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Series describing the evolution of patients with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 and supported with extracorporeal membrane oxygenation (ECMO) during the first wave of the pandemic have reported mortalities ranging from 30 to 60% [1, 2]. More recent publications have demonstrated a trend towards a higher mortality in COVID-19 patients receiving support in later periods of the pandemic, even though the overall mortality of the disease seems lower [3, 4]. The reasons for this difference are not clear. Statistical analysis was carried out in the Statistics and Bioinformatics Unit (UEB) Vall d'Hebron Hospital Research Institute (VHIR). The following practitioners provided care for the study patients

Background: The benefits of the use of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) due to COVID-19 remain controversial. Methods: In this multicenter cohort study, we analyzed all the adult patients with ARDS due to COVID-19 who received extracorporeal respiratory support at 25 ECMO centers (23 in Spain and two in Portugal) during the first and second waves of the pandemic. Follow-up ended on December 1. Our primary aim was to describe this cohort taking into account its evolution during the pandemic. We also investigated hazard ratios for hospital mortality. Findings: A total of 334 patients were included. Patients supported during the second wave [176 (52.7%)] were older (54.6±9.7 vs 50.9±10.6,p=0.001), had more comorbidities, were more frequently coinfected at the start of ECMO [62 (35.2%) vs 37 (23.3%),p=0.028] and were less likely to be treated at a high-volume center [42 (23.9%) vs 54 (34.2%),p=0.008] than those supported during the first wave [158 (47.3%)]. At December 1, 134 (40.1%) patients had died and 49 (14.6%) were still on ECMO. Among patients supported during the first wave, 93 (58.8%) were discharged and all were alive at six months. Older age [HR 3.49 (1.94-6.28),p

Background Controlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device. Case presentation We describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 min. The surgery was uneventful. Conclusions This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.

Normothermic regional perfusion (NRP) in controlled donation after circulatory death is becoming a popular method due to the favorable results of the grafts procured under this technique. This procedure requires experience, and, sometimes, the availability of extracorporeal membrane oxygenation (ECMO) machines to implement NRP is limited to tertiary hospitals. In order to provide support with NRP in controlled donation after circulatory death across the different hospitals of the Autonomous Community of Madrid, a mobile NRP team was created. In the first 18 months since its creation, the mobile NRP team participated in 33 procurements across nine different hospitals, representing 72% of all controlled donations after circulatory death in the Autonomous Community of Madrid. NRP was successfully performed in 29 (88%) cases, with a mean duration of 69 ± 27 minutes. A total of 39 kidneys, 12 livers, and 5 bilateral lungs were recovered and transplanted. None of the livers were discarded due to an elevation in transaminases during NRP. A mobile NRP team is a feasible option and, in our series, aided in the optimization and recovery of organs from donors after controlled circulatory death in centers where ECMO technology was not available.

To describe the characteristics and the evolution of patients with solid tumours admitted to the ICU and to identify factors associated with hospital mortality and to evaluate three illness severity scores.Descriptive study including 132 patients with solid tumour admitted to the ICU (2010-2016). Demographics and cancer-related data, organ failures, life-supporting therapies and severity scores: APACHE II, SOFA and ICU Cancer Mortality Model (ICMM) were collected.There were 58 patients admitted for medical reasons and 74 for scheduled surgery. The ICU and hospital mortality rate were 12.9% and 19.7%, respectively. The medical reason for admission, the number of organ failures, and the need of life-supporting therapies were significantly associated with a higher mortality (p0.05). In the logistic regression analysis, the three severity scores: SOFA (OR 1.18, 95% IC 1.14-1.48), APACHE II (OR 1.11, 95% CI 1.09-1.27), and ICMM (OR 1.03, 95% CI 1.02-1.07) were independently associated with a higher mortality (p0.05). To evaluate the discrimination, the area under the receiver operating characteristics curves (AUROC) were calculated: APACHE II (0.795, 95% CI 0.69-0.9), SOFA (0.77, 95% CI 0.69-0.864) and ICMM (0.794, 95% CI 0.697-0.891). The comparison of AUC ROC after DeLong's test showed no difference between them.Hospital mortality was associated with the type and severity of acute illness. The three severity scores were useful to assess outcome and accurate in the discrimination, but we did not find a significant difference between them.

Background Prevalence of chronic diseases and unhealthy lifestyle behaviors among the adult population of Puerto Rico (PR) is high; however, few epidemiological studies have been conducted to address these. We aimed to document the methods and operation of establishing a multisite cross-sectional study of chronic diseases and risk factors in PR, in partnership with academic, community, clinical, and research institutions. Methods The Puerto Rico Assessment of Diet, Lifestyle and Diseases (PRADLAD) documented lifestyle and health characteristics of adults living in PR, with the goal of informing future epidemiological and intervention projects, as well as public health, policy, and clinical efforts to help improve the population’s health. The study was conducted in three primary care clinics in the San Juan, PR metropolitan area. Eligible volunteers were 30–75y, living in PR for at least 10 months of the previous year, and able to answer interviewer-administered questionnaires without assistance. Questions were recorded electronically by trained interviewers, and included socio-demographic characteristics, lifestyle behaviors, self-reported medically-diagnosed diseases, and psychosocial factors. Waist and hip circumferences were measured following standardized protocols. A subset of participants answered a validated food frequency questionnaire, a legumes questionnaire, and had medical record data abstracted. Process and outcome evaluation indicators were assessed. Results The study screened 403 participants in 5 months. Of these, 396 (98%) were eligible and 380 (94%) had reliable and complete information. A subset of 242 participants had valid dietary data, and 236 had medical record data. The mean time to complete an interview was 1.5 h. Participants were generally cooperative and research collaborators were fully engaged. Having multiple sites helped enhance recruitment and sociodemographic representation. Diagnosed conditions were prevalent across sites. Challenges in data monitoring, interviewer training, and scheduling were identified and corrected, and should be addressed in future studies. Conclusions Epidemiological studies in PR can be successfully implemented in partnership with multiple institutions. Effective recruitment and implementation requires concerted planning and continued involvement from partners, frequent quality control, brief interviews, reasonable incentives, and thorough training/re-training of culturally-sensitive interviewers. Further studies are feasible and needed to help address highly prevalent chronic conditions in PR.

Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.

Objective. The purpose of this study was to understand through a quantitative assessment, the views of HPV and HPV vaccination among parents of sons from a FQHC in PR. Methods. A self-administered questionnaire was given to a convenience sample of 200 parents of sons 9–17 years old. Results. Nearly 30% of the parents reported that their sons had initiated the HPV vaccine regimen. Health care provider recommendation was significantly associated with vaccine initiation. Among parents of unvaccinated sons, the main reason for not getting the HPV vaccine was they did not know that boys were allowed to get the vaccine. Conclusions. Future efforts should focus on multilevel interventions aimed to increase knowledge as well as other modified behavioral determinants in parents of young males about HPV and the vaccine. Capacity building efforts should be targeted also to increase health providers’ education and communication skills to promote HPV vaccination effectively.

Measurements on a heavily instrumented pitch regulated variable speed Vestas V52 850 kW wind turbine situated at the DTU Riso Campus are carried out, where the effect of vortex generators mounted on almost the entire blade is tested with and without leading edge roughness. The measurements are compared to the predictions carried out by a developed design tool, where the effect of vortex generators and leading edge roughness is simulated using engineering models. The measurements showed that if vortex generators are mounted there is an increase in flapwise blade moments if the blades are clean, but also that the loads are almost neutral when vortex generators are installed if there is leading edge roughness on the blades. Finally, it was shown that there was a good agreement between the measurements and the predictions from the design tool.

Background: A quadrivalent Human Papillomavirus (HPV) vaccine was licensed in 2009 for boys and young males aged 9-26 years for the prevention of genital warts. In 2011, new recommendations to routine vaccination were given for prevention of genital warts and anal cancer in males. Given that HPV vaccine is most effective if administered prior to HPV exposure through sexual contact, vaccination promotion strategies on male adolescents younger than 17 years old are essential. Objectives: The purpose of this study was to describe the profile of parents of boys 9-17 years old, identify correlates associated with HPV vaccine initiation, and have a better understanding of the educational messages that might influence the HPV vaccine administration. Methods: A mixed-method study was conducted in HealthproMed, a Federally Qualified Health Center (FQHC) in Santurce, Puerto Rico. A self-administered questionnaire containing sociodemographic information as well as a module on HPV vaccine was collected among 200 parents. Also, two separate focus group sessions were held among parents of vaccinated and unvaccinated boys. Descriptive statistics were performed to characterize the study population. Bivariate analysis was used to assess HPV vaccine initiation (received ≤ 1 dose) as the dependent variable, and other parents and sons' characteristics as independent variables. Those variables who achieved statistical significance (p Results: The mean age of the recruited parents was 37.7 ± 7.2 years old. The vast majority were females (88.5%), born in Puerto Rico (65.3%), and reported a high school degree or lower (57.4%). Regarding sons' characteristics, their mean age was 12.5 ± 2.6 years old. Most of the parents reported that their sons had visited a healthcare provider in the last year (78.1%) and that they had a healthcare coverage (75.0%). Approximately a third of the parents reported that their sons had initiated the HPV vaccination (29.3%). Most of the interviewed parents have heard about HPV infection (88.1%), and the administration of the vaccine among males (62.4%). In multivariate analysis, parents who had asked a health provider (OR= 6.5; 95% CI= 1.2-34.4) and received a health provider recommendation (OR= 13.0; 95% CI= 2.1-82.7) to get their sons the HPV vaccine, as well as having a daughter who had received the HPV vaccine (OR= 4.9; 95% CI= 1.1-22.4), were more likely to have initiated the HPV vaccine administration. Focus groups supported our quantitative analysis in recommending health care providers for HPV vaccination. Presentations of clinical images to document the health consequences of HPV infection were suggested by parents. Interest topics among parents in order to increase HPV vaccination includes: (1) understanding of the risk factors for HPV infection; (2) vaccine costs; (3) places where the vaccine can be administered; and (4) understanding the importance of administer the vaccine in a timely schedule. Conclusions: Quantitative data shows that health care provider recommendation is associated with HPV vaccine initiation. Qualitative data, on the other hand, highlighted the topics and messages that should be included as part of educational campaigns targeting parents and young men for HPV vaccination. Since a high percentage of unvaccinated parents indicated that they have not received recommendation from healthcare providers, efforts in HPV vaccine promotion should include capacity building strategies for healthcare providers to then educate parents and their sons about the benefits of the HPV vaccination. Citation Format: Lizbeth M. Del Toro-Mejias, Alexandra Conde-Toro, Michelle Serra-Rivera, Tania M. Martinez, Veronica Rodriguez, Hector Villanueva, Luis Berdiel, Vivian Colon-Lopez. HPV vaccine initiation among Hispanic adolescent males in Puerto Rico: A mixed-method study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B62. doi:10.1158/1538-7755.DISP13-B62