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Resumen Objetivo Evaluar el nivel de implementacion de los protocolos asociados a la prevencion de la debilidad muscular adquirida en la unidad de cuidados intensivos (UCI), asi como la presencia del fisioterapeuta en distintas UCI de Espana. Metodo Estudio descriptivo, transversal realizado en 86 UCI de adultos de Espana entre los meses de marzo a junio de 2017. Se excluyeron UCI neuroquirurgicas y de grandes quemados. Se utilizo encuesta multirrespuesta que incluia preguntas sobre los protocolos de: control de glucemia, sedacion, valoracion del dolor, prevencion del delirium, manejo del delirium y movilizacion precoz. La encuesta fue rellenada a traves de un aplicativo protegido por usuario y contrasena. Analisis inferencial con t de Student o U de Mann-Whitney y de correlacion con Pearson o Rho de Spearman. Resultados El 89,5% de las UCI tenian protocolo de control de glucemia, con rango predominante de 110-140 mg/dl. El 74,4% evaluaban el nivel de sedacion, si bien solo tenian protocolos de sedacion el 36% de ellas. Con relacion a la valoracion del dolor se realizaba en el 73,7% de los pacientes comunicativos, mientras que en los no comunicativos solo era del 47,5%. Solo el 37,2% realizaban screening diario para detectar el delirium, y disponian de protocolos de prevencion del delirium el 31,4% de las UCI, del manejo del delirium el 26,7% y de movilizacion precoz el 14% de las UCI. En el 34,9% de los casos se solicita interconsulta al servicio de rehabilitacion. Conclusiones La implementacion de los diferentes protocolos asociados a la prevencion de la debilidad muscular adquirida ha sido elevada en relacion con los protocolos de control de glucemia, valoracion del nivel de sedacion y del dolor de pacientes comunicativos, mientras que baja en los de movilizacion precoz y screening y prevencion del delirio. Asimismo, es poco frecuente la presencia del fisioterapeuta en la UCI.

Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice. The Mobilise-D project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement no. 820820. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA). This publication reflects the authors’ views and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein. H.D. is a postdoctoral research fellow of the FWO-Flanders. ISGlobal acknowledges support from the Spanish Ministry of Science, Innovation, and Universities through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.

Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centered care at a practical level, a methodological study was carried out to assess the face validity of the model. Particularly, a Delphi method involving a group of 15 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a Content Validity Index-Item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic and HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing of complexity in healthcare practice.

The wish to hasten death has been little researched in the area of Mediterranean countries and we are not aware of specific studies on its particularities in home care in our setting. The aim of this work was to investigate the prevalence and evolution of wish to hasten death in home care, analysing its relationship with physical, emotional, spiritual, ethical and social-family unrest.Longitudinal observational study in palliative home care in Catalonia. 43 teams agreed on the level of complexity after the first visit and after the discharge of the patient with the HexCom model, which classifies the desire to anticipate death into Low complexity (no or sporadic manifestation); Medium (persistent desire that requires specific treatment); or High (persistent desire that is considered potentially refractory). For the comparison of proportions, Pearson's Chi-squared test was used and a multivariate logistic regression analysis was performed, in which the dependent variable corresponded to the desire to hasten initial death. The level of significance was p≤0.05.The total number of patients included in this study was 1,677, of whom 1,169 (69.7%) were oncologic. The prevalence of desire to hasten death was 6.67%. It was related to spiritual distress, especially lack of meaning (OR 3.25) and lack of connection (OR 3.81), to psychoemotional distress (OR 2.34) and to ethical distress. Protective factors were spiritual distress in relation to transcendence (OR 0.50), the caregiver being a partner (OR 0.50) and being cared for by a team that included psychology and social work (OR 0.34). The desire to anticipate death is stable in 71.6% of patients.The desire to anticipate death is a changing and complex phenomenon that can emerge at any time. The presence of psycho-emotional, spiritual-existential and ethical discomfort, especially in patients without a partner, should make us take a proactive attitude to identify it early.El deseo de adelantar la muerte ha sido poco investigado en el área de los países mediterráneos y no conocemos estudios específicos sobre sus particularidades en atención domiciliaria en nuestro entorno. El objetivo de este trabajo fue investigar la prevalencia y la evolución del deseo de anticipar la muerte en atención domiciliaria, analizando su relación con el malestar físico, emocional, espiritual, ético y sociofamiliar.Estudio observacional longitudinal en el ámbito de la atención domiciliaria paliativa en Catalunya. 43 equipos acordaron el nivel de complejidad tras la primera visita y tras el alta del paciente con el modelo HexCom, el cual clasifica el deseo de anticipar la muerte en complejidad Baja (manifestación nula o esporádica); Media (Deseo persistente que requiere tratamiento específico); o Alta (Deseo persistente que se considera potencialmente refractario). Para la comparación de proporciones se utilizó la prueba de Ji cuadrado de Pearson y se realizó un análisis de regresión logística multivariante, en el que la variable dependiente correspondía con el deseo de adelantar la muerte inicial. El nivel de significación fue p≤0,05.El número total de pacientes incluidos en este estudio fue de 1.677, de los cuales 1.169 (69,7%) eran oncológicos. La prevalencia de deseo de anticipar la muerte fue del 6,67%. Se relacionó con el malestar espiritual, ante todo con la falta de sentido (OR 3,25) y de conexión (OR 3,81), con el malestar psicoemocional (OR 2,34) y con el malestar ético. Fueron factores protectores el malestar espiritual en relación con la transcendencia (OR 0,50), que el cuidador fuese la pareja (OR 0,50) y ser atendido por un equipo en el que se incluyese psicología y trabajo social (OR 0,34). El deseo de anticipar la muerte fue estable en el 71,6% de los pacientes.El deseo de anticipar la muerte es un fenómeno cambiante y complejo que puede emerger en cualquier momento. La presencia de malestar psicoemocional, espiritual-existencial y ético, sobre todo en pacientes sin pareja, nos han de hacer tomar una actitud proactiva para identificarlo precozmente.

