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Introduction Sex hormone binding globulin (SHBG) levels are reported to be inversely associated with diabetes risk. It is unknown whether diabetes prevention interventions increase SHBG and whether resultant changes in SHBG affect diabetes risk. The purpose of this analysis was to determine whether intensive lifestyle intervention (ILS) or metformin changed circulating SHBG and if resultant changes influenced diabetes risk in the Diabetes Prevention Program (DPP).Research design and methods This is a secondary analysis from the DPP (1996–2001), a randomized trial of ILS or metformin versus placebo on diabetes risk over a mean follow-up of 3.2 years. The DPP was conducted across 27 academic study centers in the USA. Men, premenopausal and postmenopausal women without hormone use in the DPP were evaluated. The DPP included overweight/obese persons with elevated fasting glucose and impaired glucose tolerance. Main outcomes measures were changes in SHBG levels at 1 year and risk of diabetes over 3 years.Results ILS resulted in significantly higher increases (postmenopausal women: p

Background Increasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.Methods We quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.Results We compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.Conclusion EWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.

Abstract In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1–2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. Methodology: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6–12 July 2020 and 23–29 November 2020. The interactive digital platform is openly available. Primary and secondary outcomes: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1–2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. Results: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali’s urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6–12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1–2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements. These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

Abstract Background Antibiotic use for early-onset sepsis represents a high percentage of antibiotic consumption in the neonatal setting. Measures to assess infants at risk of early-onset sepsis are needed to optimize antibiotic use. Our primary objective was to assess the impact of a departmental guideline on antibiotic use among term infants with suspected EOS not confirmed, in our neonatal unit. Methods Retrospective cohort study, to compare antibiotic use in term infants during a baseline period of January to December 2018, and a postintervention period from October 2019, to September 2020, respectively. The primary outcome was antibiotic use measured by days of therapy, the antibiotic spectrum index, the antibiotic use rate, and the length of therapy. Results We included 71 infants in the baseline period and 66 infants in the postintervention period. Compared to those in the baseline period, there was a significant reduction in overall antibiotic measures in the postintervention period, (P

Macrophages play a pivotal role as host cells for Leishmania parasites, displaying a notable functional adaptability ranging from the proinflammatory, leishmanicidal M1 phenotype to the anti-inflammatory, parasite-permissive M2 phenotype. While macrophages can potentially eradicate amastigotes through appropriate activation, Leishmania employs diverse strategies to thwart this activation and redirect macrophages toward an M2 phenotype, facilitating its survival and replication. Additionally, a competition for iron between the two entities exits, as iron is vital for both and is also implicated in macrophage defensive oxidative mechanisms and modulation of their phenotype. This review explores the intricate interplay between macrophages, Leishmania, and iron. We focus the attention on the potential of iron oxide nanoparticles (IONPs) as a sort of immunotherapy to treat some leishmaniasis forms by reprogramming Leishmania-permissive M2 macrophages into antimicrobial M1 macrophages. Through the specific targeting of iron in macrophages, the use of IONPs emerges as a promising strategy to finely tune the parasite-host interaction, endowing macrophages with an augmented antimicrobial arsenal capable of efficiently eliminating these intrusive microbes.

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P

Background: The prognostic role of imaging with [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in oropharynx cancer (OPC) has been demonstrated in the past. The aim of this study was to assess the prognostic impact of both baseline and post-treatment PET/CT in patients with OPC and treated with chemo- and/or radiotherapy. Methods: The PET/CT parameters of scans performed before and after therapy were collected and analyzed to find significant prognosticators for progression-free survival (PFS) and overall survival (OS). Human papillomavirus (HPV) infection’s influence on the prognosis was also taken into account. Results: A total of 66 patients were included in the study. The staging volumetric parameters of PET/CT were significant prognosticators for OS, while the same parameters were affordable predictors for PFS at the restaging evaluation. No significant correlations between HPV infection and PET/CT parameters were reported. Conclusion: The prognostic role of volumetric [18F]FDG PET/CT parameters in patients with OPC was reported.

