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Introduction: Adherence to nutritional medical treatments is essential for attaining clinical benefits. Yet, the evidence regarding the impact of various factors on adherence to these treatments is limited, highlighting the need for strategies that facilitate early identification of prognostic adherence factors. Objectives: This study aims to identify factors that may influence adherence to nutritional medical treatment. Methods: A cross-sectional prospective study was conducted using a validated 25-item questionnaire targeted at specialists in Endocrinology, Nutrition, Rehabilitation, and Dysphagia. Results: A total of 296 health professionals participated, providing pertinent data for 614 patients with dysphagia and malnutrition during routine clinical practice in public hospitals. Several factors potentially impairing adherence were identified, such as a patient's lack of appetite, satiety, disinterest and fatigue. Texture was recognized as a facilitating factor in 96% of cases. A statistically significant correlation was found between the value patients place on the intake of oral nutrition supplements in their recovery process and their compliance with the prescribed doses. Conclusions: The results emphasize the importance of communicating with patients and caregivers about the necessity of complying with the prescribed nutritional regimen and its potential benefits. The analysis of habits also underlined the need to offer flexible, patient-tailored nutritional solutions to enhance treatment adherence.

Abstract Special histologic subtypes of breast cancer (BC) exhibit unique phenotypes and molecular profiles with diagnostic and therapeutic implications, often differing in behavior and clinical trajectory from common BC forms. Novel methodologies, such as artificial intelligence may improve classification. Genetic predisposition plays roles in a subset of cases. Uncommon BC presentations like male, inflammatory and pregnancy-related BC pose challenges. Emerging therapeutic strategies targeting genetic alterations or immune microenvironment are being explored.

Abstract Background Aedes aegypti is the primary vector of dengue, chikungunya, and Zika viruses in Colombia. Various insecticides, including pyrethroid, organophosphate, and carbamate insecticides; growth regulators; and biological insecticides, such as Bacillus thuringiensis var. israelensis, have been used to control Ae. aegypti populations. However, organophosphates such as malathion, pirimiphos-methyl, and temephos have been used over the last decade owing to the high resistance to pyrethroids. Methods This study assessed the susceptibility to organophosphates in 14 Ae. aegypti populations from the Córdoba department in northern Colombia. Moreover, possible resistance mechanisms were investigated by determining the activity levels of α-esterases, β-esterases, mixed function oxidases (MFOs), glutathione S-transferases (GSTs), and insensitive acetylcholinesterase (iAChE). Additionally, the Ace-1 gene was sequenced to identify mutations at the target site of action. Results The populations were susceptible to temephos and malathion but resistant to fenitrothion, and in three of them, to pirimiphos-methyl. Alterations in the enzyme activity levels of α-esterases and β-esterases, GST, and iAChE were observed among the populations, with high enzyme activity levels of α and β esterases associated with resistance to fenitrothion. No mutations were identified in the Ace-1 gene. Conclusions These findings are highly relevant for vector control programs in the region, as they allow for adjustments in resistance management strategies and improve the effectiveness of interventions against these arboviruses. Graphical Abstract

Chile ha logrado entregar agua potable de manera amplia y segura en contextos rurales a través de un esquema de coproducción. Esta forma de operación ha funcionado por más de 60 años y entrega agua a más del 10 % de la población. Sin embargo, la literatura reporta heterogeneidad en los resultados de cada territorio. En tal contexto, se está implementando una nueva legislación que institucionaliza dicha forma de provisión generando nuevas demandas en el Estado. Ante esto, el artículo analiza si la ley avanza en tres aspectos de la gestión integrada del agua potable rural. A partir de un análisis de contenido de la nueva ley y su reglamentación se concluye que existen avances en participación, articulación intersectorial y descentralización, pero se proyectan posibles conflictos al interior de la administración del Estado y en la vinculación de éste con las organizaciones. Se concluye que es importante para la política pública de agua potable rural mayor coordinación con otros sectores y también mayor atención a las tendencias actuales en administración pública respecto de la gestión estatal que abogan por una mayor articulación, descentralización y participación.

