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In this paper, we study the creep phenomena for self-similar models of viscoelastic materials and derive a generalization of the Kelvin–Voigt model in the framework of fractal continuum calculus. Creep compliance for the Kelvin–Voigt model is extended to fractal manifolds through local fractal-continuum differential operators. Generalized fractal creep compliance is obtained, taking into account the intrinsic time τ and the fractal dimension of time-scale β. The model obtained is validated with experimental data obtained for resin samples with the fractal structure of a Sierpinski carpet and experimental data on rock salt. Comparisons of the model predictions with the experimental data are presented as the curves of slow continuous deformations.

The trafficking of illegal substances is a global issue. Tamaulipas, a northeastern state in Mexico, is strategically located for drug trafficking to the United States by organized crime. In this study, drug seizure events conducted by the Mexican government in the main cities of Tamaulipas between 2017 and 2022 are analyzed. It was noticed that there was a decrease in events from 2017 to 2020, followed by a slight increase in 2021. Marijuana was the most seized drug, with cocaine and amphetamines following behind. The frequency of drug seizure events was higher in the border cities of Nuevo Laredo, Reynosa, and Matamoros due to their international commercial bridges with the USA. Nuevo Laredo and Reynosa showed a high amount of marijuana seized. In Matamoros, a coastal city, the quantity of cocaine seized was the highest. Results suggest that substances seized were intended to be illegally transported to the USA through Mexican border cities.

Abstract Objective To describe healthcare resource utilization (HCRU) and costs, in patients with newly diagnosed heart failure (HF) according to ejection fraction (EF) in Spain. Methods Retrospective cohort study that analyzed anonymized, integrated and computerised medical records in Spain. Patients with ≥ 1 new HF diagnosis between January 2013 and September 2019 were included and followed-up during a 4-year period. Rates per 100 person-years of HCRU and costs were estimated. Results Nineteen thousand nine hundred sixty-one patients were included, of whom 43.5%, 26.3%, 5.1% and 25.1% had HF with reduced, preserved, mildly reduced and unknown EF, respectively. From year 1 to 4, HF rates of outpatient visits decreased from 1149.5 (95% CI 1140.8–1159.3) to 765.5 (95% CI 745.9–784.5) and hospitalizations from 61.7 (95% CI 60.9–62.7) to 15.7(14.7–16.7) per 100 person-years. The majority of HF-related healthcare resource costs per patient were due to hospitalizations (year 1–4: 63.3–38.2%), followed by indirect costs (year 1–4: 12.2–29.0%), pharmacy (year 1–4: 11.9–19.9%), and outpatient care (year 1–4: 12.6–12.9%). Mean (SD) per patient HF-related costs decreased from 2509.6 (3518.5) to 1234.6 (1534.1) Euros (50% cost reduction). At baseline, 70.1% were taking beta-blockers, 56.3% renin-angiotensin system inhibitors, 11.8% mineralocorticoid receptor antagonists and 8.9% SGLT2 inhibitors. At 12 months, these numbers were 72.3%, 65.4%, 18.9% and 9.8%, respectively. Conclusions Although the economic burden of HF decreased over time since diagnosis, it is still substantial. This reduction could be partially related to a survival bias (sick patients died early), but also to a better HF management. Despite that, there is still much room for improvement.

RESUMEN Introducción y objetivos: El implante percutáneo de válvula pulmonar es, actualmente, un procedimiento habitual en pacientes con cardiopatías congénitas con un tracto de salida del ventrículo derecho disfuncionante. Hasta abril de 2022, en Europa solo estaban disponibles las válvulas expandibles con balón, que no cubrían las necesidades de las distintas anatomías del tracto de salida derecho. Desde ese año está disponible la válvula autoexpandible Venus P (MedTech, China). Presentamos la experiencia inicial en nuestro centro con esta nueva válvula pulmonar para implante percutáneo. Métodos: Descripción de los implantes valvulares con la nueva válvula autoexpandible realizados entre septiembre y noviembre de 2022. Resultados: Se han realizado 8 implantes valvulares, todos con éxito y sin complicaciones graves durante el procedimiento. Todos los pacientes presentaban insuficiencia pulmonar grave con repercusión sobre el ventrículo derecho y dilatación del tronco pulmonar, y no eran buenos candidatos para las válvulas expandibles con balón. Cinco pacientes tenían una tetralogía de Fallot de base. En 7 pacientes el implante se llevó a cabo por vía femoral y en 1 por vía yugular. Como medida de seguridad, en todos los pacientes el implante se hizo a través de una vaina DrySeal (Gore, W.L. Gore & Associates, Inc., Estados Unidos). La media de tiempo de ingreso fue de 3 días. Conclusiones: El implante de la nueva válvula autoexpandible Venus P fue, en nuestra experiencia preliminar, un procedimiento seguro y factible, que permite valvular tractos de salida derechos muy dilatados con contraindicación para las actuales válvulas expandibles con balón.