International audience; Within the European Epidemiological Study to Quantify Risks for Paediatric Computerized Tomography (EPI-CT study), a cohort was assembled comprising nearly one million children, adolescents and young adults who received over 1.4 million computed tomography (CT) examinations before 22 years of age in nine European countries from the late 1970s to 2014. Here we describe the methods used for, and the results of, organ dose estimations from CT scanning for the EPI-CT cohort members. Data on CT machine settings were obtained from national surveys, questionnaire data, and the Digital Imaging and Communications in Medicine (DICOM) headers of 437,249 individual CT scans. Exposure characteristics were reconstructed for patients within specific age groups who received scans of the same body region, based on categories of machines with common technology used over the time period in each of the 276 participating hospitals. A carefully designed method for assessing uncertainty combined with the National Cancer Institute Dosimetry System for CT (NCICT, a CT organ dose calculator), was employed to estimate absorbed dose to individual organs for each CT scan received. The two-dimensional Monte Carlo sampling method, which maintains a separation of shared and unshared error, allowed us to characterize uncertainty both on individual doses as well as for the entire cohort dose distribution. Provided here are summaries of estimated doses from CT imaging per scan and per examination, as well as the overall distribution of estimated doses in the cohort. Doses are provided for five selected tissues (active bone marrow, brain, eye lens, thyroid and female breasts), by body region (i.e., head, chest, abdomen/pelvis), patient age, and time period (1977-1990, 1991-2000, 2001-2014). Relatively high doses were received by the brain from head CTs in the early 1990s, with individual mean doses (mean of 200 simulated values) of up to 66 mGy per scan. Optimization strategies implemented since the late 1990s have resulted in an overall decrease in doses over time, especially at young ages. In chest CTs, active bone marrow doses dropped from over 15 mGy prior to 1991 to approximately 5 mGy per scan after 2001. Our findings illustrate patterns of age-specific doses and their temporal changes, and provide suitable dose estimates for radiation-induced risk estimation in epidemiological studies.

