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Introduction Climate change is one of the greatest threats to public health today, placing considerable pressure on the healthcare sector. During patient care processes, hospital facilities contribute to greenhouse gas emissions through the use of greater resources and higher energy consumption. Consequently, there is growing interest among researchers, universities, organisations and governments to study the impact of the healthcare sector on the environment and to develop strategies to mitigate its effects. The aim of this scoping review is to determine the extent and nature of current literature on global warming from hospitals and clinical services, and ways in which they contribute to its effect. Planning and execution of future research are possible once those areas with existing gaps are identified.Methods and analysis A broad literature search will be carried out to illustrate the ways in which hospitals and clinical services, processes and activities contribute to climate change. Our protocol was drafted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The final protocol was registered prospectively with the Open Science Framework. All identified studies indexed in Medline, Scopus and Embase will be examined.Ethics and dissemination This project is literature-based research; therefore, it does not require ethical approval. The results will be presented to researchers as well as policymakers in this particular area, via conferences, webinars, podcasts and online events. A peer-reviewed publication will be submitted to specific journals of interest.

This paper evaluates an experimental wetland as part of a pilot soil reclamation project in a mining area. The wetland was constructed using materials of mining origin from the area; most reactive materials of acid pH were stabilised using limestone filler. The study selected macrophytes that are tolerant to potentially toxic elements (PTEs) and resistant to salinity, namely Phragmites australis, Juncus effusus, and Iris pseudacorus. These macrophytes were then placed in pots containing substrates composed of different mixtures of topsoil, peat, and mining waste (black or yellow sand). A thorough analysis of the physicochemical and mineralogical characteristics of the materials included studies of PTE mobilisation. This study emphasises the significance of the rhizosphere in directing the transfer of PTEs to the plant and the correlation between the substrate and the development of plant defence mechanisms, such as the formation of Fe-plates. Scanning electron microscopy was used to highlight these aspects and validate the results of the analytical determinations. These wetlands can be proposed as a phytoremediation strategy for areas affected by mining and maritime influence. They are easy to construct and remain stable, providing important ecosystem services such as the natural attenuation of acid mine drainage, support for vegetation development and fauna, and a clean ecosystem.

Prenylated flavonoids (PFs) are natural flavonoids with a prenylated side chain attached to the flavonoid skeleton. They have great potential for biological activities such as anti-diabetic, anti-cancer, antimicrobial, antioxidant, anti-inflammatory, enzyme inhibition, and anti-Alzheimer’s effects. Medicinal chemists have recently paid increasing attention to PFs, which have become vital for developing new therapeutic agents. PFs have quickly developed through isolation and semi- or full synthesis, proving their high value in medicinal chemistry research. This review comprehensively summarizes the research progress of PFs, including natural PFs from the Moraceae family and their pharmacological activities. This information provides a basis for the selective design and optimization of multifunctional PF derivatives to treat multifactorial diseases.

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors.Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees. Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles.

Introduction: In this study, the suitability of selecting elite athletes from an early age was examined. Objective: The objective of this study was to verify if the behavior identified in previous research also occurs among the world's best athletes of all time who compete in the 100-meter race. Materials and methods: For this, and based on an analysis of the official classifications of all times for men and women of the International Association of Athletics Federations in the referred test , samples were used in absolute category (Top-1,000 up to the 12/31/2018) and sub -20 category (Top - 100 until 12/31/2003); power laws and other strategies typical of complex systems will be applied to analyze the data . Results: The results show how, all too often, the best male and female runners in the world in the under-20 category do not evolve positively during the rest of their sports career. improving their records in the higher categories. Only 51 men out of the top 100 U-20 runners of all time managed to improve their times once they reached the senior category, and the improvements did not always show statistically significant progressions. Consequently, an excessive investment in human and material resources to identify individuals with high athletic abilities is not always the best strategy. Conclusions: level sport at an early age can be a methodological error that should be avoided when building the sports reserves of a country or sports federation.

This article is part of an International Cooperation Project funded by the Andalusian Agency for Development Cooperation of the Junta de Andalucía, Spain in collaboration with the Mayan Technological Institute (ITMES) in San Juan de Chamelco-Cobán at the University of San Carlos de Guatemala: 2018UC006 “Maestras y maestros para niñas y niños mayas en zonas rurales diseminadas: formando los formadores.” (Teachers for Mayan girls and boys in remote rural areas: training the trainers). This cooperation project arose from the need of the university unit attached to the University of San Carlos to develop a university degree program in teacher training in bilingual infant and primary education that would consider the characteristics of the communities these new professionals would impact rural Mayan communities. In this sense, ITMES is particularly interesting for three reasons: (1) the unit is attached to the University of San Carlos, the only public university in Guatemala, as a response to the Guatemalan Constitution that indicates the need for a Mayan University; (2) the unit’s distinctive development for the formation and empowerment of Mayan culture; and (3) because its organizational structure combines receiving face-to-face instruction on weekends in the urban campus of San Juan de Chamelco-Cobán, while during the week, students carry out their personal, professional and educational activities in rural areas. Thus, a double dimension has been addressed through this international cooperation project, which has the complex task of training professionals who will work with children in rural areas but who will be trained in San Juan de Chamelco-Cobán, an urban area, the commercial and economic hub of the region, On the one hand, as will be developed further in this article, the selection and initial psycho-pedagogical-curricular training, attention to cultural, gender, and sociological diversity, of university teachers who, in the future, will be entrusted with the implementation and development of a university curriculum in teacher training aimed at and from the inclusion of children from Mayan rural communities. On the other hand, while considering the center’s organizational structure, establishing the fundamental psycho-pedagogical and organizational principles with an inclusive curricular plan will allow the training of teachers whose actions will be carried out in rural Mayan environments. As a starting hypothesis, we consider that in order to provide quality, responsible and inclusive education to children from rural Mayan environments, and beyond the traditionally technical contents that support the training curriculum legislated by the Guatemalan government, it is necessary to approach this reality by linking vitally constructed knowledge and technical contents, so that they can be formulated and reformulated in a relevant way and thus generate powerful knowledge. Thus, there arises a necessity to equip a team of professionals, prospective university teachers, who are sensitive to Mayan needs and attention to diversity, with a deep and relevant knowledge of psycho-pedagogical and curricular aspects, and with a sociological contextual knowledge of the needs of the post-modern, neoliberal and digital world. To this end, our methodology encompasses three levels: (a) the selection of a group of professionals to be trained; (b) contextual analysis of the training needs of the selected group of professionals, thereby facilitating the adaption of the training program to their individual needs and circumstances; and (c) semi-structured and in-depth interviews with seven female and nine male leaders of Mayan communities. These leaders were selected using a non-probabilistic intentional sampling method, which was collaboratively determined with the ITMES team. During these interactions, we extensively explored their perspectives on Mayan identity, as well as their perceptions of the educational system and its impact on the formation of their identity as a person and as Mayans. Through the integration of these three components, we have obtained invaluable insights into (a) the evolving training needs of the instructional team and (b) the socio-educational pressures experienced by Mayan women, and the significance of “Mayan being” as an aspect of identity. This emergent data has informed the development of a comprehensive psycho-pedagogical, curricular and sociological training plan that underpins the content of this article. Thus, for the selection of the training team, the following aspects were considered: knowledge of Mayan culture and experience in rural Mayan contexts and relationship with the educational-school world. The selection resulted in a total of 29 candidates, 18 women and 11 men, with whom the training was carried out. Regarding the initial training plan for university teachers, and after the contextual analysis, we consider it necessary to correlate three dimensions: (1) the psycho-pedagogical nature of the technical dimension. In this sense, the plan has addressed aspects related to the conceptualization of teaching, and of learning and the development of the fundamental aspects of the curriculum; (2) the idiosyncratic dimension of rural Mayan communities, beyond being a transversal axis, has also been incorporated into the plan. We incorporated analyses related to gender, in general, and gender in schools, making a triangulation with the emerging knowledge from the interviews and the conceptualization of inclusion and Mayan identity as the backbone of a quality education; and (3) the post-modern sociological dimension of today’s societies. Finally, a flexible and emerging training plan of the Mayan idiosyncrasy has been designed that allows its applicability in other similar sociological contexts, adapting the plan to the individual training needs of each context.

