age, preterm delivery, and small for gestational age [SGA]) in mother-child pairs from the Environment and Childhood (INMA) Project in Spain.Methods: Metal concentrations were measured in placenta tissue samples randomly selected from five INMA cohorts. Data on birth outcomes were obtained from medical records. Associations were assessed in a sub-sample of 327 mother-infant pairs by regression models adjusted for confounding factors and for all metals simultaneously. Effect modification by sex was also evaluated.Results: Elevated placental Cd levels (>5.79 vs. <3.30 ng/g) were associated with reduced birth weight (-111.8 g, 95%CI = -215.6; -8.06, p-trend = 0.01) and length (-0.62 cm, 95%CI = -1.20; -0.04, p-trend = 0.02), while a 10% increase in Cd was associated with 1.21-fold increased odds (95%CI = 1.01; 1.43) of LBW in the global sample but with 14% lower odds (95%CI = 0.78; 0.96) of preterm delivery in males (Pinteraction = 0.10). Detected (vs. undetected) Hg was associated with reduced head circumference (-0.49 cm, 95%CI = -1.00; 0.03) in females (Pinteraction = 0.03). A 10% increase in placental Mn was associated with slight increases in gestational age (0.04 weeks, 95%CI = 0.01; 0.07) in the global sample and in head circumference (0.05 cm, 95%CI = -0.01; 0.10) in females (Pinteraction = 0.03). Elevated Cr levels (>99.6 vs. <56.1 ng/g) were associated with reduced birth length (-0.68 cm, 95%CI = -1.33; -0.04, p-trend = 0.02) and slightly increased gestational age (0.35 weeks, 95%CI = -0.07; 0.77, p-trend = 0.08) in the global sample. As and Pb were detected in few placentas (27% and 13%, respectively) and were not associated with any studied birth outcome.Conclusions: Data suggest that in utero exposure to Cd, Hg, and Cr could adversely affect fetal growth, whereas Mn and Cr appear to have a positive effect on gestational age. Given the relatively small number of subjects, sex-specific associations should be interpreted with caution. [ABSTRACT FROM AUTHOR]

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Several RT-qPCR kits are available for SARS-CoV-2 diagnosis, some of them with Emergency Use Authorization (EUA) by FDA, but most of them lacking of proper evaluation studies due to covid19 emergency. We evaluated Viasure RT-qPCR kit (CerTest Biotec, Spain) for SARS-CoV-2 diagnosis using FDA EUA 2019-nCoV CDC kit (IDT, USA) as a gold standard. Although we found the lack of RNA quality control probe as the main limitation for the Viasure kit, the sensitivity was 91.9% and the specificity was 100%. The limit of detection (LOD) was 2000 copies/mL and 1000 copies/mL for Viasure and IDT kits, respectively. Viasure RT-qPCR kit is a reliable tool for SARS-CoV-2 diagnosis but improvement of an alternative RT-qPCR reaction for RNA extraction quality control as RNaseP is recommended. • SARS-CoV-2 RT-PCR diagnosis kits lacking of proper clinical evaluation are introduced at developing countries. • Viasure RT-qPCR kit had a sensitivity of 91.9%, a specificity of 100% and a limit of detection of 2000 copies/mL. • Viasure RT-qPCR kit is a reliable tool for SARS-CoV-2 diagnosis. [ABSTRACT FROM AUTHOR]

We read with interest the paper by Molero-Salinas I et al i . on coronavirus disease of 2019 (COVID-19) false negative travellers arriving to Spain in 2021.[1] This study challenges the effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing prior to flight departure to control COVID-19 spread. The authors report 196 COVID-19 false negative passengers with an average PCR Ct value of 20.3, meaning a high viral load. [Extracted from the article]