Abstract Current assays fail to address breast cancer’s complex biology and accurately predict treatment response. On a retrospective cohort of 1082 female breast tissues, we develop and validate mFISHseq, which integrates multiplexed RNA fluorescent in situ hybridization with RNA-sequencing, guided by laser capture microdissection. This technique ensures tumor purity, unbiased whole transcriptome profiling, and explicitly quantifies intratumoral heterogeneity. Here we show mFISHseq has 93% accuracy compared to immunohistochemistry. Our consensus subtyping and risk groups mitigate single sample discordance, provide early and late prognostic information, and identify high risk patients with enriched immune signatures, which predict response to neoadjuvant immunotherapy in the multicenter, phase II, prospective I-SPY2 trial. We identify putative antibody-drug conjugate (ADC)-responsive patients, as evidenced by a 19-feature T-DM1 classifier, validated on I-SPY2. Deploying mFISHseq as a research-use only test on 48 patients demonstrates clinical feasibility, revealing insights into the efficacy of targeted therapies, like CDK4/6 inhibitors, immunotherapies, and ADCs.

Este trabajo de investigación parte de la hipótesis de que existe una relación significativa entre el desarrollo del capital humano, la capacidad de innovación y la competitividad empresarial. Con este fin se ha propuesto medir la relación de tres variables respondiendo al interrogante: ¿Cuál es la influencia que tienen el capital humano y la capacidad de innovación para lograr la competitividad empresarial en las operadoras de turismo bolivianas? Para ello se han analizado 33 empresas operadoras de turismo en la ciudad de Sucre en Bolivia. El estudio es de enfoque cuantitativo, transversal y aplica modelos de ecuaciones estructurales basadas en el enfoque PLS (PLS-MEE). Los principales resultados evidencian una relación significativa entre las tres variables, la capacidad de innovación cumple un papel mediador siendo su efecto mayor sobre la competitividad empresarial en comparación al efecto del capital humano; lo que implica que las empresas, del sector estudiado, deben tomar mayor atención en el desarrollo de esta última variable.