Introducción: La fractura de cadera constituye una causa importante de morbilidad, deterioro funcional y mortalidad en los adultos mayores. Un mayor tiempo hasta el manejo quirúrgico afecta la supervivencia y la calidad de vida de los pacientes. Nuestro objetivo fue describir los factores asociados con el retraso quirúrgico y evaluar la calidad de vida y mortalidad a 3 meses, en pacientes llevados a cirugía por fractura proximal de fémur. Métodos: Estudio de cohorte prospectiva. Se evaluaron causas médicas y administrativas del retraso quirúrgico. Se aplicó encuesta sociodemográfica y clínica. La calidad de vida fue evaluada por medio del instrumento validado EQ-5D-5L. Se realizó seguimiento de los pacientes a los 30 y 90 días del posoperatorio. Se utilizó estadística descriptiva, curvas de Kaplan-Meier y la prueba de Wilcoxon para evaluar los desenlaces. Identificador ClinicalTrials.gov: NCT04217642. Resultados: Se incluyeron 130 pacientes, el promedio de edad fue de 78.9 años (DE 14.9). La mayoría con clasificación ASA II (53.1%) y con un índice de Charlson promedio de 4.7 (DE 1.9). En el 76.2% la causa de la fractura fue la caída desde la propia altura. El promedio de tiempo desde el ingreso hasta el manejo quirúrgico definitivo fue de 8.5 días (DE 5.1), elevando el riesgo de muerte en 6.9% (p=0.008). La demora en la autorización de la cirugía, los eventos médicos generados durante el ingreso, la solicitud de valoración por especialidades médicas adicionales y el sexo estuvieron asociados de manera estadísticamente significativa con un tiempo de retraso de 4.65, 3.29, 3.08 y 2.13 días, respectivamente. La calidad de vida (índice EQ-5D-5L) al ingreso fue en promedio de 0.137, con una tendencia hacia el aumento a los 30 días (0.464) y 90 días (0.586). Se reportó mortalidad en 14 pacientes (10.7%) a los 90 días de seguimiento. Conclusiones: Los principales factores relacionados con el retraso quirúrgico fueron administrativos como la autorización de la cirugía. A los 3 meses de seguimiento, la calidad de vida mejoró considerablemente respecto a la valoración prequirúrgica y hubo baja mortalidad en la población estudiada.

Eating disorders are psychiatric and behavioral health pathologies of high complexity and different etiology, which can affect age groups, sexes, and ethnicities indistinctly. This study aimed to evaluate the risk of eating disorders and the possible relation with the sports profile of Colombian adolescent athletes. This was an exploratory cross-sectional quantitative study that used an online form designed with a sociodemographic questionnaire and the EAT-26 scale to determine the eating disorder risk of the object population. A total of 354 adolescent athletes participated. There were 182 men and 172 women and the mean age was 15.59 (range: 10–19 years, SD = 1.938). The participants presented a significantly low risk of eating disorders (21.2%) with no differences in prevalence between both sexes. The risk of eating disorder was related to the result of the last competition (p = 0.01), the type of sport (p = 0.032), the years of sports practice (p = 0.004), and the number of training hours a day (p = 0.011). It is relevant to recognize that adolescents and athletes are vulnerable populations regarding eating disorders. In conclusion, adolescent athletes should be the object of special attention to prevent eating disorders and their consequences on health and sports performance.

In the present paper, we efficiently solve the two-body problem for extreme cases such as those with high eccentricities. The use of numerical methods, with the usual variables, cannot maintain the perihelion passage accurately. In previous articles, we have verified that this problem is treated more adequately through temporal reparametrizations related to the mean anomaly through the partition function. The biparametric family of anomalies, with an appropriate partition function, allows a systematic study of these transformations. In the present work, we consider the elliptical orbit as a meridian section of the ellipsoid of revolution, and the partition function depends on two variables raised to specific parameters. One of the variables is the mean radius of the ellipsoid at the secondary, and the other is the distance to the primary. One parameter regulates the concentration of points in the apoapsis region, and the other produces a symmetrical displacement between the polar and equatorial regions. The three most used geodesy latitude variables are also studied, resulting in one not belonging to the biparametric family. However, it is in the one introduced now, which implies an extension of the biparametric method. The results obtained using the method presented here now allow a causal interpretation of the operation of numerous reparametrizations used in the study of orbital motion.

Entre el nutrido conjunto de bienes artísticos que Arthur Byne y Mildred Stapley adquirieron y exportaron desde España con destino a Estados Unidos, durante los años veinte y treinta del siglo XX, se encontraba el patio de la casa del conde de Ayamans (Palma de Mallorca). Nuevos datos permiten ilustrar esta operación que tenía como principal objetivo satisfacer las demandas de su principal cliente: el magnate de la comunicación W. R. Hearst. El negocio fue desarrollado gracias a José Costa Ferrer, conocido en su faceta de dibujante como «Picarol», quien dotó a Mallorca del primer negocio estable dedicado al comercio internacional de arte y antigüedades; fue quien puso en manos de Byne el valioso conjunto. El estudio de la correspondencia entre José Costa y Arthur Byne ofrece pistas sobre el carácter de esta transacción que terminó con el traslado a EE.UU. del bello patio; pero también sobre la estrecha relación que en esos años se tejió entre el estudio de arte, el mercado de antigüedades y la promoción turística y cultural. Prueba de ello, los homenajes que los Byne recibieron por tal labor.