ABSTRACT Introduction and objectives: Percutaneous pulmonary valve implantation is currently a common procedure in patients with congenital heart disease with a dysfunctional right ventricular outflow tract. Until April 2022, there were only balloon-expandable valves available in Europe, which did not cover the needs of the different anatomies of the right ventricular outflow tract. Since that date we have available the self-expandible Venus P-valve (Venus MedTech, China). We present the initial experience with this new percutaneous pulmonary valve in our center. Methods: Description of the valve implants with the new self-expandible valve performed between September and November 2022. Results: Eight valve implants have been performed, all successful and without severe complications during the procedure. All patients had severe pulmonary regurgitation with a dilated right ventricle and severe dilatation of the pulmonary trunk and were not good candidates for percutaneous balloon-expandable valves. Five patients had a tetralogy of Fallot. In 7 patients, the implant was performed through the femoral vein and in one through jugular access. As a safety measure, all valves were implanted through a DrySeal sheath (Gore, W.L. Gore & Associates, Inc., United States). The mean hospital stay was 3-day. Conclusions: Valve implantation with the new self-expandible Venus P-valve was, in our preliminary experience, a safe and feasible procedure, allowing us to treat very dilated right outflow tracts, not suitable for the current balloon-expandable valves.

Non-structural carbohydrates (NSCs) are energetic compounds that can be accumulated in tissues and mobilized during periods of unfavorable conditions to maintain the biological functions of plants. The balance of these biochemical compounds is controlled by environmental factors such as temperature and irradiance. Zostera noltei and Zostera marina find one of their southern distribution limits in southern Spain, where relatively high seawater temperatures are reached during summer (23–24 °C). To better understand the effects of elevated temperatures on the concentration of NSCs, we conducted a seasonal study at Cadiz Bay, representing warm-adapted populations of these species. Our results showed a bimodal pattern in both species, with the highest NSC content observed in December and June, followed by a depletion in March and August. In addition, the NSC content observed in the leaves of Z. noltei (71.26 ± 30.77 mg g−1 dry weight) was higher than in the rhizomes and roots (52.14 ± 38.86 mg g−1 DW). The observed patterns suggest that these species accumulated NSCs to cope with periods of unfavorable environmental conditions. We also suggest that the limited concentration of NSCs in Z. noltei rhizomes and roots indicates that this population may be suffering physiological stress.

Chronic urticaria is a chronic skin disease that affects up to 1% of the general population worldwide, with chronic spontaneous urticaria accounting for more than two-thirds of all chronic urticaria cases. The Urticaria Activity Score (UAS) is a dynamic severity assessment tool that can be incorporated into daily clinical practice, as well as clinical trials for treatments. The UAS helps in measuring disease severity and guiding the therapeutic strategy. However, UAS assessment is a time-consuming and manual process, with high interobserver variability and high dependence on the observer. To tackle this issue, we introduce Automatic UAS, an automatic equivalent of UAS that deploys a deep learning, lesion-detecting model called Legit.Health-UAS-HiveNet. Our results show that our model assesses the severity of chronic urticaria cases with a performance comparable to that of expert physicians. Furthermore, the model can be implemented into CADx systems to support doctors in their clinical practice and act as a new end point in clinical trials. This proves the usefulness of artificial intelligence in the practice of evidence-based medicine; models trained on the consensus of large clinical boards have the potential of empowering clinicians in their daily practice and replacing current standard clinical end points in clinical trials.

IntroductionThere is a need to develop harmonized procedures and a Minimum Data Set (MDS) for cross-border Multi Casualty Incidents (MCI) in medical emergency scenarios to ensure appropriate management of such incidents, regardless of place, language and internal processes of the institutions involved. That information should be capable of real-time communication to the command-and-control chain. It is crucial that the models adopted are interoperable between countries so that the rights of patients to cross-border healthcare are fully respected.ObjectiveTo optimize management of cross-border Multi Casualty Incidents through a Minimum Data Set collected and communicated in real time to the chain of command and control for each incident. To determine the degree of agreement among experts.MethodWe used the modified Delphi method supplemented with the Utstein technique to reach consensus among experts. In the first phase, the minimum requirements of the project, the profile of the experts who were to participate, the basic requirements of each variable chosen and the way of collecting the data were defined by providing bibliography on the subject. In the second phase, the preliminary variables were grouped into 6 clusters, the objectives, the characteristics of the variables and the logistics of the work were approved. Several meetings were held to reach a consensus to choose the MDS variables using a Modified Delphi technique. Each expert had to score each variable from 1 to 10. Non-voting variables were eliminated, and the round of voting ended. In the third phase, the Utstein Style was applied to discuss each group of variables and choose the ones with the highest consensus. After several rounds of discussion, it was agreed to eliminate the variables with a score of less than 5 points. In phase four, the researchers submitted the variables to the external experts for final assessment and validation before their use in the simulations. Data were analysed with SPSS Statistics (IBM, version 2) software.ResultsSix data entities with 31 sub-entities were defined, generating 127 items representing the final MDS regarded as essential for incident management. The level of consensus for the choice of items was very high and was highest for the category 'Incident' with an overall kappa of 0.7401 (95% CI 0.1265-0.5812, p 0.000), a good level of consensus in the Landis and Koch model. The items with the greatest degree of consensus at ten were those relating to location, type of incident, date, time and identification of the incident. All items met the criteria set, such as digital collection and real-time transmission to the chain of command and control.ConclusionsThis study documents the development of a MDS through consensus with a high degree of agreement among a group of experts of different nationalities working in different fields. All items in the MDS were digitally collected and forwarded in real time to the chain of command and control. This tool has demonstrated its validity in four large cross-border simulations involving more than eight countries and their emergency services.