Francisco Jesús Olmo-Montes,1 José Ramón Caeiro-Rey,2 Pilar Peris,3 Verónica Pérez del Río,4,5 Íñigo Etxebarria-Foronda,6 José Manuel Cancio-Trujillo,7 Teresa Pareja,8 Esteban Jódar,9 Antonio Naranjo,10 María Jesús Moro-Álvarez,11 Manuel García-Goñi,12 Josep Vergés,13 Stefano Maratia,14 Ignasi Campos Tapias,15 Miriam Prades,16 Susana Aceituno16 1Internal Medicine Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain; 2Traumatology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; 3Rheumatology Department, Hospital Clinic de Barcelona, Barcelona, Spain; 4Traumatology Department, Hospital San Juan de la Cruz, Úbeda, Spain; 5Medicine and Dermatology Department, Faculty of Medicine of Universidad de Málaga, Málaga, Spain; 6Traumatology Department, Hospital Alto Deba, Gipuzkoa, Spain; 7Geriatrics Department, Badalona Serveis Assistencials, Badalona, Spain; 8Geriatrics Department, Hospital Universitario de Guadalajara, Guadalajara, Spain; 9Endocrinology Department, Hospital Universitario Quirón de Madrid, Madrid, Spain; 10Rheumatology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain; 11Internal Medicine Department, Hospital Central Universitario Cruz Roja “San Jose y Santa Adela”, Madrid, Spain; 12Department of Applied & Structural Economics and History, Faculty of Economics and Business, Universidad Complutense de Madrid, Madrid, Spain; 13Asociación Española con la Osteoporosis y la Artrosis (AECOSAR), Madrid, Spain; 14UCB Pharma S.A., Madrid, Spain; 15Amgen S.A., Barcelona, Spain; 16Outcomes’ 10, S.L.U., Castellón de la Plana, SpainCorrespondence: Antonio Naranjo, Department of Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria, 35011, Spain, Tel +34 928450600, Email anarher@gobiernodecanarias.orgPurpose: This study evaluates the Social Return on Investment (SROI) of implementing measures to prevent fragility fractures in postmenopausal women with osteoporosis (OP) in Spain.Methods: A group of 13 stakeholders identified necessary actions for improving refracture prevention and assessed the investment required from the Spanish National Health System (SNHS), considering direct, indirect, and intangible costs over a one-year period. Unitary costs were sourced from scientific literature and official data, and intangible costs were estimated through surveys on women’s willingness to pay for better health-related quality of life. The SROI ratio was calculated from both a social perspective (including all returns) and the SNHS perspective (including only direct and intangible costs). A sensitivity analysis evaluated the returns in worst- and best-case scenarios over three years.Results: Stakeholders agreed on four main actions: 1) establishing fracture liaison services; 2) harmonizing clinical practice guidelines and provide training for healthcare professionals (HCPs); 3) promoting HCPs’ adherence to fracture registries and 4) raising awareness of OP and fragility fractures. From the social perspective, implementing these actions would cost the SNHS € 4,375,663 but yield a social return of € 96,939,931 in the first year, resulting in a SROI ratio of € 22.15 per euro invested (€ 28.69, 23.14, 24.29, and 10.70 for the four actions, respectively). From the SNHS perspective, the return would be € 36,453,509 (€ 21,523,444 tangible), with a SROI of € 8.33 (€ 4.92 tangible) and for the four actions: € 9.99, 9.39, 8.45, and 3.79, respectively (€ 5.89, 5.54, 4.96 and 2.27 tangible). The investment would be lower than the return for all actions (3.49%, 4.32%, 4.12% and 9.34% of social perspective return, respectively) and scenarios.Conclusion: According to our SROI method, implementing different actions to improve secondary fracture prevention would achieve a considerable social benefit, which, in terms of direct, indirect, and intangible costs, would far outweigh the investment.Keywords: economic evaluation, healthcare investment, prevention measures, healthcare outcomes, fracture liaison services, health-related quality of life

El estrés académico es una preocupación significativa entre los estudiantes universitarios, afectando su bienestar emocional y rendimiento académico. La meditación mindfulness (MM) ha emergido como una intervención prometedora para mejorar las estrategias de afrontamiento al estrés. Este estudio tiene como objetivo evaluar la efectividad de un programa de meditación mindfulness de 12 semanas en mejorar las estrategias de afrontamiento al estrés académico en estudiantes de enfermería. Se utilizó un diseño experimental aleatorizado con 86 estudiantes de enfermería, asignados al grupo experimental (n=43) y al grupo control (n=43). El grupo experimental participó en un programa de MM basado en el protocolo MBSR durante 12 semanas, con sesiones semanales de 60 minutos y prácticas individuales diarias. Se midieron los niveles de mindfulness y las estrategias de afrontamiento al estrés antes y después de la intervención utilizando la Escala MAAS y la Escala de Estrategias de Afrontamiento A-CEA. Se realizaron análisis estadísticos mediante pruebas t y correlaciones de Pearson. Los resultados mostraron un incremento significativo en los niveles de mindfulness en el grupo experimental (M pre = 3.20, M post = 4.50; t (42) = -15.34, p < .001, d = 2.34), en comparación con el grupo control, que no presentó cambios significativos (p = .27). Además, se observaron mejoras significativas en las dimensiones de reevaluación positiva y planificación (p < .05) en el grupo experimental, mientras que la búsqueda de apoyo social mostró una tendencia al aumento sin alcanzar significancia estadística (p = .051). Este estudio sugiere que un programa de meditación mindfulness de 12 semanas es efectivo para mejorar ciertas estrategias de afrontamiento al estrés académico, específicamente la reevaluación positiva y la planificación. Estos hallazgos respaldan la incorporación de intervenciones de mindfulness en el currículo académico para promover el bienestar emocional y la gestión del estrés entre estudiantes universitarios.