Abstract Primary ventricular fibrillation (PVF) is a life-threatening complication of ST-segment elevation myocardial infarction (STEMI). It is unclear what roles viral infection and/or systemic inflammation may play as underlying triggers of PVF, as a second hit in the context of acute ischaemia. Here we aimed to evaluate whether the circulating virome and inflammatory proteome were associated with PVF development in patients with STEMI. Blood samples were obtained from non-PVF and PVF STEMI patients at the time of primary PCI, and from non-STEMI healthy controls. The virome profile was analysed using VirCapSeq-VERT (Virome Capture Sequencing Platform for Vertebrate Viruses), a sequencing platform targeting viral taxa of 342,438 representative sequences, spanning all virus sequence records. The inflammatory proteome was explored with the Olink inflammation panel, using the Proximity Extension Assay technology. After analysing all viral taxa known to infect vertebrates, including humans, we found that non-PVF and PVF patients only significantly differed in the frequencies of viruses in the Gamma-herpesvirinae and Anelloviridae families. In particular, most showed a significantly higher relative frequency in non-PVF STEMI controls. Analysis of systemic inflammation revealed no significant differences between the inflammatory profiles of non-PVF and PVF STEMI patients. Inflammatory proteins associated with cell adhesion, chemotaxis, cellular response to cytokine stimulus, and cell activation proteins involved in immune response (IL6, IL8 CXCL-11, CCL-11, MCP3, MCP4, and ENRAGE) were significantly higher in STEMI patients than non-STEMI controls. CDCP1 and IL18-R1 were significantly higher in PVF patients compared to healthy subjects, but not compared to non-PVF patients. The circulating virome and systemic inflammation were not associated with increased risk of PVF development in acute STEMI. Accordingly, novel strategies are needed to elucidate putative triggers of PVF in the setting of acute ischaemia, in order to reduce STEMI-driven sudden death burden.

Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles. Abstract: This guide for living donor renal transplantation (LDRT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current RT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDRT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This guide does not forget that LDRT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able to take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDRT programmes when evaluating potential donors.Finally, this guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

This study aims to better understand students who attend Basic Vocational Training Cycles (Basic Professional Training, BTP) by implementing measures that ensure diversity. This quantitative research project approximated students’ perception of their passage through previous studies and their satisfaction and goals after finishing the school year. The sample consisted of 352 students from Cordoba (Spain). A questionnaire was used that follows the CIPP model. After exploratory factor analysis was completed with different groups of items and their descriptive analyses, various tests were carried out to consider the hypotheses (Pearson’s correlation (r), one-factor analysis of variance, and repeated ANOVA measures). The results indicate that the educational interest of the students is academic and professional. Likewise, there is no relationship detected between socio-professional goals and average academic levels and attributions with respect to repetitions of previous courses, although these goals vary depending on students’ satisfaction with the vocational cycles. We conclude that the course of the FPB influences decisions regarding academic–professional projects.

Sport has never been a more appreciated tool than at present, particularly when dealing with development at various levels of society, be it communities, gender issues, or factors affecting youth. The objective of this systematic review was to determine the level of empirical evidence on the impact of sport based interventions on human development. A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach was utilized to conduct a systematic literature search of selected databases with a search range of 2010 to 2021. Findings indicate an increase in the number of studies on the subject, continent, research design, and journal publication. Content analysis revealed the sample characteristics; objectives and content used in the programs; methodology and intervention strategies; and program limitations. Future research should extend the search to other databases, languages, and subjects related sustainability of community interventions.

Abstract To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.

Resumen: La resistencia a antibióticos supone una amenaza para la salud pública a nivel mundial. Su estrecha relación con el consumo de antibióticos hace necesaria la adopción de medidas para optimizar su uso. Los programas de optimización del uso de antibióticos (PROA) se diseñan para mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectos adversos asociados a su uso y garantizar la administración de tratamientos costo-eficientes. En la práctica clínica pediátrica el uso inadecuado de antibióticos es una realidad. Es por ello que los PROA deben incluir objetivos y estrategias específicos dirigidos a familias y pediatras. La implementación de estos programas requiere la implicación de instituciones, profesionales y población, adaptándolos a las características de cada ámbito asistencial. La atención primaria (AP) pediátrica presenta unas peculiaridades organizativas y asistenciales (hiperdemanda e inmediatez, escasos recursos profesionales especializados, dificultades en el acceso a la formación continuada y a la retroalimentación informativa) que exigen el diseño de medidas y estrategias propias para conseguir los objetivos fijados, que incluyan medidas estructurales, organizativas, de flujo de información y de formación continuada. Es necesario que estos programas alcancen a todos los profesionales, abordando la formación continuada, las herramientas de apoyo a la prescripción y el acceso a pruebas diagnósticas, con la adecuada coordinación interniveles. Se debe evaluar periódicamente el impacto de las distintas acciones en los objetivos planteados. La información generada debe revertir a los profesionales para que puedan adaptar su práctica clínica a la consecución óptima de los objetivos. Abstract: Antibiotic resistance is a major threat to global health. Optimizing the use of antibiotics is a key measure to prevent and control this problem. Antimicrobial Stewardship Programs (ASPs) are designed to improve clinical outcomes, minimize adverse effects and protect patients, and to ensure the administration of cost-effective treatments. Inappropriate use of antibiotics also occurs in pediatric clinical practice. For this reason, ASPs should include specific objectives and strategies aimed at pediatricians and families. Implementing these programs requires the involvement of institutions and policy makers, healthcare providers as well as individuals, adapting them to the characteristics of each healthcare setting. Pediatric primary care (PPC) faces specific issues such as high demand and immediacy, scarce specialized professional resources, difficulties to access regular training and to obtain feedback. This requires the design of specific policies and strategies to achieve the objectives, including structural and organizational measures, improvement of the information flow and accessibility to frequent trainings. These programs should reach all health professionals, promoting regular trainings, prescription support tools and supplying diagnostic tests, with adequate coordination between health care levels. Periodic evaluations and surveillance tools are useful to assess the impact of the actions taken and to provide feedback to health providers in order to adapt and improve their clinical practice to meet ASPs objectives.