Xavier Busquet-Duran,1–3 Eva Maria Jiménez-Zafra,1 Josep Maria Manresa-Domínguez,2,4,5 Magda Tura-Poma,1 Olga Bosch-delaRosa,6 Anna Moragas-Roca,1 Maria Concepción Galera Padilla,1 Susana Martin Moreno,1 Emilio Martínez-Losada,1 Silvia Crespo-Ramírez,6 Ana Isabel López-Garcia,1 Pere Torán-Monserrat2,4 1Home Care Program, Support Team, PADES Granollers, Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Barcelona, Spain; 2Multidisciplinary Research Group on Health and Society (GREMSAS), Barcelona, Spain; 3Department of Nursing, University Foundation of Bages (FUB), University of Vic. Central University of Catalunya, Barcelona, Spain; 4Metropolitan Nord Unit of Research Support, University Institute of Research in Primary Care (IDIAP) Jordi Gol, Barcelona, Spain; 5Department of Nursing, Autonomous University of Barcelona, Barcelona, Spain; 6Psychosocial Care Team (EAPS), Red Cross, Granollers, Barcelona, SpainCorrespondence: Xavier Busquet-Duran Email xbusquet@umanresa.catBackground: Complexity has become a core issue in caring for patients with advanced disease and/or at the end-of-life. The Hexagon of Complexity (HexCom) is a complexity assessment model in the process of validation in health-care settings. Our objective is to use the instrument to describe differences in complexity across disease groups in specific home care for advanced disease and/or at the end-of-lifepatients, both in general and as relates to each domain and subdomain.Methods: Cross-sectional study of home care was conductedin Catalonia. The instrument includes 6 domains of needs (clinical, psychological/emotional, social/family, spiritual, ethical, and death-related), 4 domains of resources (intrapersonal, interpersonal, transpersonal, and practical), and 3 levels of complexity (High (H), Moderate (M), and Low (L)). Interdisciplinary home care teams assessed and agreed on the level of complexity for each patient.Results: Forty-three teams participated (74.1% of those invited). A total of 832 patients were assessed, 61.4% of which were cancer patients. Moderate complexity was observed in 385 (47.0%) cases and high complexity in 347 (42.4%). The median complexity score was 51 for cancer patients and 23 for patients with dementia (p< 0.001). We observed the highest level of complexity in the social/family domain. Patients/families most frequently used interpersonal resources (80.5%).Conclusions: This study sheds light on the high-intensity work of support teams, the importance of the social/family domain and planning the place of death, substantial differences in needs and resources across disease groups, and the importance of relationship wellbeing at the end-of-life.Keywords: home care services, palliative care, terminally ill, terminal care, non-cancer patient, complexity, interdisciplinary research

Knowledge on the environmental determinants of physical activity in COPD is scarce and no information on the specific role of air pollution is available. We aimed to explore the association between air pollution and physical activity in COPD patients, hypothesizing that higher levels of air pollution may negatively impact on physical activity. This is a cross-sectional analysis of baseline pre-randomisation data from the multi-centre Urban Training study (NCT01897298) in Catalonia. We estimated annual residential averages of nitrogen dioxide (NO2) and particulate matter (PM2.5, PM10 and PM2.5absorbance) using land-use regression models. We assessed physical activity (daily step count and sedentary time) using the Dynaport MoveMonitor, and physical activity experience using the C-PPAC difficulty score. We built mixed-effect linear regression models for each outcome and exposure, adjusting for confounders with a random intercept for the city area. We included 407 patients (mean (SD) 69 (8) y, 85% male, FEV1 57% pred); median (p25-p75) levels of air pollutants were at the WHO health limits (NO2 43.5 µg/m3 [35.0-48.7]; PM2.5 12.6 µg/m3 [10.7-13.8]; PM10 24.9 µg/m3 [22.3-27.7]). Multi-variable analysis showed an association between NO2 and sedentary time (Coef=0.23 [95% CI 0.03, 0.43] per IQR change, p=0.027) and C-PPAC difficulty (-2.57 [-5.12, -0.02] per IQR change, p=0.048). No other significant associations were observed. In COPD patients, higher NO2 levels of residential areas are associated with increased sedentary times and the experience of increased difficulty during physical activity. This likely contributes to the negative effects of air pollution in COPD patients and requires further investigation.

A new hybrid diffuse optical platform was developed with fast, time-resolved and correlation spectroscopied. We present the device and results from an on-going clinical trial to evaluate hemodynamic and metabolic biomarkers for guiding acute ischemic stroke management.