El trabajo expone los resultados de la investigación llevada a cabo para detectar necesidades y diseñar un plan de formación laboral para una empresa del sector de la madera. Se trata de un estudio de caso, no experimental con enfoque mixto a partir de un cuestionario y entrevistas semiestructuradas diseñados ad hoc. Cualitativamente se recurre al análisis de contenido y cuantitativamente a tablas de contingencias bivariantes, complementadas mediante el estadístico de correlación para variables cuantitativas ordinales (rho) y el estadístico de contraste Ji cuadrado de Pearson (χ2), con un nivel de riesgo del 5%. Los resultados muestran el valor de la identificación previa de necesidades como fundamento para establecer las dimensiones, contenidos y metodología de un plan de formación segmentado en acciones para toda la plantilla, para dirección de equipos y para los departamentos de producción y de administración. Un plan de formación diseñado no solo para actualizar conocimientos y habilidades de los trabajadores, promoviendo su desarrollo profesional, sino también para responder a las actuales demandas de empresas sostenibles y éticas. Adicionalmente, el estudio contribuye también a mostrar la relevancia de la Pedagogía Laboral.

Abstract Oncogenic transformation leads to changes in glutamine metabolism that make transformed cells highly dependent on glutamine for anabolic growth and survival. Herein, we investigated the cell death mechanism activated in glutamine-addicted tumor cells in response to the limitation of glutamine metabolism. We show that glutamine starvation triggers a FADD and caspase-8-dependent and mitochondria-operated apoptotic program in tumor cells that involves the pro-apoptotic TNF-related apoptosis-inducing ligand receptor 2 (TRAIL-R2), but is independent of its cognate ligand TRAIL. In glutamine-depleted tumor cells, activation of the amino acid-sensing general control nonderepressible-2 kinase (GCN2) is responsible for TRAIL-R2 upregulation, caspase-8 activation, and apoptotic cell death. Interestingly, GCN2-dependent ISR signaling induced by methionine starvation also leads to TRAIL-R2 upregulation and apoptosis. Moreover, pharmacological inhibition of transaminases activates a GCN2 and TRAIL-R2-dependent apoptotic mechanism that is inhibited by non-essential amino acids (NEAA). In addition, metabolic stress upon glutamine deprivation also results in GCN2-independent FLICE-inhibitory protein (FLIP) downregulation facilitating caspase-8 activation and apoptosis. Importantly, downregulation of the long FLIP splice form (FLIPL) and apoptosis upon glutamine deprivation are inhibited in the presence of a membrane-permeable α-ketoglutarate. Collectively, our data support a model in which limiting glutamine utilization in glutamine-addicted tumor cells triggers a previously unknown cell death mechanism regulated by GCN2 that involves the TRAIL-R2-mediated activation of the extrinsic apoptotic pathway.

X-ray irradiation is an emerging non-thermal technology that is used as a preservation and sanitization technique to inactivate pathogens and spoilage organisms, increasing the shelf life of products. In this work, two different types of surface-ripened cheeses, Brie and Camembert, produced with cow milk, were treated with X-rays at three dose levels, 2.0, 4.0 and 6.0 kGy, to evaluate the irradiation effects on the volatile profile using a volatolomic approach. The headspace solid-phase microextraction (HS-SPME) technique combined with gas chromatography–mass spectrometry (GC–MS) was used to extract and analyze the volatile fraction from these dairy matrices. The HS-SPME method was optimized by a central composite design in combination with a desirability optimization methodology. The Carboxen/PDMS fiber, 50 °C for extraction temperature and 60 min for time extraction were found to be the best parameter settings and were applied for this investigation. The obtained fingerprints demonstrated that the irradiation-induced changes are dose dependent. The X-ray irradiation produced many new volatiles not found in the non-irradiated samples, but it also varied the amount of some volatiles already present in the control. Specifically, aldehydes and hydrocarbons increased with the irradiation dose, whereas alcohols, carboxylic acids, esters, methyl esters, ketones, lactones and sulfur-containing compounds showed a non-linear dependence on the dose levels; indeed, they increased up to 4.0 kGy, and then decreased slightly at 6.0 kGy. This trend, more evident in the Camembert profile, is probably due to the fact that these compounds are involved in different oxidation mechanisms of lipids and proteins, which were induced by the radiation treatment. In these oxidative chemical changes, the production and degradation processes of the volatiles are competitive, but at higher doses, the decomposition reactions exceed those of formation. A principal component analysis and partial least square discriminant analysis were used to discriminate between the treated and untreated samples. Moreover, this study allowed for the identification of potential markers of X-ray treatment for the two cheeses, confirming this approach as a useful tool for the control of irradiated surface-ripened cheeses.