ObjectivesTo assess performance of interstitial pneumonia (IP) with autoimmune features (IPAF) criteria in clinical practice and describe the utility of additional workup in identifying patients with underlying connective tissue diseases (CTD).MethodsWe set a retrospective study of our patients with autoimmune IP, who were allocated to CTD-IP, IPAF or undifferentiated autoimmune IP (uAIP) subgroups according to the updated classification criteria. Presence of the process-related variables comprising IPAF defining domains was scrutinized in all patients, and, when available, the results of nailfold videocapillaroscopy (NVC) were recorded.ResultsThirty nine out of 118 patients, accounting for 71% of former undifferentiated cases, fulfilled IPAF criteria. Arthritis and Raynaud’s phenomenon were prevalent in this subgroup. While systemic sclerosis-specific autoantibodies were restricted to CTD-IP patients, anti-tRNA synthetase antibodies were also present in IPAF. In contrast, rheumatoid factor, anti-Ro antibodies and ANA nucleolar patterns could be found in all subgroups. Usual interstitial pneumonia (UIP) / possible UIP were the most frequently observed radiographic patterns Therefore, the presence of thoracic multicompartimental findings as also performance of open lung biopsies were useful in characterizing as IPAF those UIP cases lacking a clinical domain. Interestingly, we could observe NVC abnormalities in 54% of IPAF and 36% of uAIP tested patients, even though many of them did not report Raynaud’s phenomenon.ConclusionBesides application of IPAF criteria, distribution of IPAF defining variables along with NVC exams help identify more homogeneous phenotypic subgroups of autoimmune IP of potential relevance beyond clinical diagnosis.

Antibiotic resistance is a major threat to global health. Optimizing the use of antibiotics is a key measure to prevent and control this problem. Antimicrobial Stewardship Programs (ASPs) are designed to improve clinical outcomes, minimize adverse effects and protect patients, and to ensure the administration of cost-effective treatments. Inappropriate use of antibiotics also occurs in pediatric clinical practice. For this reason, ASPs should include specific objectives and strategies aimed at pediatricians and families. Implementing these programs requires the involvement of institutions and policy makers, healthcare providers as well as individuals, adapting them to the characteristics of each healthcare setting. Pediatric primary care (PPC) faces specific issues such as high demand and immediacy, scarce specialized professional resources, difficulties to access regular training and to obtain feedback. This requires the design of specific policies and strategies to achieve the objectives, including structural and organizational measures, improvement of the information flow and accessibility to frequent trainings. These programs should reach all health professionals, promoting regular trainings, prescription support tools and supplying diagnostic tests, with adequate coordination between health care levels. Periodic evaluations and surveillance tools are useful to assess the impact of the actions taken and to provide feedback to health providers in order to adapt and improve their clinical practice to meet ASPs objectives. Resumen: La resistencia a antimicrobianos supone una amenaza para la salud pública a nivel mundial. Su estrecha relación con el consumo de antibióticos hace necesaria la adopción de medidas para optimizar su uso. Los Programas de Optimización del Uso de Antibióticos (PROA) se diseñan para mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectos adversos asociados a su uso y garantizar la administración de tratamientos costo-eficientes. En la práctica clínica pediátrica el uso inadecuado de antibióticos es una realidad. Es por ello que los PROA deben incluir objetivos y estrategias específicos dirigidos a familias y pediatras. La implementación de estos programas requiere la implicación de instituciones, profesionales y población, adaptándolos a las características de cada ámbito asistencial. La atención primaria (AP) pediátrica presenta unas peculiaridades organizativas y asistenciales (hiperdemanda e inmediatez, escasos recursos profesionales especializados, dificultades en el acceso a la formación continuada y a la retroalimentación informativa) que exigen el diseño de medidas y estrategias propias para conseguir los objetivos fijados, que incluyan medidas estructurales, organizativas, de flujo de información y de formación continuada. Es necesario que estos programas alcancen a todos los profesionales, abordando la formación continuada, las herramientas de apoyo a la prescripción y el acceso a pruebas diagnósticas, con la adecuada coordinación interniveles. Se debe evaluar periódicamente el impacto de las distintas acciones en los objetivos planteados. La información generada debe revertir a los profesionales para que puedan adaptar su práctica clínica a la consecución óptima de los objetivos.

El objetivo de la investigación fue diseñar una escala permita examinar los valores en el deporte del alumnado de ESO y Bachillerato españoles sobre los valores generados en el ámbito deportivo. La muestra del estudio estuvo formada por 1316 alumnos pertenecientes a quince centros educativos de Enseñanza Secundaria Obligatoria (ESO) y Bachillerato españoles. Se realizó un Análisis Factorial exploratorio (AFE) para comprobar la validez interna del cuestionario y un análisis factorial confirmatorio. Finalmente, el “cuestionario de valores deportivos y olímpicos” es un instrumento con el que se pueden conocer la percepción de los valores asociados al deporte por la población de entre 12 y 18 años. Palabras clave: Educación, Olimpismo, deporte, adolescentes, lengua española Abstract. The aim of the present research was to design a scale that would allow us to examine the sporting values of Spanish middle and high school students associated to the values generated in the sports sphere. The sample was composed of 1316 students from fifteen high school education centers in Spain. An exploratory factor analysis (EFA) was performed to verify the internal validity of the questionnaire, as well as a confirmatory factory analysis (CFA). Finally, the "questionnaire of sports and Olympic values" is an instrument with which the perception of the values ​​associated with sport by the population between 12 and 18 years of age can be known. Keywords: Education; Olympism; Sport, teenagers, Spanish language.

IntroductionThere is currently no validated score capable of classifying cancer-associated pulmonary embolism (PE) in its full spectrum of severity. This study has validated the EPIPHANY Index, a new tool to predict serious complications in cancer patients with suspected or unsuspected PE.MethodThe PERSEO Study prospectively recruited individuals with PE and active cancer or receiving antineoplastic therapy from 22 Spanish hospitals. The estimation of the relative frequency θ of complications based on the EPIPHANY Index categories was made using the Bayesian alternative for the binomial test.ResultsA total of 900 patients, who were diagnosed with PE between October 2017 and January 2020, were enrolled. The rate of serious complications at 15 days was 11.8%, 95% highest density interval [HDI], 9.8-14.1%. Of the EPIPHANY low-risk patients, 2.4% (95% HDI, 0.8-4.6%) had serious complications, as did 5.5% (95% HDI, 2.9-8.7%) of the moderate-risk participants and 21.0% (95% HDI, 17.0-24.0%) of those with high-risk episodes. The EPIPHANY Index was associated with overall survival (OS) in patients with different risk levels: median OS was 16.5, 14.4, and 4.4 months for those at low, intermediate, and high risk, respectively. Both the EPIPHANY Index and the Hestia criteria exhibited greater negative predictive value and a lower negative likelihood ratio than the remaining models. The incidence of bleeding at 6 months was 6.2% (95% HDI, 2.9-9.5%) in low/moderate-risk vs 12.7% (95% HDI, 10.1-15.4%) in high-risk (p-value = 0.037) episodes. Of the outpatients, serious complications at 15 days were recorded in 2.1% (95% HDI, 0.7-4.0%) of the cases with EPIPHANY low/intermediate-risk vs 5.3% (95% HDI, 1.7-11.8%) in high-risk cases.ConclusionWe have validated the EPIPHANY Index in patients with incidental or symptomatic cancer-related PE. This model can contribute to standardize decision-making in a scenario lacking quality evidence.

