Search

Carlos Camps Herrero,1 Antonio Antón Torres,2 Juan Jesús Cruz-Hernández,3 Alfredo Carrato,4 Manuel Constenla,5 Eduardo Díaz-Rubio,6 Margarita Feyjoo Saus,7 Jesus Garcia-Foncillas,8 Pere Gascón,9 Vicente Guillem101Jefe de Servicio de Oncología Médica, Consorcio Hospital General Universitario, Valencia, Spain; 2Jefe del Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain; 3Jefe del Servicio de Oncología Médica, Hospital Universitario De Salamanca-IBSAL, Salamanca, Spain; 4Jefe del Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain; 5Jefe de Servicio de Oncología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; 6Jefe del Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain; 7Jefe del Servicio de Oncología Médica, Hospital La Moraleja, Madrid, Spain; 8Jefe de Servicio de Oncología Médica, Hospital Universitario “Fundación Jiménez Díaz”, Madrid, Spain; 9Jefe del Servicio de Oncología Médica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; 10Jefe del Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, SpainPurpose: There is a lack of standards for the diagnosis, assessment and management of breakthrough cancer pain (BTcP). La Fundación ECO (the Foundation for Excellence and Quality in Oncology) commissioned a study to establish a consensus and lay the foundations for the appropriate management of BTcP in oncology patients.Patients and methods: A modified Delphi survey comprising two rounds was used to gather and analyze data, which was conducted over the Internet. Each statement that reached a consensus with the respondents was defined as a median consensus score (MED) of ≥7, and agreement among panelists as an interquartile range (IQR) of ≤3.Results: In total, 69 medical oncologists responded, with a broad consensus that BTcP implied exacerbations of high-intensity pain, as opposed to moderate pain. Furthermore, they concurred that appropriate diagnostic equipment is needed, and that rapid-onset fentanyl formulations should be the preferred treatment for BTcP management. The panelists agreed that a lack of appropriate information and training to attend to patients, as well as limited patient visitation rights, were barriers to effective BTcP management. Regarding gaps in detected knowledge, the panelists were unsure of the measures necessary to assess the burden of the disease on the patient’s quality of life and associated medication costs. Alongside this, there was a lack of awareness of the technical specifics of the different formulations of rapid-onset fentanyl.Conclusion: These results represent the current status of BTcP management. They may inform recommendations and provide a framework for future research.Keywords: breakthrough pain, rapid-onset opioids, fentanyl, medical oncology, pain management

Recently, the integration of coaching methodologies within educational environments has garnered significant attention due to their potential to enhance student learning outcomes and overall academic performance. While the literature extensively examines the effectiveness of coaching in a plethora of scenarios (e.g., sports, business, and entrepreneurship), there remains a notable research gap regarding its application within undergraduate educational environments, where coachees have unique characteristics in terms of background, age/maturity, resources availability, and population size. This literature review aims to address this gap by synthesizing existing research on the implementation of coaching strategies in educational settings and how they can cope with a large number of students. Through a comprehensive analysis, this study elucidates the current state of knowledge, identifies prevailing methodologies, and evaluates the outcomes associated with employing coaching techniques in group contexts. Moreover, this work explores the potential benefits and challenges of utilizing coaching strategies in group sessions, offering insights into their scalability and applicability within diverse educational settings. The findings of this review underscore the importance of further research in this domain to advance our understanding of how coaching methodologies can be effectively adapted to facilitate collaborative learning experiences and promote student success on a broader scale. Ultimately, this study advocates for the integration of group coaching approaches as a promising avenue for enhancing the efficiency and accessibility of traditional tutoring and mentoring practices in education.

Background: Equatorial Guinea (EG) is located on the African west coast, with only 0.4 trained physicians per 1,000 resident population. The country has one medical school and there is no specialist training program. From 2000 to 2022, 524 doctors have received their medical degree. However, the number of national surgical specialists in the entire country is currently 42. Objective: Formación Especializada Sanitaria en Guinea Ecuatorial (FES Guinea) is a program specifically aimed at designing and implementing a long-term national surgical specialist training program. Methods: Más Que Salud (+QS), which means “More than Health” in Spanish, is a nonprofit organization leading the FES Guinea program. We used the theory of change (ToC) framework to evaluate the work accomplished and implement subsequent phases. The initial phase (A) included a needs assessment and mapping of available resources. An intermediate phase (B) started with a memorandum of understanding to implement a Train the Trainer program. The consolidation phase (C) consists of educational interventions and future advanced training projects. Findings: The ToC model allowed us an analyses of initial and intermediate phases. The needs assessments and resources mapping were executed while several scientific meetings and workshops were given. Scholarships to support specialist training abroad benefited six physicians in a diverse set of surgical disciplines. A regulatory commission to implement the FES Guinea program and the National Medical Council of EG were created. Working directly with the EG Ministry of Health, +QS codesigned a National Health Development Plan that began implementation in 2021 to continue until 2025. Conclusions: The ToC model allowed us to predict the current and future potential effects of FES Guinea on surgical workforce development in EG. This is a unique surgical training program, which combined effective initiatives spearheaded initially by an NGO that successfully incorporated both local health and academic authorities, ensuring sustainability.