The prevalence of mental disorders in prisons is a growing phenomenon involving various social actors, the health of persons deprived of liberty and the functioning of penitentiary institutions. The objective of this study is to describe the challenges and strategies implemented by the members of the Technical Committees (TC) to attend, evaluate and monitor the prison treatment of persons deprived of liberty with mental disorders in the CEDES of the state of Tamaulipas. Through semi-structured interviews applied to the personnel of the Technical Committees of state penitentiaries, it was found that one of the main obstacles to the care of this social group is the lack of psychiatrists, as well as specialized personnel for their care; therefore, the staff develops various strategies to meet the requirements of this social group in occupational therapy, primary care and pharmacotherapy.

Resumen: Introducción y objetivos: La quinasa ligada a integrina (ILK) endotelial controla la producción del óxido nítrico, modulando señales de transducción al interior celular. La disminución de ILK endotelial se ha relacionado con la calcificación valvular. Analizamos la asociación de la ILK con la calcificación de la válvula aórtica. Métodos: Estudio observacional, unicéntrico y prospectivo. Recogimos tejido valvular aórtico de pacientes intervenidos de estenosis aórtica, y controles de válvulas no calcificadas. Cuantificamos los niveles de ILK endotelial empleando técnicas de análisis molecular, así como marcadores de crecimiento óseo (BMP2 y RUNX2). Para el control de factores de confusión empleamos regresión logística múltiple por pasos, introduciendo parámetros relacionados con la aterosclerosis y calcificación valvular (edad, DM, HTA, insuficiencia renal). Resultados: Obtuvimos muestras de 75 pacientes y 28 controles. El 69,9% eran varones, la edad media fue de 67 años (DE 9,59 años). Los niveles de ILK fueron significativamente más bajos en válvulas patológicas que en controles (0,96 vs. 0,76; p

IntroductionThe antinociceptive and pharmacological activities of C-Phycocyanin (C-PC) and Phycocyanobilin (PCB) in the context of inflammatory arthritis remain unexplored so far. In the present study, we aimed to assess the protective actions of these compounds in an experimental mice model that replicates key aspects of human rheumatoid arthritis.MethodsAntigen-induced arthritis (AIA) was established by intradermal injection of methylated bovine serum albumin in C57BL/6 mice, and one hour before the antigen challenge, either C-PC (2, 4, or 8 mg/kg) or PCB (0.1 or 1 mg/kg) were administered intraperitoneally. Proteome profiling was also conducted on glutamate-exposed SH-SY5Y neuronal cells to evaluate the PCB impact on this key signaling pathway associated with nociceptive neuronal sensitization.Results and discussionC-PC and PCB notably ameliorated hypernociception, synovial neutrophil infiltration, myeloperoxidase activity, and the periarticular cytokine concentration of IFN-γ, TNF-α, IL-17A, and IL-4 dose-dependently in AIA mice. In addition, 1 mg/kg PCB downregulated the gene expression for T-bet, RORγ, and IFN-γ in the popliteal lymph nodes, accompanied by a significant reduction in the pathological arthritic index of AIA mice. Noteworthy, neuronal proteome analysis revealed that PCB modulated biological processes such as pain, inflammation, and glutamatergic transmission, all of which are involved in arthritic pathology.ConclusionsThese findings demonstrate the remarkable efficacy of PCB in alleviating the nociception and inflammation in the AIA mice model and shed new light on mechanisms underlying the PCB modulation of the neuronal proteome. This research work opens a new avenue to explore the translational potential of PCB in developing a therapeutic strategy for inflammation and pain in rheumatoid arthritis.

Abstract Aims To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. Results Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9–27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. Conclusions HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.