Este estudio tuvo como objetivo establecer la relación entre mindfulness y la calidad del sueño en estudiantes de una universidad privada de Lima, Perú. Se utilizó un enfoque metodológico cuantitativo con un diseño no experimental y de nivel correlacional. La muestra estuvo compuesta por 133 estudiantes del sexto al octavo ciclo de la carrera de Educación Física. La salud de Sueño se evaluó mediante el Índice de Salud de Sueño de Pittsburgh y la atención plena se midió mediante el Cuestionario de Atención Plena de Cinco Facetas. Los resultados revelaron una correlación negativa, significativa y moderada entre la calidad del sudor y la atención plena, lo que sugiere que un mayor nivel de atención plena se asocia con una mejor calidad del sudor. En concreto, las dimensiones "actuar con conciencia", "ausencia de juicio" y "descripción" mostraron correlaciones negativas significativas con la calidad del sudor. Estos hallazgos indican que los estudiantes con puntuaciones más altas en estas dimensiones de mindfulness experimentan una mejor calidad de sudor. Se concluye que promover prácticas de mindfulness en el entorno universitario podría mejorar la calidad del año académico y el bienestar general de los estudiantes. Palabras clave: Mindfulness, calidad del sudor, estudiantes universitarios, correlación, salud mental. Abstract. This study aimed to establish the relationship between mindfulness and sleep quality in students from a private university in Lima, Peru. A quantitative methodological approach was used with a non-experimental design and a correlational level. The sample consisted of 133 students from sixth to eighth cycle of the Physical Education degree. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and mindfulness was measured with the Five Facet Mindfulness Questionnaire. The results revealed a negative, significant and moderate correlation between sleep quality and mindfulness, suggesting that a higher level of mindfulness is associated with better sleep quality. Specifically, the dimensions "acting with awareness", "absence of judgment" and "description" were found to show significant negative correlations with sleep quality. These findings indicate that students with higher scores in these mindfulness dimensions experience better sleep quality. It is concluded that promoting mindfulness practices in the university environment could improve the quality of sleep and the general well-being of students. Keywords: Mindfulness, sleep quality, college students, correlation, mental health.

Summary: Background: Paediatric acute bronchiolitis normally occurs from October to April in the temperate northern hemisphere, peaking in January. Nonpharmacological measures to control the spread of COVID-19 resulted in a decrease in the number of cases of bronchiolitis during the 2020–21 season. The discontinuation of these measures created an uncertain scenario. Aim: To describe the epidemiological evolution of acute bronchiolitis seasons and the changes in the demographics of the affected population before, during, and after the implementation of nonpharmacological interventions for COVID-19 in Spain. Methods: This was a multicentre and descriptive study. A total of 6,334 infants aged up to 12 months who were diagnosed with acute bronchiolitis were recruited from sixteen Spanish hospitals. We collected data from participants from September 1st, 2021, through August 31st, 2023, as part of the ECEALHBA research project. The study periods were before (P1), during (P2), and after (P3) the COVID-19 pandemic. Findings: In P2 and after the discontinuation of nonpharmacological interventions, an unexpected increase in the number of acute bronchiolitis cases was observed from June–August 2021, resulting in an out-of-season peak. A subsequent peak was observed in November 2021, earlier than expected for the 2021-22 season. In the 2022-23 season, admissions followed a historical trend, with a greater number of cases than in the two previous seasons. Statistically significant differences in the length of stay (p