The biocompatible polymer polyetheretherketone (PEEK) is a suitable candidate to be part of potential all-polymer total joint replacements, provided its use is associated with better osseointegration, mechanical performance, and wear resistance. Seeking to meet the aforementioned requirements, respectively, we have manufactured a PEEK composite with different fillers: carbon fibers (CF), hydroxyapatite particles (HA) and graphene platelets (GNP). The mechanical outcomes of the composites with combinations of 0, 1.5, 3.0 wt% GNP, 5 and 15 wt% HA and 30% of wt% CF concentrations pointed out that one of the best filler combinations to achieve the previous objectives was 30 wt% CF, 8 wt% HA and 2 wt% of GNP. The study compares the bioactivity of human osteoblasts on this composite prepared by injection molding with that on the material manufactured by the Fused Filament Fabrication 3D additive technique. The results indicate that the surface adhesion and proliferation of human osteoblasts over time are better with the composite obtained by injection molding than that obtained by 3D printing. This result is more closely correlated with morphological parameters of the composite surface than its wettability behavior.

Here we present a study of the characterization and optimization of the production of trans-Resveratrol (t-R) in grape (Vitis vinifera cv. Gamay) cell cultures elicited with methyl jasmonate (MeJA) and dimethyl-β-cyclodextrin (DIMEB). The aim of this study was to determine the influence of a number of factors of the grapevine cell culture on t-R production level in 250 mL shaken flasks that would enable the better control of this bioproduction system when it is upscaled to a 2 L stirred bioreactor. The factors included the optimal growth phase for elicitation, the concentration of elicitors and of biomass, the order of addition of elicitors, and the illumination regime and ageing of cells. We found out that the optimal biomass density for the production of t-R was 19% (w/v) with an optimal ratio of 0.5 g DIMEB/g biomass. The most productive concentrations of the elicitors tested were 50 mM DIMEB and 100 µM MeJA, reaching maximum values of 4.18 mg·mL−1 and 16.3 mg·g biomass−1 of t-R concentration and specific production, respectively. We found that the order of elicitor addition matters since, as compared with the simultaneous addition of both elicitors, the addition of MeJA 48 h before DIMEB results in ca. 40% less t-R production, whilst there is no significant difference when MeJA is added 48 h after DIMEB. Upon upscaling, the better conditions tested for t-R production were aeration at 1.7 vol/vol/min without agitation, 24 °C, and 30 g·L−1 sucrose, achieving production rates similar to those obtained in shaken flasks.

Guatemala is a country with a long history of conflict, poverty and violence that still affects young people. However, their exist non-governmental organizations such as Guatemalan Olympic Foundation (FUNOG) whose purpose is imparting sport and Olympic values as educational principles of the institution. The aim of this study is to describe the sport, health, and psychological characteristics of the youth who participate in this organization. The research’s objectives were accomplished through a quantitative methodology and the involvement of 91 participants. Results emphasised the participants’ elevated levels of physical activity exceeded those of other youth of same ages. No link was found between the level of physical activity and other personal or health variables. Age was negatively correlated with factors pertaining to meaning in life but not with dialectics. A correlation was found between self-esteem and goals, tasks, and empathy, but health literacy was negatively correlated with interpersonal relationships. These data incentivise us to design and evaluate sport programmes not only as an educational strategy to promote health literacy and social-emotional skills, but also to improve the perception of the purpose of life.

The Atacama Desert, one of the driest places on earth, holds a rich biodiversity that becomes most appreciable in years when unusual rainfall accumulation triggers a phenomenon of explosive development of ephemeral herbaceous and woody desert species known as “desierto florido” or “blooming desert.” Despite the scientific importance of this unique phenomenon only few studies have addressed the mechanisms of flower phenotypic divergence under the fluctuating environment provided by this recurrent event. We investigated the mechanisms of floral color diversity in Cistanthe longiscapa (Montiaceae), a dominant species across the ephemeral blooming landscape of Atacama Desert. Our analyses show that the variation in colors of C. longiscapa flowers result from petals containing betalain pigments with different absorption spectra. The different pigment composition of petals causes flower color differences in the visible and ultraviolet (UV) range of the spectrum. Through color vision models we show that C. longiscapa flowers are highly polymorphic in their color appearance for insect pollinators. Our results highlight the variable nature in flower color of C. longiscapa varieties blooming simultaneously in a geographical restricted area. Given the importance of color in attracting floral visitors, the observed color variability could contribute to increased cross pollination in extreme desert conditions, while accounting for complex and fluctuating histories of plant-pollinator interactions.

Abstract The Mediterranean‐type climate region of Chile is a globally unique biodiversity hotspot but its protected area system does not adequately represent the biological diversity, nor does it provide equitable access to people. We explored options to expand the protected area system to cost‐effectively improve the conservation of forest ecosystem types while simultaneously enhancing social accessibility to protected areas. Social accessibility is defined as the access of municipalities to cultural ecosystem services provided by protected areas which depends on distance to highly demanded protected areas and income of the municipalities. Using systematic conservation planning methods, we identified priority areas for extending the existing protected area system that: (a) minimise land acquisition cost, (b) maximise social accessibility and (c) optimise for both cost and accessibility. The results show that it is possible to improve social accessibility while simultaneously minimising land cost. Considering cost alone, the protected area system could be expanded to improve biodiversity conservation by 86% at the cost of $47 million USD, which would also increase the accessibility of protected areas by 12%. Accessibility can be increased by a further 18% by jointly considering cost and accessibility without compromising the cost or biodiversity performance. New private conservation policy developed in Chile could help offset the costs of conservation through novel public–private partnerships. Our results can provide specific guidance to policymakers to strategically identify new locations for protected areas which cost‐effectively improve biodiversity conservation, while at the same time reducing inequality in social accessibility. The consideration of social access in reserve design could increase the success of protected areas as a conservation tool by bringing people closer to nature. A free Plain Language Summary can be found within the Supporting Information of this article.

El teléfono celular se ha convertido en un aparto de uso cotidiano y tan extendido que incluso se lo utiliza en las salas de operaciones para distintos tipos de finalidades. El objetivo de este trabajo es describir las características del uso de los teléfonos celulares en la sala de operaciones. El tipo de trabajo fue observaciones, descriptivo, transversal con cuestionario cerrado, donde participaron personal de salud con acceso a la sala de operaciones. Se realizaron 190 encuestas, el 97,4% introduce el teléfono celular en quirófano y de estos el 71% lo utiliza dentro de quirófano. El uso cada vez mayor de estos aparatos se deberían regir por reglas de higiene y la implicancia ética de su uso en relación al paciente.