Our objective was to know the COVID-19 vaccination coverage in multiple sclerosis (MS) patients and its factors associated. A retrospective cohort study was carried out. Patients seen at the MS unit of the University Clinical Hospital of Zaragoza between 2017 and 2021 were included. Variables were obtained by reviewing the specialized and primary care records. Associations between receiving COVID-19 full primo-vaccination, as well as one booster dose since autumn 2022, and the other variables were analyzed using bivariate analysis and multiple logistic regression models. Of the 359 included patients, 90.3% received the COVID-19 full primo-vaccination. Having been born in Spain (aOR = 3.40) and having received the 2020–2021 influenza vaccine (aOR = 6.77) were associated with receiving the COVID-19 full primo-vaccination. Vaccination with a COVID-19 booster dose was detected in 141 patients (39.3%). Sex (man) (aOR = 2.36), age (60 years or over) (aOR = 6.82), type of MS (Primary Progressive/Secondary Progressive) (aOR = 3.94), and having received the 2022–2023 influenza vaccine (aOR = 27.54) were associated with receiving such a booster dose. The COVID-19 booster dose was administered at the same time as the 2022–2023 influenza vaccine in 57.8% (67/116) of the patients vaccinated with both vaccines. The COVID-19 full primo-vaccination coverage is higher than in other countries. However, the decrease in vaccination coverage with the booster dose makes it necessary to develop strategies to improve it that are not limited to administering the flu vaccine together with the COVID-19 booster dose. Such strategies should be in focus, especially for women under 60 years of age.

The larynx is an organ of the upper airway that participates in breathing, glutition, voice production, and airway protection. These complex functions depend on vocal fold (VF) movement, facilitated in turn by the action of the intrinsic laryngeal muscles (ILM). The necessary precise and near-instantaneous modulation of each ILM contraction relies on proprioceptive innervation of the larynx. Dysfunctional laryngeal proprioception likely contributes to disorders such as laryngeal dystonia, dysphagia, vocal fold paresis, and paralysis. While the proprioceptive system in skeletal muscle derived from somites is well described, the proprioceptive circuitry that governs head and neck structures such as VF has not been so well characterized. For over two centuries, researchers have investigated the question of whether canonical proprioceptive organs, muscle spindles, and Golgi tendon organs, exist in the ILM, with variable findings. The present work is a state-of-the-art review of the peripheral component of laryngeal proprioception, including current knowledge of canonical and possible alternative proprioceptive circuitry elements in the larynx.

IntroductionBefore the pandemic, suicide was already considered a global public health problem. The outbreak of COVID-19, a coronavirus-related infectious disease, began to impact people's physical and mental health. The factors that either contribute to or mitigate this risk need to be better understood, and this can only be accomplished through research. Therefore, this study aimed to study the prevalence of suicidal ideation and behavior in Tamaulipas, Mexico, during the COVID-19 pandemic.MethodsA quantitative, descriptive, and cross-sectional study was conducted. The sample consisted of 659 participants, of whom 194 (29.5%) were men and 465 (70.5%) participants were oldwomen, ranging in age between 16 and 68 years (M = 22.56, SD = 7.26). An adapted version of the Spanish version of the Columbia Suicidal Severity Rating Scale was used to assess the seriousness of suicidal ideation and behavior.ResultsThe higher rates of suicidal indicators were suicidal ideation with “wish to dead” (39.9%), while the lower was suicidal ideation with a specific plan (8.2%). A total of 18.2% of participants reported “suicidal attempts before COVID-19,” of whom 40% reported “suicidal attempts in the last 3 months.” Suicidal behavior rates were lower: 13.7% of participants reported “non-specific preparatory behavior” and 13.3% reported “actual suicide attempts.” Women were more likely than men to exhibit almost all indicators of suicidal ideation and behavior (OR = 1.63–2.54; 95% CI = 1.11–2.41, 1.76–3.68), as well as confinement (OR = 2.60; 95% CI = 1.73–3.91). Confinement for more than 40 days (OR = 0.55–0.66; 95% CI = 0.40–0.75, 0.47–0.93) and knowing a person infected with COVID-19 (OR = 1.57–2.01; 95% CI = 1.02–2.42, 1.20–3.34) were associated with a higher risk of exhibiting several suicidal indicators and having previously attempted suicide.ConclusionBeing a woman, knowing a person infected with COVID-19, and being confined, especially for longer than 40 days, are all risk factors for suicidal ideation. Therefore, intervention programs are needed to reduce the suicide risk prevalence, especially these days because of the influence of the pandemic, and should be primarily focused on those who present the risk factors associated with suicidal behavior identified in this study.

Our objective was to analyze the sources, characteristics, tone, and content of the most viewed YouTube videos in Spanish about Covid-19 vaccines. In February 2021, a search was carried out on YouTube using the terms “Vacuna Covid,” “Vacuna coronavirus,” and “Vacuna Covid19.” Associations between tone, source, and others variables (e.g. number of views or dislikes) were studied with a Mann–Whitney U-test and a chi-square test. A total of 118 videos were analyzed; 63.6% were originated from Mexico and the USA; media created 57.6% of the videos. Positive tone was observed in 53.4%. The most discussed topics were target groups for vaccination (38.9%) and safety (43.2%). The 68 videos produced by media accumulated 31,565,295 views (55.0% of views), and the 19 videos created by health professionals obtained 10,742,825 views (18.7% of views). A significantly smaller number of likes was obtained in videos of media compared to those created by health professionals (p = .004). Videos made by health professionals, compared to those of media, showed a greater positive tone (OR = 3.09). Hoaxes/conspiracy theories were identified in 1.7% of the videos. Monitoring that the information on YouTube about Covid-19 vaccines is reliable should be a central part of Covid-19 vaccination campaigns.