Objetivo: Determinar la correlación entre la glucosa salival y marcadores de disfunción de célula beta en pacientes con Diabetes Mellitus tipo 2 (DM2). Materiales y métodos: Estudio transversal llevado a cabo en el Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) en Lima, Perú durante el año 2021. Se categorizó en buen control metabólico (HbA1c

Resumen: Introducción: En 2017 se realizó una encuesta a nivel mundial sobre el cumplimiento de las prácticas que promueve la Neo-IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia en las unidades neonatales). Objetivo: Presentar los resultados de las unidades españolas que participaron en la encuesta mundial y compararlos con los obtenidos internacionalmente. Material y métodos: Estudio transversal mediante una encuesta sobre el cumplimiento de los requisitos de la Neo-IHAN («Tres principios básicos», «Diez pasos adaptados a unidades neonatales» y el «cumplimiento del Código internacional de comercialización de sucedáneos de leche materna»). El cumplimiento se calculó como la media en cada indicador y una puntuación media final para cada unidad neonatal. Para las puntuaciones parciales y finales de cada país y a nivel internacional se utilizó la mediana. Las puntuaciones van de 0 a 100. Resultados: La tasa de respuesta en España fue del 90% de las unidades de nivel 2 y 3. El rango de la media para las unidades neonatales fue de 37 a 99, sin diferencias según el nivel asistencial. La puntuación global de España (72) está por debajo de la mediana internacional (77), así como en 8 de los 14 requisitos de la Neo-IHAN. Las unidades neonatales de hospitales con maternidades acreditadas IHAN obtuvieron una puntuación media final significativamente mayor, así como en 9 de los 14 requisitos frente a las no acreditadas. Conclusiones: Los resultados, tanto internacionales como nacionales, indican una mejora de las prácticas de la lactancia materna en las unidades neonatales. Los beneficios de la acreditación IHAN de las maternidades alcanzan a las unidades neonatales. España tiene varios puntos clave por debajo de la puntuación internacional. Abstract: Introduction: In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). Objective: Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. Material and methods: Cross-sectional study through a survey on compliance with the Neo-BFHI (“Three basic principles”, “Ten steps adapted to neonatal wards” and “the compliance with the International Code of Marketing of Breast-milk Substitutes” and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. Results: The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. Conclusions: Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.

Introduction: In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). Objective: To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. Material and methods: Cross-sectional study through a survey on compliance with the Neo-BFHI (“Three basic principles”, “Ten steps adapted to neonatal wards” and “the compliance with the International Code of Marketing of Breast-milk Substitutes” and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. Results: The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. Conclusions: Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score. Resumen: Introducción: En 2017 se realizó una encuesta a nivel mundial sobre el cumplimiento de las prácticas que promueve la Neo-IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia en las unidades neonatales). Objetivo: Presentar los resultados de las unidades españolas que participaron en la encuesta mundial y compararlos con los obtenidos internacionalmente. Material y métodos: Estudio transversal mediante una encuesta sobre el cumplimiento de los requisitos de la Neo-IHAN (“Tres principios básicos”, “Diez pasos adaptados a unidades neonatales” y “el Cumplimiento del Código Internacional de Comercialización de Sucedáneos de Leche Materna”). El cumplimiento se calculó como la media en cada indicador y una puntuación media final para cada unidad neonatal. Para las puntuaciones parciales y finales de cada país y a nivel internacional se utilizó la mediana. Las puntuaciones van de 0 a 100. Resultados: La tasa de respuesta en España fue del 90% de las unidades de nivel 2 y 3. El rango de la media para las unidades neonatales fue de 37 a 99, sin diferencias según el nivel asistencial. La puntuación global de España (72) está por debajo de la mediana internacional (77) así como en 8 de los 14 requisitos de la Neo-IHAN. Las unidades neonatales de hospitales con maternidades acreditadas IHAN, obtuvieron una puntuación media final significativamente mayor así como en 9 de los 14 requisitos frente a las no acreditadas. Conclusiones: Los resultados tanto internacionales como nacionales indican una mejora de las prácticas de la lactancia materna en las unidades neonatales. Los beneficios de la acreditación IHAN de las maternidades alcanzan a las unidades neonatales. España tiene varios puntos clave por debajo de la puntuación internacional.

Abstract Background Vitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed. Methods The COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed. Results In the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0–10.5] vs. 9.5 [95%CI 9.0–10.5] days), admission to ICU (17.2% [95%CI 13.0–22.3] vs. 16.4% [95%CI 12.3–21.4]) and death rate (8.0% [95%CI 5.2–12.1] vs. 5.6% [95%CI 3.3–9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes. Conclusions The randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes. Trial registration COVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov ( NCT04552951 ).