Synaptic plasticity is obstructed by pathogenic tau in the brain, representing a key mechanism that underlies memory loss in Alzheimer's disease (AD) and related tauopathies. Here, we found that reduced levels of the memory-associated protein KIdney/BRAin (KIBRA) in the brain and increased KIBRA protein levels in cerebrospinal fluid are associated with cognitive impairment and pathological tau levels in disease. We next defined a mechanism for plasticity repair in vulnerable neurons using the C-terminus of the KIBRA protein (CT-KIBRA). We showed that CT-KIBRA restored plasticity and memory in transgenic mice expressing pathogenic human tau; however, CT-KIBRA did not alter tau levels or prevent tau-induced synapse loss. Instead, we found that CT-KIBRA stabilized the protein kinase Mζ (PKMζ) to maintain synaptic plasticity and memory despite tau-mediated pathogenesis. Thus, our results distinguished KIBRA both as a biomarker of synapse dysfunction and as the foundation for a synapse repair mechanism to reverse cognitive impairment in tauopathy.

This paper explores the rapidly growing impact of Artificial Intelligence (AI) in education, with a focus on its integration into teaching English as a Foreign Language (EFL). AI offers educators new opportunities to innovate and enhance the teaching process. This review aims to provide a thorough analysis of AI, specifically ChatGPT, in EFL classrooms, highlighting both the perspectives of teachers and learners. The study centers on university instructors who have incorporated ChatGPT into their daily English teaching practices. Research data was sourced from databases Scopus and Web of Science, with relevant studies selected based on predetermined criteria. Findings indicate that EFL teachers value ChatGPT for its ability to offer instant explanations, create supplementary teaching materials, and promote student engagement through interactive sessions. However, concerns persist regarding certain limitations of the chatbot, indicating the need for further refinements. The study emphasizes the importance of training and guiding educators in using AI tools effectively to minimize potential challenges. Lastly, it calls for more experimental research to further assess ChatGPT’s role and effectiveness in EFL teaching.

Research is a common feature in developed countries. Those who dedicate themselves to this activity produce important tools for individual, community, and national development. However, developing countries suffer the opposite situation. In these nations, little investment is devoted to research, and they lack dissemination mechanisms, while offering few possibilities of capitalizing on its benefits. For this reason, the present study carries out an analysis of the relevance of the research, an establishment of these proposal needs in the Latin American context, and the establishment of the bases for a systemic proposal based on a research training program. In that sense, this proposal takes into account the limited economic resources and the lack of investigative culture in the Latin American territory. It is accompanied by a prototype of the training program, based on good practices and lessons learned so far.

The objective of this work is to create, and validate, a questionnaire aimed at assessing those actions undertaken by school management teams to promote inclusion in compulsory education sector in Spain. It is based on the perspective of teaching teams (members of management teams and teachers). To determine the psychometric properties of the questionnaire a descriptive, exploratory factorial and confirmatory factorial analysis was performed. In the pilot phase of the instrument, 243 members of teaching teams participated. The results obtained confirm that it is a valid and reliable scale with a bifactorial structure. The first of these factors includes actions carried out by the management teams to energise inclusive culture in their schools and thus turn them into inclusive communities. The other set of actions includes interventions with the aim of improving the training of students and creating professional learning communities.

This study analyses teachers' opinions concerning the actions taken by management teams in favor of policies which address inclusion in compulsory education schools in Granada (Spain). This is quantitative research in which the LIE-Q-Teaching Team has been used. Two hundred forty-three teachers participated in this study which involved a descriptive and inferential analysis. Results show that the actions promoting inclusion mainly relate to the management of teaching-learning processes and professional development. Results also reveal that there are significant differences based on the ownership of the school, its educational level and the socio-economic status of the area in which it is located.