Cytokines, demyelination and neuroaxonal degeneration in the central nervous system are pivotal elements implicated in the pathogenesis of multiple sclerosis (MS) and its nonclinical model of experimental autoimmune encephalomyelitis (EAE). Phycocyanobilin (PCB), a chromophore of the biliprotein C-Phycocyanin (C-PC) from Spirulina platensis, has antioxidant, immunoregulatory and anti-inflammatory effects in this disease, and it could complement the effect of other Disease Modifying Treatments (DMT), such as Interferon-β (IFN-β). Here, our main goal was to evaluate the potential PCB benefits and its mechanisms of action to counteract the chronic EAE in mice. MOG35-55-induced EAE was implemented in C57BL/6 female mice. Clinical signs, pro-inflammatory cytokines levels by ELISA, qPCR in the brain and immunohistochemistry using precursor/mature oligodendrocytes cells antibodies in the spinal cord, were assessed. PCB enhanced the neurological condition, and waned the brain concentrations of IL-17A and IL-6, pro-inflammatory cytokines, in a dose-dependent manner. A down- or up-regulating activity of PCB at 1 mg/kg was identified in the brain on three (LINGO1, NOTCH1, and TNF-α), and five genes (MAL, CXCL12, MOG, OLIG1, and NKX2-2), respectively. Interestingly, a reduction of demyelination, active microglia/macrophages density, and axonal damage was detected along with an increase in oligodendrocyte precursor cells and mature oligodendrocytes, when assessed the spinal cords of EAE mice that took up PCB. The studies in vitro in rodent encephalitogenic T cells and in vivo in the EAE mouse model with the PCB/IFN-β combination, showed an enhanced positive effect of this combined therapy. Overall, these results demonstrate the anti-inflammatory activity and the protective properties of PCB on the myelin and support its use with IFN-β as an improved DMT combination for MS.

Mientras en los países culturalmente anglosajones cada vez es menor la tendencia a tener policías de corte y estilo militar, en los de cultura latina es todo lo contrario. Incluso, en alguns existe una forma de entender la seguridad con un enfoque paralelo de estamentos operando simultáneamente, uno de naturaleza militar y otro de naturaleza civil. Dentro de este texto nos concentraremos en poner bajo relieve las similitudes y diferencias que se puedan apreciar respecto de la Guardia Civil Española, institución policíal de carácter hispano, y la institución mexicana de reciente creación, la Guardia Nacional. La relación histórica entre España y México permite realizar un breve esbozo comparativo para presentar a continuación una base para comprender la evolución de sus fuerzas policiales y cómo es que la seguridad pública ha sido concebida y puesta en marcha en ambos países.

YouTube has become a large source of health information, and it has the capacity to influence users: for instance, regarding their vaccination habits. The aim of our study was to analyze the characteristics of the videos published on YouTube about the meningococcal B vaccine (4CMenB, Bexsero®). A search was made on YouTube using the keyword “Bexsero.” The association between the authorship of videos (health professionals or others) and the rest of the variables (tone of the message and vaccination recommendations, among others) was evaluated using the Chi-square test. In total, 77 videos were analyzed; 74% supported the use of the vaccine, and the most frequently mentioned vaccination recommendations were in epidemic outbreaks (28.6%) and in children (18.2%). Depending on the type of authorship, significant differences were observed regarding the tone of the message and the frequency with which the videos discussed effectiveness, dosage, adverse effects, and vaccination recommendations. There is a difficulty in obtaining information on vaccination recommendations. Recommendations are very diverse since there is a great heterogeneity in the official recommendations for the use of this vaccine, depending on the country the information is from.

Pneumococcal vaccination is recommended for chronic kidney disease (CKD) patients. We evaluated the impact of implementing a hospital vaccine consultation on their vaccination coverages. A sample was drawn from consecutive cases referred to our clinic between November 2014 and June 2018. 101 patients were analyzed: 4 had received the pneumococcal conjugated vaccine 13-valent at the time of the first appointment, whereas 93 had received it after being seen (RR (95%-CI) = 23.3 (8.88–60.85)). Moreover, 5 had received the pneumococcal polysaccharide vaccine 23-valent at the time of the first appointment, whereas 90 had received it after being seen (RR (95%-CI) = 18.0 (7.64–42.42)). Implementing a hospital-based vaccine consultation represents an effective intervention to improve pneumococcal vaccination coverage in these patients.