Background: The neurodevelopmental effects of high doses of ionizing radiation (IR) in children are well established. To what extent such effects exist at low-to-moderate doses is unclear. Considering the increasing exposure of the general population to low-to-moderate levels of IR, predominantly from diagnostic procedures, the study of these effects has become a priority for radiation protection. Objectives: We conducted a systematic review of the current evidence for possible effects of low-to-moderate IR doses received during gestation, childhood and adolescence on different domains of neurodevelopment. Data sources: Searches were performed in PubMed, Scopus, EMBASE and Psychinfo on the 6th of June 2017 and repeated in December 2018. Study eligibility criteria: We included studies evaluating the association between low-to-moderate IR doses received during gestation, childhood and adolescence, and neurodevelopmental functions. Study appraisal and synthesis methods: Studies were evaluated using the Cochrane Collaboration′s risk of bias tool adapted to environmental sciences. A qualitative synthesis was performed. Results: A total of 26 manuscripts were finally selected. Populations analyzed in these publications were exposed to the following sources of IR: atomic bomb (Hiroshima and Nagasaki), diagnostic/therapeutic radiation, and Chernobyl and nuclear weapon testing fallout.There was limited evidence for an association between low-to-moderate doses of IR and a decrease in general cognition and language abilities, that is, a causal interpretation is credible, but chance or confounding cannot not be ruled out with reasonable confidence. Evidence for a possible stronger effect when exposure occurred early in life, in particular, during the fetal period, was inadequate. Evidence for an association between IR and other specific domains, including attention, executive function, memory, processing speed, visual-spatial abilities, motor and socio-emotional development, was inadequate, due to the very limited number of studies found. Limitations, conclusions, and implications of key findings: Overall, depending on the domain, there was limited to inadequate evidence for an effect of low-to-moderate IR doses on neurodevelopment. Heterogeneity across studies in terms of outcome and exposure assessment hampered any quantitative synthesis and any stronger conclusion. Future research with adequate dosimetry and covering a range of specific neurodevelopmental outcomes would likely contribute to improve the body of evidence. Systematic review registration number: The systematic review protocol was registered in PROSPERO (registration number CRD42018091902). Keywords: Ionizing radiation, Low dose, Neurodevelopment, Epidemiology, Child health

Objetivo: Adaptar la ICU Mobility Scale (IMS) al ámbito de las unidades de cuidados intensivos (UCI) de España y evaluar las propiedades métricas de la IMS versión española (IMS-Es). Método: Estudio descriptivo de carácter métrico desarrollado en dos fases. Fase 1: adaptación al español de la IMS mediante equipo de enfermeras y fisioterapeutas (traducción, piloto, retrotraducción y acuerdo). Fase 2: análisis de propiedades métricas (validez convergente, divergente y predictiva, fiabilidad interobservador, sensibilidad y diferencia mínima importante) de la IMS-Es. Se registraron características de los pacientes (Barthel, Charlson, IMC, sexo), nivel de sedación/agitación (RASS), estancias en UCI y hospital, supervivencia, calidad de vida (SF-12), debilidad muscular (MRC-SS) y movilidad (IMS-Es) en los pacientes del estudio multicéntrico nacional MOviPre. Resultados Tras obtener la IMS-Es, se implementó en 645 pacientes de 80 UCI españolas entre abril y junio de 2017. Validez convergente: moderada correlación entre IMS-Es y MRC-SS (r = 0,389; p < 0,001) y comparación significativa entre grupos con y sin debilidad adquirida en la UCI (p < 0,001). Validez divergente: no correlación entre IMS-Es e IMC (r [IC 95%]: −0,112 [−0,232 a 0,011]), peso (r [IC 95%]: −0,098 [−0,219 a 0,026]), Charlson (r [IC 95%]: −0,122 [−0,242 a 0,001]) y Barthel (r [IC 95%]: −0,037 [−0,160 a 0,087]) y sin diferencias entre sexos (p = 0,587) ni categorías de IMC (p = 0,412). Validez predictiva: moderadas y significativas correlaciones con estancia en hospital post-UCI (r [IC 95%]: −0,442 [−0,502 a −0,377]) y componente físico del SF-12 (PCS) (r [IC 95%]: 0,318 [0,063 a 0,534]); pacientes sin movilización activa en UCI mayor riesgo de mortalidad hospitalaria (OR [IC 95%]: 3,769 [1,428 a 9,947]). Fiabilidad interobservador: muy buena concordancia entre enfermeras (CCI [IC 95%]: 0,987 [0,983 a 0,990]) y entre enfermera-fisioterapeuta (CCI [IC 95%]: 0,963 [0,948 a 0,974]). Sensibilidad al cambio: efecto pequeño al alta de UCI (d = 0,273) y moderado a los 3 meses del alta hospitalaria (d = 0,709). Diferencia mínima importante: punto de corte de la diferencia de 2 puntos, sensibilidad del 91,1% y especificidad del 100,0%. Conclusiones: La IMS-Es es útil, válida y fiable para ser implementada por enfermeras de UCI y por fisioterapeutas al valorar la movilidad de los pacientes críticos. Objective: To adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es). Method: Descriptive metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study. Results After obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r = .389; P < .001) and significant comparison between groups with and without ICU-acquired weakness (P < .001). Divergent validity: no correlation between IMS-Es and BMI [r (95% CI): −.112 (−.232 to .011)], weight [r (95% CI): −.098 (−.219 to .026)], Charlson [r (95% CI): −.122 (−.242 to .001)] and Barthel [r(95% CI): −.037 (−.160 to .087)] and no differences between sexes (P = .587) or BMI categories (P = .412). Predictive validity: moderate and significant correlations with post-ICU hospital stay [r (95% CI): −.442 (−.502 to −.377)] and physical component of SF-12 (PCS) [r (95% CI): .318 (.063 to .534)]; patients without active mobilisation in ICU increased risk of hospital mortality [OR (95% CI): 3.769 (1.428 to 9.947)]. Interobserver reliability: very good concordance between nurses [CCI (95% CI): .987 (.983 to .990)] and nurse-physiotherapist [CCI (95% CI): .963 (.948 to .974)]. Sensitivity to change: small effect on discharge from ICU (d = .273) and moderate effect at 3 months after hospital discharge (d = .709). Minimal important difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity. Conclusions: The IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients. Sin financiación No data JCR 2020 0.239 SJR (2020) Q3, 31/61 Advanced and Specialized Nursing No data IDR 2020 UEM