Introduction: The aim of this study was to validate the S100B protein as a diagnostic tool for ruling out the presence of intracranial lesion (IL) after mild traumatic brain injury (mTBI). Subjects with a Glasgow Coma Scale (GCS) score of 15 and at least one neurological symptom post-trauma were selected from a large Spanish cohort. Methods: A number of 260 patients with mTBI were enrolled. Blood samples were extracted within 6 h and CT scan performed within 24 h post-injury. Blood samples were also drawn from 18 healthy subjects. Results: CT scan revealed the presence of IL in 22 patients (8.5%). Patients with mTBI had higher S100B serum levels (p = 0.008) than the healthy subjects (p < 0.001). The ROC analysis of S100B discriminated between patients with and without IL (AUC: 0.671; 95%CI: 0.574-0.769; p = 0.008). The multivariate analysis identified male gender (OR: 5.39; 95%CI: 1.45-20.10; p = 0.012), age > 65 (OR: 2.97; 95%CI: 1.04-8.44; p = 0.041) and S100B level >0.10 µg/L (OR: 7.93; 95%CI: 1.03-60.76; p = 0.046) as independent risk factors for IL in patients with mTBI. Conclusion: Measurement of S100B within 6 h of mTBI accurately predicts risk of IL in patients with a GCS score of 15 and at least one neurological symptom. [ABSTRACT FROM AUTHOR]

This study focuses on business incubators in Spain, which helps compare regions within Spain. This study has four goals: to shape taxonomy of the Spanish business incubator system, to compare between regions, to identify the factors affecting incubators' success, and to analyse during the COVID pandemic. Of the 478 business incubators registered in Spain, 89 were selected as the sample for study. Business incubators provide office space, equipment and mentoring services, as well as financial, legal and administrative support for entrepreneurs and start-up companies. Non-parametric statistical techniques are used to compare between regions, considering each regional business incubator as an ecosystem. The study focuses on six Spanish regions: Madrid, Catalonia, Castile-Leon, Aragon, Basque Country and Galicia. • Catalonia, Galicia and Aragon occupy the highest positions related to the item 'good opportunities to start a company'. • Incubators where public funding and innovation as strategic objective have better probability of success. • The text includes a taxonomy of the characteristics that contribute to developing an entrepreneurial ecosystem. • Recommendation on policy in Spain would be that public funding can help start-ups mainly when they are focused on innovation. [ABSTRACT FROM AUTHOR]

Aluminum (Al), antimony (Sb), and lithium (Li) are relatively common toxic metal(oid)s that can be transferred into breast milk and potentially to the nursing infant. This study assessed concentrations of Al, Sb, and Li in breast milk samples collected from donor mothers and explored the predictors of these concentrations. Two hundred forty-two pooled breast milk samples were collected at different times post-partum from 83 donors in Spain (2015–2018) and analyzed for Al, Sb, and Li concentrations. Mixed-effect linear regression was used to investigate the association of breast milk concentrations of these elements with the sociodemographic profile of the women, their dietary habits and utilization of personal care products (PCPs), the post-partum interval, and the nutritional characteristics of milk samples, among other factors. Al was detected in 94% of samples, with a median concentration of 57.63 μg/L. Sb and Li were detected in 72% and 79% of samples at median concentrations of 0.08 μg/L and 0.58 μg/L, respectively. Concentrations of Al, Sb, and Li were not associated with post-partum time. Al was positively associated with total lipid content of samples, weight change since before pregnancy, and coffee and butter intakes and inversely with meat intake. Li was positively associated with intake of chocolate and use of face cream and eyeliner and inversely with year of sample collection, egg, bread, and pasta intakes, and use of hand cream. Sb was positively associated with fatty fish, yoghurt, rice, and deep-fried food intakes and use of eyeliner and inversely with egg and cereal intakes and use of eyeshadow. This study shows that Al, Sb, and Li, especially Al, are widely present in donor breast milk samples. Their concentrations in the milk samples were most frequently associated with dietary habits but also with the lipid content of samples and the use of certain PCPs. [Display omitted] • Al, Sb, and Li were widely detected in donor milk samples. • Concentrations of Al were several times higher than those of Sb and Li. • Concentrations of Al, Sb, and Li were associated with dietary habits. • Use of certain personal care products was associated with higher Sb and Li. [ABSTRACT FROM AUTHOR]