This study used the Community of Inquiry framework to examine how university instructors designed, facilitated, and supported social and cognitive processes in online courses, and how instructors and students experienced these processes. In early 2021, 25 online focus groups were organized with instructors (n = 52) and students (n = 44) from all faculties of a large Dutch university to discuss this. In terms of design, instructors restructured their courses (e.g. reduced group sizes to intensify interaction and implemented a flipped classroom approach) and communicated more explicitly about the course structure and expectations to better enable students to self-regulate their learning process. During the course, instructors orchestrated cognitive and social processes by facilitating discourse (e.g. breakout room activities and collaboration activities) and offering direct support (e.g. online progress monitoring and "being there" for students). The analysis illustrated how teaching presence plays a crucial role in fostering cognitive and social processes in online courses. This study contributes to a better understanding of the role of teaching presence in a community of inquiry, while providing insights that can inform the development of effective online teaching strategies.

Meninges cover the surface of the brain and spinal cord and contribute to protection and immune surveillance of the central nervous system (CNS). How the meningeal layers establish CNS compartments with different accessibility to immune cells and immune mediators is, however, not well understood. Here, using 2-photon imaging in female transgenic reporter mice, we describe VE-cadherin at intercellular junctions of arachnoid and pia mater cells that form the leptomeninges and border the subarachnoid space (SAS) filled with cerebrospinal fluid (CSF). VE-cadherin expression also marked a layer of Prox1+ cells located within the arachnoid beneath and separate from E-cadherin+ arachnoid barrier cells. In vivo imaging of the spinal cord and brain in female VE-cadherin-GFP reporter mice allowed for direct observation of accessibility of CSF derived tracers and T cells into the SAS bordered by the arachnoid and pia mater during health and neuroinflammation, and detection of volume changes of the SAS during CNS pathology. Together, the findings identified VE-cadherin as an informative landmark for in vivo imaging of the leptomeninges that can be used to visualize the borders of the SAS and thus potential barrier properties of the leptomeninges in controlling access of immune mediators and immune cells into the CNS during health and neuroinflammation.

El presente artículo tiene como objetivo comprender el problema de la tierra en la Araucanía a partir de su desarrollo histórico, considerando principalmente sus dimensiones socioeconómicas y sus consecuencias políticas. Para ello, se realiza un análisis en base a antecedentes bibliográficos, lo que permite trazar una trayectoria de diversos hitos que han marcado los caminos de la Araucanía hasta hoy. En este sentido, algunas de las características actuales de la región, como la pobreza, la desigualdad y el conflicto, se pueden analizar desde la mirada de las acciones y acontecimientos que ocurrieron en este período. Las principales conclusiones señalan que la ocupación y colonización de la Araucanía por parte del Estado chileno, dan lugar a una serie de problemas locales con respecto a la tierra que no se han resuelto, sino que han avanzado y se han extendido. Esto ha generado inestabilidad en el espacio rural de la región, por lo que los problemas sociales y económicos provocan nuevas crisis políticas. El problema de la tierra, muy ligado al subdesarrollo, en este período pasó de ser un problema económico-social, a un problema político permanente, una disputa por el territorio, en una lógica colonización y resistencia (descolonización).

Conseguir crear comunidades inclusivas es un proceso compartido en el que deben implicarse todos los agentes educativos, labor que debe ser impulsada desde un liderazgo inclusivo que fomente la participación y la adecuada respuesta a la diversidad. Por ello, en esta investigación nos centramos en analizar cómo percibe el profesorado de los centros andaluces la labor desarrollada por el equipo directivo en este ámbito. Se presentan los datos recogidos tras aplicar un cuestionario a 747 docentes para valorar el grado en el que el liderazgo ejercido por la dirección de los centros educativos favorece la inclusión. Se han realizado análisis descriptivos y análisis inferenciales, comprobándose que existen diferencias estadísticamente significativas. En general los docentes valoran positivamente las iniciativas para el fomento de la participación de todos y la comunicación con las familias, mientras que las prácticas que consideran que necesitan mejorar están relacionadas con las acciones emprendidas para colaborar con otros centros, con el mundo empresarial y con la participación de los miembros de la comunidad educativa en la evaluación de las labores de dirección. Podemos decir que la gestión de los líderes escolares está bien valorada por los equipos docentes, pero aún quedan retos por conseguir.