Background The examination of peripheral blood is routinely used as a basic test in daily medical practice. Reliable reference intervals are necessary to avoid misdiagnoses, and the establishment of those intervals is an important task for clinical laboratories. The aim of the present study was to establish the reference intervals for complete blood count (CBC) on a Sysmex XN haematology analyser in healthy adults from the southern metropolitan area of Barcelona (Spain). Methods A total of 213 apparently healthy adults who received a general health examination at Hospital Universitari de Bellvitge were recruited to this study. Blood samples collected in K3EDTA tubes were analysed on a Sysmex XN. Statistically relevant gender based partition was assessed, outliers removed, and the reference intervals calculated in concordance with Clinical and Laboratory Standards Institute (CLSI) EP28-A3C guidelines. Results The CBC reference intervals were established in 191 adults (64 men and 127 women) who fulfilled all of the inclusion criteria. Significant gender-dependent differences in red blood cells, haematocrit, haemoglobin and platelets were found. The rest of the CBC reference intervals were obtained from the overall data. Conclusions We report CBC reference intervals established on a Sysmex XN analyser, a widely used automated analyser for which reference intervals were previously lacking in the literature. However, these reference intervals we recommend should be validated by individual laboratories for the local population as recommended by CLSI.

[ES] El agua es un recurso natural y vital para el desarrollo de la vida, pero el uso inadecuado de esta junto con los vertidos industriales, urbanos y agrícolas ha provocado la contaminación de la misma. Por este motivo, estos efluentes son tratados en plantas con el fin de eliminar principalmente la materia orgánica, metales disueltos y partículas de gran tamaño, entre otras. Sin embargo, los tratamientos convencionales de dichas plantas no son capaces de eliminar los componentes no biodegradables. La necesidad de implantar sistemas adicionales para degradar estos compuestos, entre los cuales abundan los contaminantes emergentes, es más que evidente, por ende, se trabaja con un método cuyo potencial consiga eliminar estos compuestos; se analiza así la interacción de un producto farmacéutico, el ibuprofeno, con el ozono. Se estudia también el grado de disolución del ibuprofeno con agua, sosa cáustica, metanol y acetona. Posteriormente, se realiza la oxidación avanzada con la mezcla más homogénea posible determinando finalmente si se consigue degradar el ibuprofeno y por tanto, reducir su concentración en el agua., [EN] Water is a natural and vital resource for the development of life, but the inappropriate use of it along with industrial, urban and agricultural discharges has caused its contamination. For this reason, these effluents are treated in plants in order to eliminate mainly organic matter, dissolved metals and large particles, among others. However, conventional treatments of these plants are not able to eliminate non-biodegradable components. The need to implement additional systems to degrade these compounds, among which there are many emerging pollutants, is more than evident; therefore, we work with a method whose potential is able to eliminate these compounds; analyzing the interaction of a pharmaceutical product, ibuprofen, with ozone. The degree of dissolution of ibuprofen with water, caustic soda, methanol and acetone is also studied. After that, advanced oxidation is carried out with the most homogeneous mixture possible, finally determining if it is possible to degrade ibuprofen and, therefore, reduce its concentration in water.