Large animal models of acute myocardial infarction (AMI) play a crucial role in translating novel therapeutic approaches to patients as denoted by their use in the right-before-human testing platform. At present, the porcine model of AMI is used most frequently as it mimics the human condition and its anatomopathological features accurately. We want to describe to, and share with, the translational research community our experience of how different anaesthetic protocols (sevoflurane, midazolam, ketamine+xylazine+midazolam, and propofol) and pig breeds [Large White and Landrace x Large White (LLW)] can dramatically modify the outcomes of a well-established porcine model of closed-chest AMI. Our group has extensive experience with the porcine model of reperfused AMI and, over time, we reduced the time of ischaemia used to induce the disease from 90 to 50 min to increase the salvageable myocardium for cardioprotection studies. For logistical reasons, we changed both the anaesthetic protocol and the pig breed used, but these resulted in a dramatic reduction in the size of the myocardial infarct, to almost zero in some cases (sevoflurane, 50-min ischaemia, LLW, 2.4 ± 3.9% infarct size), and the cardiac function was preserved. Therefore, we had to re-validate the model by returning to 90 min of ischaemia. Here, we report the differences in infarct size and cardiac function, measured by different modalities, for each combination of anaesthetic protocol and pig breed we have used. Furthermore, we discuss these combinations and the limited literature pertaining to how these two factors influence cardiac function and infarct size in the porcine model of AMI.

Ultimate advances in genetic technologies have permitted the detection of transmitted cases of congenital diseases due to parental gonadosomatic mosaicism. Regarding Cornelia de Lange syndrome (CdLS), up to date, only a few cases are known to follow this inheritance pattern. However, the high prevalence of somatic mosaicism recently reported in this syndrome (∼13%), together with the disparity observed in tissue distribution of the causal variant, suggests that its prevalence in this disorder could be underestimated. Here, we report a new case of parental gonadosomatic mosaicism in SMC1A gene that causes inherited CdLS, in which the mother of the patient carries the causative variant in very low allele frequencies in buccal swab and blood. While the affected child presents with typical CdLS phenotype, his mother does not show any clinical manifestations. As regards SMC1A, the difficulty of clinical identification of carrier females has been already recognized, as well as the gender differences observed in CdLS expressivity when the causal variant is found in this gene. Currently, the use of DNA deep-sequencing techniques is highly recommended when it comes to molecular diagnosis of patients, as well as in co-segregation studies. These enable us to uncover gonadosomatic mosaic events in asymptomatic or oligosymptomatic parents that had been overlooked so far, which might have great implications regarding genetic counseling for recurrence risk.

Bread wheat has traditionally been selected for whitish derived flours. As a consequence, the current varieties carry carotenogenic alleles associated with low grain carotenoid. In contrast, high grain yellow pigment content (YPC) has been a major target in durum wheat programs since yellow colour is an important aesthetic factor for pasta production. Phytoene synthase 1 (Psy1) genes have an important role in the determination of the carotenoid content in wheat. In this work, we have transferred the genes Psy1-A1 and Psy1-B1 from durum to bread wheat by inter-specific hybridization in order to evaluate the combined effect of these genes for the improvement of grain carotenoid content, as well as the development of carotenoid-enriched bread wheat lines. Inter-specific breeding coupled with a MAS approach based on Psy1-A1 and Psy1-B1 alleles has allowed the development of bread wheat pre-breeding lines with enhanced grain carotenoid content (16–23% mean). These biofortified lines have the potential to become new varieties or to be used as recurrent parents in bread wheat breeding programs.

Antibiotic burden is a critical issue in neonatal intensive care units (NICU) and antibiotic use is considered a quality indicator of neonatal care. Our aim was to optimize antibiotic use through a quality improvement (QI) initiative that included revision of departmental protocols and implementation of a surveillance system based on process indicators.MethodsThis is descriptive study of a cohort of all very low birth weight (VLBW) infants admitted to the NICU from 2014 to 2019. A series of QI interventions were made during the study period and included departmental protocols and the implementation of a surveillance system based on process indicators. The primary outcome was the percentage of VLBW infants who had received early antibiotics (ampicillin, gentamicin, or cefotaxime on the day of birth or day 1 or 2 after birth), antibiotics for longer than 3 days (despite negative blood culture), or no antibiotics.ResultsDuring the study period, a significant relative reduction was seen in the proportion of VLBW infants administered early antibiotics (46%; p < 0.01) and in infants provided antibiotics for longer than 3 days (90%; p < 0.01). Additionally, the percentage of VLBW with “no antibiotics” during their NICU stay increased fivefold (6 to 30%; p < 0.001).ConclusionsIn our NICU, the implementation of a QI initiative that is based on affordable methods to track process indicators and evaluate the results led into a significant reduction in antibiotic exposure in VLBW infants. This approach is easy to implement in other NICUs as well.