In the context of the COVID-19 pandemic, the co-circulation of influenza and SARS-CoV-2 viruses may have severe complications for vulnerable populations. For this reason, the World Health Organization pointed to the 2020–2021 anti-influenza campaign as being of special relevance. Our aim was to assess the 2020–2021 influenza vaccination coverage, and its associated factors, among patients in a Spanish multiple sclerosis (MS) unit. A cross–sectional study was conducted. People attending the MS unit of the Clinical Hospital of Zaragoza during 2020 were included. Variables were obtained by reviewing records. Associations with 2020–2021 influenza vaccination were analyzed using bivariate analysis and a multiple logistic regression model. A total of 302 patients were studied; 62.6% were women, whose mean age (standard deviation) was 47.3 (11.5) years. The 2020–2021 influenza vaccination coverage was 55.3% (59.8% in women and 47.8% in men). A total of 89.7% had at least one other indication for vaccination (e.g., immunosuppressive treatment in 225 patients). The variables associated with getting vaccinated were being female (adjusted odds ratio (95% confidence interval) (aOR (95%CI) = 2.12 (1.12–3.99)), having received the 2019–2020 influenza vaccine (aOR (95%CI) = 31.82 (14.71–68.86)) and being born in Spain (aOR (95%CI) = 12.91 (1.07–156.28)). Coverage is moderate compared to other countries. It is necessary to develop strategies to improve it, especially in men and those born outside Spain.

There are different indications for the placement of a pleural drainage. It is indicated in a massive pneumothorax or a pleural effusion, and a tunnelled indwelling pleural catheter is put in place. As in any procedure, complications may occur. A broken catheter is a rare one, and when it occurs, it has to be removed by thoracoscopic surgery. This article describes the first case of a removal of a fractured pleural catheter in a preterm newborn with a bilateral pneumothorax using interventional radiology. We propose an alternative way less invasive that could enable a shorter recovery time with fewer complications.

(1) Background: Early response after acute myocardial infarction (AMI) prevents extensive cardiac necrosis, in which inflammation resolution, including expression of anti-inflammatory interleukin-10 (IL-10), may play a key role. (2) Methods: We synthesized NIL10, a micelle-based nanoparticle, to target IL-10 receptor in mice and pigs subjected to AMI. (3) Results: Administration of NIL10 induced cardiac protection of wild-type and IL-10 knockout mice and pigs subjected to AMI. Cardiac protection was not induced in IL-10-receptor null mice, as shown by a significant recovery of cardiac function, in which inflammatory foci and fibrosis were strongly reduced, together with the finding that resolving M2-like macrophage populations were increased after day 3 of reperfusion. In addition, anti-inflammatory cytokines, including IL-4, IL-7, IL-10, IL-13, IL-16, and IL-27 were also elevated. Mechanistically, NIL10 induced activation of the IL-10 receptor/STAT-3 signaling pathway, and STAT3-dependent inhibition of nuclear translocation of pro-inflammatory NF-ĸB transcription factor. (4) Conclusions: Taken together, we propose using NIL10 as a novel therapeutic tool against AMI-induced cardiac damage.

Gracilarioids and Gigartinales are of great economic importance due to the phycocolloids they contain in their cell wall and are used in different industries worldwide. Field and laboratory cultures of two species of red seaweeds (Gracilaria gracilis and Chondracanthus teedei), confirmed after DNA analysis, were carried out to foster the increasing use of this species in Spain as a food source. Vegetative cultures carried out in an open-lock gate within a traditional salina in the ay of Cadiz (Southern Spain) rendered maximum growth rates in April (3.64% day−1) for G. gracilis and in November (4.68% day−1) for C. teedei, the latter showing significant differences between the months of the year. For laboratory cultures, samples of the two species used for sporulation were obtained from tidal creeks in several nearby locations of the Bay. In order to grow fertile carposporophytes from spores, Provasoli enriched seawater medium (ES medium), Miquel A + B and f/2 were used as culture medium at a temperature of 18 °C and irradiance of 30 µmol m−2 s−1 in 12:12 h photoperiod. Both species developed a basal disc after 12–15 days in ES medium and Miquel A + B, and new microscopic seedlings were observed at 20–25 days in ES medium. With f/2 medium, no growth was observed after sporulation. The life cycle of G. gracilis was completed in ES medium over a period of 11 months with a mean growth rate of 3.28% day−1. The present study is an important step towards the development of seaweed cultivation in the Bay of Cadiz, especially in integrated multi-trophic cultivation in salinas as part of the more sustainable use of the marine resources in coastal communities.

Our objective was to determine the influenza vaccination rate in a Spanish cohort of multiple sclerosis (MS) patients. A retrospective cohort study was carried out. Patients who attended the MS unit of the Lozano Blesa Hospital of Zaragoza between January 2015 and 2020 were included. The variables were obtained by reviewing the specialized and primary care records. Associations between receiving the vaccine in each flu season and the other variables were analyzed using bivariate analysis and multiple logistic regression models. A total of 260 patients were studied, with a median age of 31 years at the time of diagnosis. A total of 62.3% (162/260) were women. Vaccination coverage ranged from 20.4% in the 2015–2016 and 2016–2017 seasons to 41.5% in the 2019–2020 season (p = 0.000). Having been vaccinated in the previous season (ORa: 16.47–390.22; p = 0.000) and receiving a vaccination recommendation from the hospital vaccination unit (ORa: 2.44–3.96; p < 0.009) were associated with being vaccinated. The coverage is in an intermediate position compared to other countries. It is necessary to improve the referral system of these patients to the hospital vaccination unit because the information obtained by this service contributed to higher vaccination rates.