Abstract Due to their versatility and the high biomass yield produced, cultivation of phototrophic organisms is an increasingly important field. In general, open ponds are chosen to do it because of economic reasons; however, this strategy has several drawbacks such as poor control of culture conditions and a considerable risk of contamination. On the other hand, photobioreactors are an attractive choice to perform cultivation of phototrophic organisms, many times in a large scale and an efficient way. Furthermore, photobioreactors are being increasingly used in bioprocesses to obtain valuable chemical products. In this review, we briefly describe different photobioreactor set‐ups, including some of the recent designs, and their characteristics. Additionally, we discuss the current challenges and advantages that each different type of photobioreactor presents, their applicability in biocatalysis and some modern modeling tools that can be applied to further enhance a certain process.

Abstract Background Walking is an essential activity for everyone and for older adults in particular, given that it is the most accessible form of physical activity and one of the healthiest transportation modes. Understanding how walkability (the potential of the environment to enable and/or encourage walking) has been objectively measured and analyzed for older adults is critical to create more inclusive, healthy, and sustainable environments and to promote healthy aging. Despite the numerous reviews on physical activity among older adults and its relationship with the built environment, the literature still lacks comparison reviews focusing specifically on objective operationalizations of walkability for older adults vs. the general population. Methods We conducted a systematic review of 146 empirical studies that measured walkability objectively in relation to walking-related outcomes. We compared studies focused on older adults (n = 24) and the general population (n = 122). Content analysis included the characteristics of the study design, walkability measures, spatial extent, and associations found between walkability and walking-related outcomes. Results In both groups of publications, the majority of studies were conducted in the US, Canada, and Europe, and largely in high-income countries. They were mostly published in health-related journals and used cross-sectional designs, operationalized walkability by using indexes, employed self-reported measures for walking-related outcomes, and found positive associations between walkability and walking outcomes. However, we observed some differences among studies focusing on older adults. Compared to studies focusing on the general population, a larger proportion of studies on older adults was conducted in the Middle East and Asia, and they used longitudinal designs, mixed methods to measure walking-related outcomes, variables related with land-use characteristics, safety from traffic and crime, and greenery, and a larger proportion found positive, as well as no associations between walkability and walking-related outcomes. Conclusion Although there is a promising increase in interest in older adults-focused walkability studies in the last decade, there is still a need for more studies focusing on different settings, using wider spatial extents, longitudinal designs, objective or mixed methods to collect outcome data, and specific variables and/or specially created indexes for older adults and for settings.

Many academics, urban planners and policymakers subscribe to the benefits of implementing the concept of the 15-Minute City (FMC) in metropolises across the globe. Despite the interest raised by the concept, and other variants of chrono-urbanism, to date, only a few studies have evaluated cities from the FMC perspective. Most studies on the subject also lack a proper well-defined methodology that can properly assess FMC conditions. In this context, this study contributes to the development of an appropriate FMC-measuring method by using network analysis for services and activities in the City of Barcelona (Catalonia, northeastern Spain). By using network analyst and basing our analysis on cadastral parcels, this study is able to detail the overall accessibility conditions of the city and its urban social functions based on the FMC perspective. The resulting spatial synthetic index is enhanced with the creation of partial indexes measuring the impact of education, provisioning, entertainment, public and non-motorized transport, and care facilities. The results show that most residents of this dense and compact city live in areas with proximity to services, that can clearly be labeled as FMC, although there are some shortfalls in peripheral areas. Results validate the FMC methodology as a viable method to highlight spatial inequalities at the microscale level, a valuable tool for the development of effective planning policies.

ABSTRACTUrban growth boundaries (UGBs) established by urban planning, are common containment strategies to prevent urban sprawl. We analyze the effectiveness of the UGB strategy in the case of the Metropolitan Region of Santiago de Chile, established by the land use plan in 1994. We describe and quantify the annual growth rate and the development of new built-up areas inside and outside the boundary using GIS. The results show that the expansion of built-up areas is greater outside than inside the UGB (75% vs. 49%), and with a higher annual growth rate outside the UGB (14.6% vs. 2.8%). To achieve greater effectiveness in the strategy, it is necessary to overcome those regulatory mechanisms that allow urbanization beyond the boundary, identified as a factor that promotes expansion, contradicting the objective of the plan.

Theta and gamma oscillations in the hippocampus have been hypothesized to play a role in the encoding and retrieval of memories. Recently, it was shown that an intrinsic fast gamma mechanism in medial entorhinal cortex can be recruited by optogenetic stimulation at theta frequencies, which can persist with fast excitatory synaptic transmission blocked, suggesting a contribution of interneuronal network gamma (ING). We calibrated the passive and active properties of a 100-neuron model network to capture the range of passive properties and frequency/current relationships of experimentally recorded PV+ neurons in the medial entorhinal cortex (mEC). The strength and probabilities of chemical and electrical synapses were also calibrated using paired recordings, as were the kinetics and short-term depression (STD) of the chemical synapses. Gap junctions that contribute a noticeable fraction of the input resistance were required for synchrony with hyperpolarizing inhibition; these networks exhibited theta-nested high frequency oscillations similar to the putative ING observed experimentally in the optogenetically-driven PV-ChR2 mice. With STD included in the model, the network desynchronized at frequencies above ~200 Hz, so for sufficiently strong drive, fast oscillations were only observed before the peak of the theta. Because hyperpolarizing synapses provide a synchronizing drive that contributes to robustness in the presence of heterogeneity, synchronization decreases as the hyperpolarizing inhibition becomes weaker. In contrast, networks with shunting inhibition required non-physiological levels of gap junctions to synchronize using conduction delays within the measured range.