La dinámica social establecida en la actualidad demanda de los docentes la constante actualización a través de formación. Uno de los ámbitos formativos se centra en el desarrollo e implementación dentro del aula de metodologías activas que permitan al alumno construir su propio aprendizaje. El Aprendizaje Cooperativo (AC) incide de forma directa en la construcción propia del aprendizaje desde la dimensión social, ya que es en este ámbito donde tienen cabida los procesos de aprendizaje. Nuestra investigación se centra en la influencia del AC en el estatus sociométrico del alumnado de educación primaria y secundaria. Para ello se ha desarrollado una herramienta que permite delimitar el impacto de esta metodología activa a través de la variación producida en el estatus sociométrico del alumno dentro del grupo clase. Se presenta aquí el proceso de validación de la herramienta desarrollada.

Agropyron cristatum (P genome) is a Triticeae species from the wheat tertiary gene pool which has economic importance as forage and also displays traits beneficial to wheat. Resistance to leaf rust was previously mapped to the short arm of chromosome 1P (1PS) in A. cristatum by the development of a compensating Robertsonian translocation involving chromosome arm 1PS and the long arm of wheat chromosome 1B (1BL). In this study, chromosome arm 1PS was engineered using the ph1b mutation to induce 1BS/1PS homoeologous recombination and to obtain new translocations with shortened fragments of chromosome arm 1PS. Two translocations with different alien fragment sizes were identified by genomic in situ hybridization, wheat 1BS- and 1PS-specific molecular markers and gene-specific markers for glutenin, Glu-B3 and gliadin Gli-B1 seed storage protein. One translocation (called type 1) replaces a proximal segment of 1PS chromatin, and the other (called type 2) replaces a distal 1PS segment and introduces the Glu-B3 and Gli-B1 wheat storage protein loci. Six specific EST-STS markers for chromosome arm 1PS amplified PCR products in the recombinant type 2 translocation line. Resistance analysis showed that the type 2 translocation was highly resistant to a virulent race of leaf rust pathogen. The new wheat–A. cristatum translocations obtained yield material with seedling plant resistance to leaf rust and seed storage protein loci.

Il presente lavoro intende riflettere sull’importanza del nido come momento di apprendimento attraverso un’azione educativa costante e collaborativa che si esplica nella programmazione e nella realizzazione di buone prassi didattico-inclusive. La prospettiva è garantire il successo formativo del bambino partendo dalla capacità di interpretare e organizzare sistemi di formazione più estesi (Chiappetta Cajola, 2017), in grado di formare e valorizzare esperienze ludiformi (Ambretti, Palumbo, Lavega & Sibilio, 2018), riconosciute come substrato per i futuri apprendimenti scolastici.

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.

Background: QTc prolongation is an adverse effect of COVID-19 therapies. The use of a handheld device in this scenario has not been addressed. Objectives: To evaluate the feasibility of QTc monitoring with a smart device in COVID-19 patients receiving QTc-interfering therapies. Methods: Prospective study of consecutive COVID-19 patients treated with hydroxychloroquine ± azithromycin ± lopinavir-ritonavir. ECG monitoring was performed with 12-lead ECG or with KardiaMobile-6L. Both registries were also sequentially obtained in a cohort of healthy patients. We evaluated differences in QTc in COVID-19 patients between three different monitoring strategies: 12-lead ECG at baseline and follow-up (A), 12-lead ECG at baseline and follow-up with the smart device (B), and fully monitored with handheld 6-lead ECG (group C). Time needed to obtain an ECG registry was also documented. Results: One hundred and eighty-two COVID-19 patients were included (A: 119(65.4%); B: 50(27.5%); C: 13(7.1%). QTc peak during hospitalization did significantly increase in all groups. No differences were observed between the three monitoring strategies in QTc prolongation (p = 0.864). In the control group, all but one ECG registry with the smart device allowed QTc measurement and mean QTc did not differ between both techniques (p = 0.612), displaying a moderate reliability (ICC 0.56 [0.19–0.76]). Time of ECG registry was significantly longer for the 12-lead ECG than for handheld device in both cohorts (p < 0.001). Conclusion: QTc monitoring with KardiaMobile-6L in COVID-19 patients was feasible. Time of ECG registration was significantly lower with the smart device, which may offer an important advantage for prevention of virus dissemination among healthcare providers.