La enfermedad vascular cerebral (EVC) afecta cada año a más de 15 millones de personas en el mundo, de ellos, 5 millones sufren discapacidad permanentemente y 5 millones deben pasar por un largo proceso de rehabilitación para regresar a sus vidas normales. Dentro de las técnicas de rehabilitación, la Estimulación Eléctrica Funcional (EEF) se ha utilizado durante décadas para tratar a pacientes hemipléjicos con un éxito relativo. Otra técnica que ha logrado resultados experimentales muy promisorios es la estimulación medular invasiva. Esta consiste en colocar electrodos directamente en la médula y estimular eléctricamente. Con el fin de evitar la invasividad de esta técnica, recientemente se ha propuesto la Estimulación Eléctrica Medular Transcutánea (EEMT). Esta técnica aún se encuentra en etapa de investigación, y una de las principales limitantes es la falta de estimuladores capaces de proveer la potencia y generación de pulsos adecuados para una adecuada estimulación y que permitan el desarrollo de más investigación sobre esta técnica. El prototipo aquí presentado consiste en la etapa de potencia de un estimulador capaz de generar pulsos para las técnicas de estimulación EEF y EEMT y formará parte de otros bloques (no presentados en este documento) para conformar un estimulador bimodal con fines de investigación que se utilizará en el Instituto Nacional de Rehabilitación LGII. El dispositivo presentado es capaz de proporcionar impulsos bifásicos de 50 μs a 500 μs, con frecuencia variable en un rango de 1 a 150 Hz con una amplitud de más de 190 mA, así como una corriente constante de hasta 10 mA. Estos parámetros son adecuados para realizar estimulación de tipo EEF y EEMT de acuerdo con el estado del arte de la técnica.

The effect of the pulse current, pulse on time and pulse off time on the surface roughness of AISI 304 stainless steel workpieces produced by electric discharge machining (EDM) using grade GSP-70 graphite electrodes was studied. A factorial design was performed, considering two levels for each of the three established parameters. From the statistical analysis, it was obtained that the pulse current and pulse on time are the most significant machining parameters on the obtained surface roughness values of the stainless steel AISI 304 workpieces machined by EDM. On the other hand, the regression analysis of a second order model was done to estimate the average roughness (Ra) in terms of the pulse current, pulse on time and pulse off time. Finally, the mean absolute percentage error (MAPE) of the roughness values estimated by the second order regression model and the roughness obtained experimentally is also presented.

El cultivo de especies acuícolas es una actividad comúnmente practicada alrededor del mundo. En México, el cultivo de camarón es una de las principales fuentes de ingresos en el área de la acuicultura. La calidad del agua es un factor relevante en el éxito del cultivo en granjas camaronícolas, por lo que su monitoreo resulta ser de vital importancia. Este estudio presenta un nuevo modelo computacional para la evaluación de la calidad del agua en granjas de cultivo extensivo para camarón Litopenaeus vannamei. Mediante el uso de las redes neuronales artificiales se creó un indicador de la calidad del agua, mismo que permite establecer una relación entre la dinámica de los parámetros del ecosistema y diferentes estados para el cultivo de la especie (excelente, bueno, regular y deficiente). Se seleccionaron cuatro parámetros medioambientales debido a su importancia en el hábitat: temperatura del agua, pH, oxígeno disuelto y salinidad. Los resultados obtenidos muestran un buen funcionamiento y eficiencia por parte del sistema propuesto, al compararlo con otros modelos de evaluación empleados para este fin. Las evaluaciones muestran a las RNA como una buena opción para la evaluación y detección de estados óptimos o no deseados para un buen manejo del agua en este tipo de cultivos.

Objetivo: Evaluar la cultura de seguridad del paciente en personas directivas/gestoras. Método: Estudio descriptivo transversal efectuado entre febrero y junio de 2011 en personal directivo/gestor del Servicio Aragonés de Salud mediante entrevistas semiestructuradas. Resultados: Se realizaron 12 entrevistas. Todos/as admitieron la existencia de diversidad de problemas de seguridad del paciente y coincidieron en reconocerla como prioritaria de forma más teórica que práctica. La excesiva rotación de directivos/as se consideró como una importante barrera que dificulta establecer estrategias a largo plazo y dar continuidad a medio plazo. Conclusiones: Este trabajo recogió las percepciones sobre cultura de seguridad del paciente en directivos/as, hecho esencial para mejorar la cultura de seguridad del paciente en este colectivo y en las organizaciones que dirigen.