Abstract Damage to the small intestine caused by non-steroidal anti-inflammatory drugs (NSAIDs) occurs more frequently than in the upper gastrointestinal tract, is more difficult to diagnose and no effective treatments exist. Hence, we investigated whether probiotics can control the onset of this severe condition in a murine model of intestinal inflammation induced by the NSAID, indomethacin. Probiotic supplementation to mice reduce the body weight loss, anemia, shortening of the small intestine, cell infiltration into the intestinal tissue and the loss of Paneth and Goblet cells associated with intestinal inflammation. Furthermore, a high antimicrobial activity in the intestinal fluids of mice fed with probiotics compared to animals on a conventional diet was elicited against several pathogens. Interestingly, probiotics dampened the oxidative stress and several local and systemic markers of an inflammatory process, as well as increased the secretion of IL-10 by regulatory T cells. Even more importantly, probiotics induced important changes in the large intestine microbiota characterized by an increase in anaerobes and lactobacilli, and a significant decrease in total enterobacteria. We conclude that oral probiotic supplementation in NSAID-induced inflammation increases intestinal antimicrobial activity and reinforces the intestinal epithelial barrier in order to avoid pathogens and commensal invasion and maintain intestinal homeostasis.

El artículo presenta los resultados de un estudio cuyo propósito se focalizó en el diseño y validación de una escala para la valoración de la formación en investigación educativa, basada en el modelo matemático en torno a las respuestas del ítem (IRT) y adaptada a la escala acumulativa de Guttman. Atendiendo a los niveles de investigación científica, el estudio fue desarrollado en cuatro fases: 1) exploratoria (validez de contenido) por medio de muestreo teórico, entrevistas semiestructuradas y grupos focales; 2) descriptiva (validez de constructo) a través del método Delphi; 3) analítica (consistencia) y 4) explicativa (análisis R&R) por medio la aplicación de la escala en mención. Intervinieron en el estudio 19 participantes del profesorado investigador, 5 egresadas del programa de licenciatura y 26 integrantes del alumnado en formación investigativa. La argumentación teórico-contextual, la clasificación de reactivos a través de conglomerados, las medidas de concordancia, los índices de consistencia interna y el análisis de estabilidad (R&R) permitieron fundamentar la validación de la escala. La ejecución de la escala a través de constructos, reactivos e indicadores binarios diferenciales proporciona una valiosa aproximación a la valoración de los procesos de formación investigativa al tener en cuenta las dimensiones del saber, el hacer y el ser. Con los hallazgos del estudio se busca contribuir en el fortalecimiento de la investigación educativa por medio de la reflexión en torno a su evaluación.

El fin de este trabajo es dejar precedentes del inicio y evolución de la cirugía percutánea en nuestro país ya que se ha convertido en un arma más que ofrecer al paciente, probablemente una de las intervenciones más beneficiosas en términos de complicaciones y altas tasas de buenos resultados. El inicio en el país data desde 1981 siendo prácticamente paralela al inicio a nivel mundial de estas técnicas. Actualmente esta técnica se encuentra ampliamente aceptada y se practica en centros públicos, del interior y la capital, así como en centros privados.

Resumen: El presente trabajo de investigación-acción es un análisis mixto de corte descriptivo de los errores de micro-redacción, macro-redacción, metodológicos y de escritura en una presentación pública cometidos por 46 estudiantes noveles de psicología al realizar una recopilación de artículos científicos para una materia académica; escogiéndose el proyecto de mayor calidad del semestre y comparándolo con los demás trabajos académicos de la asignatura. El objetivo de esta experiencia pedagógica se fundamenta en que los estudiantes deben aprender destrezas tan importantes en la investigación como la capacidad de conseguir información científica fiable y válida en diferentes bases de datos, el sintetizar todos esos datos en un documento genuino que se rige por reglas específicas de escritura y el realizar una presentación de los resultados en un aula con público en un tiempo estipulado. Las principales conclusiones de este estudio resaltan que los alumnos universitarios tienen carencias importantes a la hora de realizar un resumen integrado y estructurado basado en una normativa concreta. Abstract: The present research-action work is a descriptive mixed analysis of the micro-writing, macro-writing, methodological and writing in a public presentation errors committed by 46 novel psychology students when they making a compilation of scientific articles for an academic subject; choosing the highest quality project of the semester and comparing it with other academic works of the course. The objective of this pedagogical experience is based on the fact that students must learn researching skills such as important in research as the ability to obtain reliable and valid scientific information in from different databases, synthesizing all these data in a genuine document that is administrated by specific rules of writing and finally, they must make a public presentation of the results in a classroom within a stipulated time. Principal conclusions of this study indicate that university students have significant lacks when it comes to making an integrated and structured summary based on a specific regulation.

Fungal allergy is the third most frequent cause of respiratory pathologies and the most related to a poor prognosis of asthma. The genera Alternaria and Cladosporium are the most frequently associated with allergic respiratory diseases, with Alternaria being the one with the highest prevalence of sensitization. Alternaria alternata is an outdoor fungus whose spores disseminate in warm and dry air, reaching peak levels in temperate summers. Alternaria can also be found in damp and insufficiently ventilated houses, causing what is known as sick building syndrome. Thus, exposure to fungal allergens can occur outdoors and indoors. However, not only spores but also fungal fragments contain detectable amounts of allergens and may function as aeroallergenic sources. Allergenic extracts of Alternaria hyphae and spores are still in use for the diagnosis and treatment of allergic diseases but are variable and insufficiently standardised, as they are often a random mixture of allergenic ingredients and casual impurities. Thus, diagnosis of fungal allergy has been difficult, and knowledge about new fungal allergens is stuck. The number of allergens described in Fungi remains almost constant while new allergens are being found in the Plantae and Animalia kingdoms. Given Alt a 1 is not the unique Alternaria allergen eliciting allergy symptoms, component-resolved diagnosis strategies should be applied to diagnose fungal allergy. To date, twelve A. alternata allergens are accepted in the WHO/IUIS Allergen Nomenclature Subcommittee, many of them are enzymes: Alt a 4 (disulfide isomerase), Alt a 6 (enolase), Alt a 8 (mannitol de-hydrogenase), Alt a 10 (aldehyde dehydrogenase), Alt a 13 (glutathione-S-transferase) and Alt a MnSOD (Mn superoxide dismutase), and others have structural and regulatory functions such as Alt a 5 and Alt a 12, Alt a 3, Alt a 7. The function of Alt a 1 and Alt a 9 remains unknown. Other four allergens are included in other medical databases (e.g., Allergome): Alt a NTF2, Alt a TCTP, and Alt a 70 kDa. Despite Alt a 1 being the A. alternata major allergen, other allergens, such as enolase, Alt a 6 or MnSOD, Alt a 14 have been suggested to be included in the diagnosis panel of fungal allergy.