The use of food dyes in meat is regulated by the current European and non-European legislation, due to several food safety concerns. A reliable method for the quali-quantitative determination of 12 food dyes (Amaranth, Ponceau 4R, Carmine, Ponceau SX, Ponceau 3R, Allura Red AC, Carmoisine, Erythrosine, Sudan I, Sudan II, Sudan III and Sudan IV) in meat products, by high performance liquid chromatography coupled to UV diode array detection is presented. The extraction was accomplished by using acetonitrile, methanol, water, and ammonia, 50:40:9:1 (v/v/v/v) as the solvent and ultrasonic bath. The chromatographic separation was obtained with a C18 RP column eluted by a gradient of acetate buffer/acetonitrile. Good analytical performances characterized this method (Table 1), in terms of selectivity, sensitivity, accuracy and ruggedness. Both method precision (CV% range: 6%–15%) and recovery percentages (range: 86%–105%) resulted in compliance with Decision 2002/657/EC, and the expanded measurement uncertainties, estimated by a bottom-up approach, were in the range 6%–20%. All these results demonstrated that the procedure can be applied successfully for confirmation analyses of commercial meat products. • 12 food dyes were determined in meat by new HPLC/UV-DAD method. • The analytical method was fully validated for accurate confirmation analyses. • Method accuracy, sensitivity, selectivity and ruggedness resulted satisfactory. Method name: 12 dyes in meat by HPLC-UV-DAD, Keywords: Food safety, Colourings, Liquid chromatography

No one wants to eat food that is unsafe and that can put their health at risk in any way or form [...]

Reactor and accelerator-based neutrino experiments have played a critical role in the understanding of neutrino oscillations and are currently dominating the high-precision measurements of neutrino oscillation parameters. The discovery of a non-zero θ13 by the reactor experiments has opened the possibility of observing CP violation in the lepton sector by long-baseline accelerator experiments. The current knowledge of the neutrino oscillation parameters will be expanded upon in the near future through more precise measurements, including the discovery of the neutrino mass ordering and the CP-violating phase. This review summarizes the distinct and complementary approach of reactor and accelerator-based neutrino experiments to measure neutrino oscillations. The main scientific achievements of the Double Chooz reactor neutrino experiment and the science program to be developed by the DUNE long-baseline neutrino experiment with the world’s most intense neutrino beam are presented in this article. Spain has strongly contributed to these results and will continue to play a prominent role in the neutrino oscillation program in the coming years.

Multi-exciton states may emerge in atomically thin transition metal dichalcogenides as a result of strong many-body interactions. Here, the authors report experimental evidence of four- and five-particle biexciton complexes in monolayer WSe2 and their electrical control.

Nelle Indicazioni Nazionali per il Curricolo della scuola dell’infanzia del 2012 si suggerisce una rivisitazione dell’organizzazione curricolare a partire dal recupero di tutte le forme di gioco e di movimento libero o guidato come occasione volta alla scoperta e costruzione identitaria del sé collettivo e personale. Con tali finalità il “senso del movimento” ha assunto una propria valenza non solo come il prodotto dell’azione integrata e sinergica di recettori sensoriali propri della cinestesia (Berthoz,1998) ma come fondamento della costruzione di significati più ampi realizzabile attraverso le relazioni multiformi ed adattive che si instaurano tra il corpo e l’ambiente attraverso percorsi ludiformi. In questa prospettiva, nei documenti ministeriali del 2012 dedicati all’infanzia, assume un valore decisivo la rivisitazione delle modalità di contatto del bambino con la realtà, i suoi diversi codici ludici, compreso quello motorio, mettendo in primo piano l’uso ludico del corpo e il movimento. Questa pluridimensionalità del fenomeno ludico-motorio suggerisce la capitalizzazione delle proprietà didattiche del gioco e del movimento, suggerendo una possibile riprogettazione di itinerari didattici fin dalla scuola dell’infanzia. Tocca perciò alla scuola recuperare questa carenza accogliendo i suggerimenti educativo-inclusivi provenienti dalla psicomotricità, nel tentativo di ricostruire quelle condizioni per conoscere quali forme di gioco siano più adatte (come tematica, come struttura, come possibilità di variazione e trasformazione di regole, come potenzialità di apprendimento) ai bambini nelle età che ci interessano (Staccioli, 1987).