Background Intensive care unit–acquired muscle weakness (ICUAW) has an incidence of 40–46%. Early mobilisation is known to be a protective factor. Objective The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW. Methods A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse–patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3–5 of the ICU stay. Results The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53–62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00–1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00–1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38–0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95–0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97–0.99]), presence of delirium (OR = 0.98; 95% CI [0.97–0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97–0.99]). Conclusions The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Ciencias, Departamento de Física Teórica. Fecha de lectura: 26-06-2019, This thesis, presented in the form of a "compilation of articles", touches different areas of Theoretical Physics. The first part, which comprises the first two articles, focuses on using applied holography to study out-of-equilibrium physics. More specifically, in the first article we study quantum processes called quenches and we show, by holographically constructing gravitational dual backgrounds, the way to implement a quantum quench with a real change in the hamiltonian in a Lorentz-invariant manner. The second article is framed under the theory of anomalous transport. The object of study is the gravitational contribution to the chiral anomaly, which through the chiral magnetic effect induces an energy current proportional to the square of the temperature when the system is in equilibrium. In this framework, we implement holographic quantum quenches to bring the system out of equilibrium, where no temperature can be well defined. Our results indicate a strong suppression of this effect when the system is very far from equilibrium. The second part of the thesis lies in the context of exact, non-linear general relativity. In the third article, we characterize generic, non-expanding black hole horizons and study the effect of supertranslations on them. We present a freely specifiable data set which is both necessary and sufficient to reconstruct the full horizon geometry and is composed of objects that are invariant under supertranslations. Therefore we conclude that these transformations do not transform the geometry of the horizon and should be regarded as pure gauge., Esta tesis, presentada en la forma de "compilación de artículos", toca diferentes areas de la Física Teórica. La primera parte, que consta de los dos primeros artículos, se centra en usar holografía aplicada al estudio de la física fuera del equilibrio. Más concretamente, en el primer artículo estudiamos procesos cuánticos llamados quenches y demostramos, construyendo holográficamente los escenarios gravitacionales de la teoría dual, la manera de implementar un quench cuántico con un cambio real en el hamiltoniano de manera invariante Lorentz. El segundo artículo se encuadra bajo la teoría de transporte anómalo. El objeto de estudio es la contribución gravitacional a la anomalía quiral, que a través del efecto magnético quiral induce una corriente de energía que es proporcional al cuadrado de la temperatura cuando el sistema está en equilibrio. En este escenario implementamos quenches holográficos para llevar al sistema fuera del equilibrio, donde la temperatura no está bien definida. Nuestros resultados indican una fuerte supresión de este efecto cuando el sistema está lejos de encontrarse en equilibrio. La segunda parte de esta tesis se encuentra en el contexto de la relatividad general exacta y no-lineal. En el tercer artículo, caracterizamos horizontes genéricos y que no se expanden de agujeros negros, y estudiamos el efecto que tienen las supertraslaciones en ellos. Presentamos un conjunto de datos que pueden especificarse libremente, que son necesarios y suficientes para reconstruir la geometría completa del horizonte y que son invariante bajo supertraslaciones. Por lo tanto concluimos que estas transformaciones no transforman la geometría del horizonte y deben ser consideradas como puro gauge.