The advent of omic platforms revealed the significant benefits of probiotics in the prevention of many infectious diseases. This led to a growing interest in novel strains of probiotics endowed with health characteristics related to microbiome and immune modulation. Therefore, autochthonous bacteria in plant ecosystems might offer a good source for novel next-generation probiotics. The main objective of this study was to analyze the effect of Rouxiella badensis acadiensis Canan (R. acadiensis) a bacterium isolated from the blueberry biota, on the mammalian intestinal ecosystem and its potential as a probiotic microorganism. R. acadiensis, reinforced the intestinal epithelial barrier avoiding bacterial translocation from the gut to deep tissues, even after feeding BALB/c mice for a prolonged period of time. Moreover, diet supplementation with R. acadiensis led to increases in the number of Paneth cells, well as an increase in the antimicrobial peptide α defensin. The anti-bacterial effect of R. acadiensis against Staphylococcus aureus and Salmonella enterica serovar Typhimurium was also reported. Importantly, R. acadiensis-fed animals showed better survival in an in vivo Salmonella enterica serovar Typhimurium challenge compared with those that received a conventional diet. These results demonstrated that R. acadiensis possesses characteristics of a probiotic strain by contributing to the reinforcement and maintenance of intestinal homeostasis.

The Pseudomonas chlororaphis phylogenetic subgroup of species, within the Pseudomonas fluorescens group, currently includes seven bacterial species, all of which have environmental relevance. Phylogenomic analyses help clarify the taxonomy of strains in the group and allow for precise identification. Thirteen antibiotic-resistant strains isolated in a previous study from nine different sampling sites in the Danube River were suspected to represent a novel species and are investigated taxonomically in the present study, together with four other strains isolated from the Woluwe River (Belgium) that were phylogenetically closely related in their rpoD gene sequences. The strains were characterized phenotypically, chemotaxonomically (fatty acid composition and main protein profiles), and phylogenetically. They could not be assigned to any known Pseudomonas species. Three genomes of representative strains were sequenced and analyzed in the context of the genome sequences of closely related strains available in public databases. The phylogenomic analysis demonstrates the need to differentiate new genomic species within the P. chlororaphis subgroup and that Pseudomonas piscis and Pseudomonas aestus are synonyms. This taxonomic study demonstrates that 14 of the characterized isolates are members of the Pseudomonas_E protegens_A species in the GTDB taxonomy and that they represent a novel species in the genus Pseudomonas, for which we propose the name Pseudomonas danubii sp. nov. with strain JDS02PS016T (=CECT 30214T = CCUG 74756T) as the type strain. The other three strains (JDS08PS003, rDWA16, and rDWA64) are members of the species Pseudomonas_E protegens_B in the GTDB taxonomy and need further investigation for proposal as a new bacterial species.

The purpose of this study was to determine the effect of simulated ankle range of motion modification on the dynamic valgus index (DVI) of female soccer players during a monopodal squat. A second objective compared the frontal plane projection angles (FPPA) of hip and knee to identify the greatest contribution to the DVI. The dominant leg (DL) and non-dominant leg (NDL) were evaluated in 16 female soccer players during a monopodal squat, under Basal conditions: “without wedge” (WW); Restrictive: “with dorsiflexor wedge” (DW) and Facilitator: “with plantiflexor wedge” (PW) of ankle. With the Kinovea software, the DVI was identified by adding the hip and knee FPPA. The three conditions in the dominant leg and non-dominant leg, the FPPA in each condition were compared and effect sizes were determined. No condition showed differences in DVI in DL vs. NDL. In DL, DVI increased with large effect in DW and decreased with large effect in PW compared to WW and DW. In NDL, DVI increased with large effect in DW compared to WW and PW. In both legs, hip FPPA was higher than knee FPPA in all conditions. It is concluded that the simulated restriction of ankle dorsiflexion is effective for an increase in DVI, while the facilitator allows its decrease with greater effect on NDL. The hip is the joint with the greatest contribution to the DVI, independent of condition. Resumen. El propósito de este estudio fue determinar el efecto de la modificación simulada del rango de movimiento del tobillo sobre el índice de valgo dinámico (IVD) de jugadoras de fútbol, durante una sentadilla monopodal. Un segundo objetivo comparó los ángulos de proyección en el plano frontal (APPF) de cadera y rodilla para identificar el mayor aporte al IVD. Se evaluó en 16 mujeres futbolistas, durante una sentadilla monopodal, la pierna dominante (PD) y no dominante (PND), en las condiciones Basal: “sin cuña” (SC); Restrictiva: “con cuña dorsiflexora” (CD) y Facilitadora: “con cuña plantiflexora” (CP) de tobillo. Con el software Kinovea se identificó el IVD sumando los APPF de cadera y rodilla. Se compararon las tres condiciones en la pierna dominante y no dominante, los APPF en cada condición y se determinaron los tamaños de efecto. Ninguna condición presentó diferencias en IVD en PD vs PND. En PD, el IVD aumentó con gran efecto en CD y disminuyo con gran efecto en CP comparado con SC y CD. En PND, el IVD aumentó con gran efecto en CD comparado con SC y CP. En ambas piernas, el APPF de cadera fue mayor que el de rodilla en todas las condiciones. Se concluye que la restricción simulada de la dorsiflexión de tobillo es efectiva para un aumento del IVD, mientras que la facilitadora permite su disminución con mayor efecto en PND. La cadera es la articulación con mayor aporte al IVD, independiente de la condición.

Abstract Mechanisms that reliably and efficiently guide practitioners to find relevant evidence are urgent for conservation decision‐making in Chilean Patagonia. The objective of this study was to systematically collect, characterize, and synthesize the extensive evidence about conservation knowledge in Chilean Patagonia focusing on the impacts of global change drivers on ecosystems and human–nature relationships, identifying knowledge gaps, and providing policy recommendations. The quality of the evidence was assessed through a predefined level‐of‐evidence hierarchy scale, applied to a sample of the studies reviewed. We compiled ~1000 studies documenting that evidence focusing on terrestrial and marine ecosystems has grown exponentially. For terrestrial ecosystems, most studies have addressed climate change, habitat change, and invasive species; while for marine ecosystems, studies have focused on pollution, invasive species, and habitat change. We identified that an important gap is the study of the social dimensions of conservation, and future efforts should focus on incorporating traditional and local knowledge as this can help point the way to ecosystem conservation. The appraisal of the quality of the evidence showed that ~80% of the sample represented reliable evidence with underlying data and an experimental design. Enhanced efforts to deliver this evidence to decision‐makers in a user‐friendly format for evidence uptake in conservation policy are urgent. In this review, we provide a tool that can help practitioners to find evidence reliably to improve decision‐making for the conservation of ecosystems in Chilean Patagonia.

Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is

Abstract Latin America and the Caribbean (LAC) is one of the world's most biodiverse regions, but this diversity is threatened by the overexploitation of natural resources and internal social conflicts. In 2018, 33 LAC countries were invited to sign and ratify the landmark Escazú Agreement, which is the first legally binding environmental agreement to explicitly integrate human rights with environmental matters. The agreement outlines an approach to enhance the protection of environmental defenders, increase public participation in environmental decision‐making, and foster cooperation among countries for biodiversity conservation. However, clear mechanisms to implement the ideals of the Agreement are currently lacking. We identify the key provisions of the Agreement and link these to tangible mechanisms which aim to integrate human rights and nature conservation. These mechanisms include technological (e.g., free online data), human‐based (e.g., legal advice from multidisciplinary teams), and nature‐based solutions (e.g., transboundary species management). As environmental assets––and threats to them––span national boundaries, the collaborative and participatory provisions of the agreement could catalyze coordinated transboundary environmental management. Because of the importance of this Agreement for the LAC region, we added a Spanish version of this manuscript in the Supplementary Material (versión del artículo en español en el material suplementario).

BackgroundThe role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 remains to be determined. The study was aimed to evaluate whether vitamin D3 supplementation could prevent respiratory worsening among hospitalized patients with COVID-19.Methods and findingsWe designed a multicentre, randomized, double-blind, sequential, placebo-controlled clinical trial. The study was conducted in 17 second and third level hospitals, located in four provinces of Argentina, from 14 August 2020 to 22 June 2021. We enrolled 218 adult patients, hospitalized in general wards with SARS-CoV-2 confirmed infection, mild-to-moderate COVID-19 and risk factors for disease progression. Participants were randomized to a single oral dose of 500 000 IU of vitamin D3 or matching placebo. Randomization ratio was 1:1, with permuted blocks and stratified for study site, diabetes and age (≤60 vs >60 years). The primary outcome was the change in the respiratory Sepsis related Organ Failure Assessment score between baseline and the highest value recorded up to day 7. Secondary outcomes included the length of hospital stay; intensive care unit admission; and in-hospital mortality. Overall, 115 participants were assigned to vitamin D3 and 105 to placebo (mean [SD] age, 59.1 [10.7] years; 103 [47.2%] women). There were no significant differences in the primary outcome between groups (median [IQR] 0.0 [0.0-1.0] vs 0.0 [0.0-1.0], for vitamin D3 and placebo, respectively; p = 0.925). Median [IQR] length of hospital stay was not significantly different between vitamin D3 group (6.0 [4.0-9.0] days) and placebo group (6.0 [4.0-10.0] days; p = 0.632). There were no significant differences for intensive care unit admissions (7.8% vs 10.7%; RR 0.73; 95% CI 0.32 to 1.70; p = 0.622), or in-hospital mortality (4.3% vs 1.9%; RR 2.24; 95% CI 0.44 to 11.29; p = 0.451). There were no significant differences in serious adverse events (vitamin D3 = 14.8%, placebo = 11.7%).ConclusionsAmong hospitalized patients with mild-to-moderate COVID-19 and risk factors, a single high oral dose of vitamin D3 as compared with placebo, did not prevent the respiratory worsening.Trial registrationClincicalTrials.gov Identifier: NCT04411446.

Este artículo reflexiona sobre el cuerpo trans* como territorio de poder que hace resistencia al poder hegemónico, cuyo orden busca “normalizar” los cuerpos de acuerdo con lo estipulado socialmente bajo el “deber ser” del género. Para ello se realiza un abordaje teórico sobre el cuerpo, desde posturas como las de Foucault y Butler que lo conciben como entidad que en sí misma es poder. Con base en los referentes teóricos presentados, se expresan los argumentos que permiten entender los cuerpos trans* como territorios de subversión frente al orden establecido sobre estos. Se concluye que las personas trans, si bien se resisten a la heterosexualidad obligatoria, posiblemente no sea de forma estructural y radical, sino desde dentro del orden social, generando ciertas fisuras en sus prácticas y performances que presentan ante el sistema, develando una presencia que excede sus linealidades.

This work describes the development and characterization of fluorescent nanocomposite hydrogels, with high swelling and absorption capacity, and prepared using a green protocol. These fluorescent materials are obtained by incorporating, for the first time, polyfluorenes-based nanoparticles with different emission bands—poly[9,9-dioctylfluorenyl-2,7-diyl] (PFO) and poly[(9,9-di-n-octylfluorenyl-2,7-diyl)-alt-(1,4-benzo-{2,1,3}-thiadiazole)] (F8BT)—into a three-dimensional polymeric network based on polyacrylamide. To this end, two strategies were explored: incorporation of the nanoparticles during the polymerization process (in situ) and embedment after the hydrogel formation (ex situ). The results show that the combination of PFO nanoparticles introduced by the ex situ method provided materials with good storage stability, homogeneity and reproducibility properties, allowing their preservation in the form of xerogel. The fluorescent nanocomposite hydrogels have been tested as a transportable and user-friendly sensing platform. In particular, the ability of these materials to specifically detect the enzyme alkaline phosphatase (ALP) has been evaluated as a proof-of-concept. The sensor was able to quantify the presence of the enzyme in an aqueous sample with a response time of 10 min and LOD of 21 nM. Given these results, we consider that this device shows great potential for quantifying physiological ALP levels as well as enzyme activity in environmental samples.

Guatemala is a multiethnic and multicultural country that has suffered from poverty and violence. Sports can serve as tool to foster development across the country; however, there is limited research on the use of sports as a tool for promoting broader social benefits in Guatemala. The purpose of this study was to compare sports and the health and physiological characteristics of at-risk youths in Guatemala. The research objectives were achieved through a quantitative approach and the participation of 90 youths involved in an educational organization through sports and 91 youths who have not been influenced by any organization. The results showed that urban at-risk youths involved in a sports for education organization develop more self-esteem; they have higher levels of physical activity than their peers who are not involved in an educational organization; the socioemotional competencies of self-regulation and motivation are higher in urban areas; empathy is higher in men than in women; the level of the self-perception of health is lower and health literacy higher. However, the at-risk youths who are not involved in an educational organization showed that their self-regulation was higher, and the level of health literacy was higher for all factors. This was through a set of attitudes and skills as a result of their historical development and sociocultural strategies transmitted from generation to generation to foster health and physical activity.