Resumen: Objetivo: Conocer la frecuencia y la magnitud de la hipofosforemia neonatal ( 32 semanas con peso 32 weeks with weight

Objective: To determine the frequency and magnitude of neonatal hypophosphataemia (32 weeks with weight 32 semanas con peso

A method for the determination of β-agonists was developed by combining the separation of analytes through high-performance liquid chromatography, with a reversed-phase column, coupled to the pulsed amperometric detection at a glassy carbon electrode. Preliminary experiments, using cyclic voltammetry, allowed for an understanding of the electrochemical behavior of clenbuterol, fenoterol, and terbutaline. By analyzing the electrochemical response, the conditions for detecting the analytes and for cleaning the working electrode were identified. The proposed potential-time profile was designed to prevent contamination of the carbon electrode following consecutive analyses, so ensuring a reproducible and sensitive quantitative determination. The waveform electrochemical parameters, including detection and delay times, have been optimized in terms of sensitivity, detection limits, and long-term response stability. The chromatographic separation was carried out using a C8 column in isocratic mode, and a mixture of acetic acid and acetonitrile. The optimized experimental conditions were used for the analysis of standard solutions and real samples. Detection limits, lower than the maximum residue limit set for clenbuterol by European directives, were obtained for all β-agonists investigated. The method validation was performed by evaluating the linearity, selectivity, precision, and recovery. Calf urine samples were used to verify the applicability of the proposed method, analyzing both enriched and naturally contaminated urine samples.

Crested wheatgrass (Agropyron cristatum L. Gaertn., genome P), included in the Triticeae tribe (family Poaceae), is one of the most important grasses in temperate regions. It has been valued as a donor of important agronomic traits for wheat improvement, including tolerance to cold, drought, and high salinity, as well as resistance to leaf rust, stripe rust, and powdery mildew. For successful incorporation of beneficial alleles into wheat, it is essential that recombination between wheat and A. cristatum chromosomes occurs. In this work, we analysed chromosome associations during meiosis in wheat lines carrying chromosome introgressions from A. cristatum chromosomes 5P and 6P in the presence and absence of Ph1 locus using fluorescence in situ hybridisation. The results showed that the Ph1 locus does not affect chromosome associations between A. cristatum and wheat chromosomes because there were no interspecific chromosome associations; therefore, no recombination between chromosomes from wheat and Agropyron were observed in the absence of the Ph1 locus. The 5P and 6P A. cristatum chromosomes do not have a suppressor effect on the Ph1 locus. Wheat univalents in metaphase I suggest that Agropyron chromosomes might carry genes having a role in wheat homologous chromosome associations. Putative effect of the Agropyron genes on wheat chromosome associations does not interact with the Ph1 locus.

Los últimos datos aportados por la Comisión Europea señalan que la demencia afecta actualmente a casi cincuenta millones de personas en todo el mundo y que cada año se detectan 7.7 millones de nuevos casos. A día de hoy, el Alzheimer es la demencia más padecida por la población mundial pudiendo constituir en términos relativos el 70% de las demencias. En la actualidad no existen tratamientos farmacológicos que den una respuesta definitiva a este tipo de patologías. Las utilizaciones de terapias no farmacológicas abren un amplio abanico de posibilidades desde el ámbito de la prevención, y de la mejora de la calidad de vida en cuidadores y familiares de enfermos con demencia, básicamente con sintomatología de “sobrecarga”. En este articulo hacemos una revisión sobre investigaciones relacionadas con la “atención plena” ( MF) y de su implementación como estrategias potenciales en el abordaje de este tipo de patologías. Los últimos trabajos aportados con técnicas morfométricas por neuroimagen constituyen un importante avance a la hora de intentar aportar evidencia científica en este campo.

Quantum emitters have been recently isolated in 2D materials, yet their spatial controllability remains an open challenge. Here, the authors devise a method to create arrays of quantum emitters in WSe2 and WS2, by taking advantage of the strain distribution induced by a nanopatterned silica substrate.