Background: CT scan is a life-saving medical diagnostic tool, entailing higher levels of ionising radiation exposure than conventional radiography, which may result in an increase in cancer risk, particularly in children. Information about the use and potential health effects of CT scan imaging among young people in Spain is scarce. Objective: This paper aims to estimate the number of radiation-related cancer cases which can be expected due to the use of CT scanning in Spanish children and young adults in a single year (2013). Methods: The 2013 distribution of number and types of CT scans performed in young people was obtained for Catalonia and extrapolated to the whole Spain. Organ doses were estimated based on the technical characteristics of 17,406 CT examinations extracted from radiology records. Age and sex-specific data on cancer incidence and life tables were obtained for the Spanish population. Age and sex-specific risk models developed by the Committee on Health Risks of Exposure to Low Levels of Ionizing Radiations (BEIR VII) and Berrington de Gonzalez were used, together, with the dose estimates to derive the lifetime attributable risks of cancer in Spain due to one year of CT scanning and project the number of future cancer cases to be expected. Results: In 2013, 105,802 CT scans were estimated to have been performed in people younger than age 21. It was estimated that a total of 168.6 cancer cases (95% CrI: 30.1–421.1) will arise over life due to the ionising radiation exposure received during these CTs. Lifetime attributable risks per 100,000 exposed patients were highest for breast and lung cancer. The largest proportion of CTs was to the head and neck and hence the highest numbers of projected cancer cases were of thyroid and oral cavity/pharynx. Conclusions: Despite the undeniable medical effectiveness of CT scans, this risk assessment suggests a small excess in cancer cases which underlines the need for justification and optimisation in paediatric scanning. Given the intrinsic uncertainties of these risk projection exercises, care should be taken when interpreting the predicted risks. Keywords: CT scan, Risk, Cancer, Young population, Ionising radiation

Recent publications reported that children in disadvantaged areas undergo more CT scanning than others. The present study is aimed to assess the potential differences in CT imaging by socioeconomic status (SES) in Spanish young scanned subjects and if such differences vary with different indicators or different time point SES measurements. The associations between CT scanning and SES, and between the CT scan rate per patient and SES were investigated in the Spanish EPI-CT subcohort. Various SES indicators were studied to determine whether particular SES dimensions were more closely related to the probability of undergoing one or multiple CTs. Comparisons were made with indices based on 2001 and 2011 censuses. We found evidence of socio-economic variation among young people, mainly related to autonomous communities of residence. A slightly higher rate of scans per patient of multiple body parts in the less affluent categories was observed, possibly reflecting a higher rate of accidents and violence in these groups. The number of CT scans per patient was higher both in the most affluent and the most deprived categories and somewhat lower in the intermediate groups. This relation varied with the SES indicator used, with lower CT scans per patients in categories of high unemployment and temporary work, but not depending on categories of unskilled work or illiteracy. The relationship between these indicators and number of CTs in 2011 was different than that seen with the 2001 census, with the number of CTs increasing with higher unemployment. Overall we observed some differences in the SES distribution of scanned patients by Autonomous Community in Spain. There was, however, no major differences in the frequency of CT scans per patient by SES overall, based on the 2001 census. The use of different indicators and of SES data collected at different time points led to different relations between SES and frequency of CT scans, outlining the difficulty of adequately capturing the social and economic dimensions which may affect health and health service utilisation.

Marc Bosch de Doria, alcalde de Dosrius.

L’homme est depositaire du capital genetique du vivant et represente une espece dans la lignee evolutive. Mais l’espece humaine innove. Au lieu de s’adapter au milieu, elle l’a adapte a ses exigences et c’est la seule espece qui est capable d’influencer son evolution. Durant la premiere periode de sa vie, developpement et maturite sexuelle, l’homme s’inscrit dans le processus evolutif en transmettant son capital genetique et en elevant sa progeniture ; la seconde periode n’a pas de finalite apparente. Cette periode comprend le vieillissement – un processus propre a l’humain – et dans cette perspective pourrait se comprendre comme le fruit d’une adaptation au nouvel environnement que l’homme s’est cree. Au cours du vieillissement, le potentiel cerebral sculpte durant la periode de developpement et de maturite, optimalise la structuration de l’espece humaine dans le temps socio-culturel. Cette structuration est d’abord individuelle, car chaque individu est caracterise par la specificite de l’information qu’il porte, mais elle est aussi collective, car a chaque generation, la connaissance doit etre partagee. Cette structuration est favorisee par la coexistence, au sein d’une meme population, d’individus d’âges tres diversifies, porteurs d’informations a des etats differents de maturation.