Partiendo de la importancia que la educación emocional tiene en los alumnos de Educación Infantil resulta obligado que estas competencias también estén presentes en la formación de los docentes. El objetivo de este trabajo es analizar la oferta formativa sobre educación emocional impartida desde los CFIEs de Burgos y Miranda de Ebro. Se realizó un estudio descriptivo y transversal. Se llevaron a cabo análisis de frecuencias con el programa estadístico SPPS v. 22. Se obtiene que el 69,9% de los cursos analizados están relacionados con la educación emocional o inteligencia emocional, que este tipo de cursos se ha triplicado en los últimos años, siendo los centros públicos lo que en su mayoría los realizan. Los destinatarios principales son el profesorado de las etapas de infantil y primaria. La educación emocional en el desempeño docente del profesorado de Educación Infantil es un aspecto clave para que éstos puedan implementar metodologías activas que posibiliten el desarrollo integral del alumnado. Por lo tanto, pese a que la oferta de formación permanente vinculada a las habilidades emocionales se está incrementando en los últimos años, es necesario que los responsables de los CFIEs planifiquen un plan de actuación que se desarrolle en todas las zonas de la provincia de Burgos.

Introduction: Intellectual disability presents a series of clinical manifestations that affect psychological, emotional, social, and functional level. The Mindfulness aims to change the relationship that people have with daily activities, trying to point them at the present moment. In this way you will know better answers in the Middle, and you will favour emotional regulation, and behavioral. Objective: Demonstrate the effect of applying the Mindfulness technique as a means to improve communication skills and social in people with intellectual disabilities from occupational therapy. Methodology: Type longitudinal, quasi-experimental study. Collected data about the social skills of the users and the facets of the Mindfulness, using the EHS and FFMQ scales respectively. The intervention was carried out with the Mindfulness technique in 8 sessions of 45 minutes. And a sample of 12 users, with an average age of 40 years (DT = ± 8,21307). Results: Were statistically significant improvement in self-expression in social situations and in the beginning of positive interactions with the opposite sex. Conclusions: Scores have improved in all the variables in the post-test, but not all in a meaningful way. Likely to increase the number of sessions would increase the probability of finding more significant results.

The present study analyzes the effectiveness of a procedure of automatic reduction of prejudice, based on the assumption of the perspective of the members of stereotyped groups. Specifically, the evaluation of this cognitive strategy in the elderly population is addressed, and potentially modulating variables between the intervention and its effects on prejudice are considered: personality, values, empathy and attribution. Data were collected from a sample of 58 participants with a mean age of 63 years, in which an intervention based on mental imagery aimed at reducing prejudice was implemented. The results show a moderate effectiveness of the strategy and find interaction with several modulating variables, notably particularly kindness, along with attributional activity and values of benevolence, universalism, self direction and conformity, which modulated the effectiveness of perspective taking. The discussion, in addition to contrasting parallels and divergences with the results of other experiments, suggests some applications in the training of elder people, demonstrating that cognitive self-regulation is considered as a relevant competence in the advanced stages of life, decisive for achieving a satisfactory and inclusive active ageing.

The benefits at the psychological level of the regular practice of physical-sport activity in elderly people are unquestionable; similarly, intergenerational programs promote their psychological well-being. In this sense, some authors point out the need to investigate the benefits of physicalsport practice in an intergenerational format. The objective of this work has been to know the impact that sports practice has on self-esteem, self-efficacy, depression and psychological well-being of the elderly and whether the intergenerational format provides differential benefits at an emotional level. For it we have carried out a systematic review by analyzing various papers and studies that address this subject since 2000 to the present. The databases consulted were Scopus, WOS, CSIC and Dialnet. Twelve scientific articles have been analyzed. The results allow us to verify how sport or physical exercise adapted to the elderly improves their self-esteem, self-concept, indicators of depression and in general their subjective well-being. In the same way, intergenerational sports practice increases the emotional well-being of the elderly. Although, in the latter case, studies are scarce and research is demanded on the differential efficacy of sports programs between peers or in an intergenerational format.

Our research focuses on determining the preeminence of education for leisure within the competencial configuration of teachers in their initial training through the analysis of international, European, and national documents related to profesional teaching skills. The interest lies in the detected need to include within teaching performance aspects related to transversal skills, that may satisfy the educational objective of promoting and developing each student.

Nuestro trabajo expone los resultados de la investigación llevada a cabo para identificar los principales rasgos que definen en la actualidad el modelo competencial de persona adulta y conocer las inferencias y repercusiones que comporta en la formación inicial del Educador Social. Mediante la triangulación del análisis de la política educativa nacional y supranacional con los datos empíricos de entrevistas a 50 personas mayores, con edades entre 45 y 80 años, identificamos las nuevas expectativas y necesidades que el aprendizaje a lo largo de la vida induce en la formación de estos profesionales y en qué aspectos se materializa la necesidad de modificar su perfil y competencias.