Abstract Infra-red emission (980 nm) of sub 10 nm Yb3+-doped NaYF4 nanoparticles has been sensitized through the excitation of 2-hydroxyperfluoroanthraquinone chromophore (1,2,3,4,5,6,7-heptafluro-8-hydroxyanthracene-9,10-dione) functionalizing the nanoparticle surface. The sensitization is achieved with a broad range of visible light excitation (400–600 nm). The overall near infra-red (NIR) emission intensity of Yb3+ ions is increased by a factor 300 as a result of the broad and strong absorption of the chromophore compared with ytterbium’s intrinsic absorption. Besides the Yb3+ NIR emission, the hybrid composite shows organic chromophore-based visible emission in the orange-red region of the spectrum. We observe the energy migration process from the sensitized Yb3+ ions at the surface to those in the core of the particle using time-resolved optical spectroscopy. This highlights that the local environments for emitting Yb3+ ions at the surface and center of the nanoparticle are not identical, which causes important differences in the NIR emission dynamics. Based on the understanding of these processes, we suggest a simple strategy to control and modulate the decay time of the functionalized Yb3+-doped nanoparticles over a relatively large range by changing physical or chemical parameters in this model system.

The aim of this research is to analyze the influence of cutting speed, feed rate and cutting depth on the surface finish of grade GSP-70 graphite specimens for use in electrical discharge machining (EDM) for material removal by means of Computer Numerical Control (CNC) milling with low-speed machining (LSM). A two-level factorial design for each of the three established factors was used for the statistical analysis. The analysis of variance (ANOVA) indicates that cutting speed and feed rate are the two most significant factors with regard to the roughness obtained with grade GSP-70 graphite by means of CNC milling. A second order regression analysis was also conducted to estimate the roughness average (Ra) in terms of the cutting speed, feed rate and cutting depth. Finally, the comparison between predicted roughness by means of a second order regression model and the roughness obtained by machined specimens considering the combinations of low and high levels of roughness is also presented.

In Europe, the consumption of seaweeds and derived products has increased in recent years, due to the expansion of Asian cuisine and the emergence of many top-level chefs. Often in collaboration with scientists, many have initiated a new gastronomy using algae. However, little is known about the quality and degree of freshness of seaweeds for direct consumption or fresh use. For this reason, different analytical methods were applied to test sea vegetables and other marine products. These methods included physical (aw, pH, color, and texture), chemical (total volatile base nitrogen, TVB-N; and trimethylamine, TMA-N) parameters, microbiological count, and sensory evaluation. In this study, freshness quality and shelf life of the green seaweed Ulva rigida (UR) was evaluated during a 12-day period, stored at 4 and 16 °C. The parameters that proved to be most useful for evaluating its freshness were the TVB, TMA, microbiological, and sensory analyses. The physicochemical and microbiological parameters established a shelf life of UR of 6 days for a storage temperature of 16 °C and up to 10 days for a storage temperature of 4 °C. The changes that UR undergoes during its storage from the sensory point of view are more pronounced than those produced from the physicochemical point of view, which can condition its applications.

Objective: To find out what measures medical students believe could help improve their influenza vaccination coverage. Method: On 5 November 2019, the Dean of the Zaragoza Medical School sent an e-mail to the students asking them to fill out a questionnaire through Google Forms, in which they were asked to describe, in an open field, the measures that they believed could contribute to improving their flu vaccination coverage. The content of the responses was analyzed in a classic way, extracting descriptors and selecting the most representative verbatim accounts. Results: The main measures proposed were to improve the training on influenza and its vaccine, to improve the accessibility of the vaccine in time and space, to provide incentives to get vaccinated, to create visible and positive attitudes towards the vaccine, and to increase the diffusion of information about the vaccination campaign. Conclusion: This qualitative study has found potential measures to be applied specifically to medical students to improve their vaccination coverage in our country.

Seagrasses form one of the most productive and threatened ecosystems worldwide because of global change and anthropogenic pressures. The frequency of extreme climatic events, such as heat waves, are expected to increase and may drive even more adverse effects than gradual warming. This study explores for the first time the effects of a sudden and temporary increase of temperature in situ on carbon metabolism and dissolved organic carbon (DOC) fluxes in a community dominated by a seagrass (Cymodocea nodosa) during two contrasting seasons (winter and summer). Results showed a positive correlation between temperature and seagrass production between seasons, while the experimental sudden and temporary increase in water temperature did not produce significant differences in carbon community metabolism and DOC fluxes in winter. In contrast, high temperature conditions in summer enhanced significantly the net community production and affected positively to DOC fluxes. Hence, this study indicates that a sudden and temporary increase in water temperature, which characterize marine heat waves, in temperate areas may enhance the autotrophic metabolism of seagrass communities and can yield an increase in the DOC released, in contrast to previous researches suggesting solely negative effects on seagrasses.

Global change has been acknowledged as one of the main threats to the biosphere and its provision of ecosystem services, especially in marine ecosystems. Seagrasses play a critical ecological role in coastal ecosystems, but their responses to ocean acidification (OA) and climate change are not well understood. There have been previous studies focused on the effects of OA, but the outcome of interactions with co-factors predicted to alter during climate change still needs to be addressed. For example, the impact of higher CO2 and different hydrodynamic regimes on seagrass performance remains unknown. We studied the effects of OA under different current velocities on productivity of the seagrass Zostera noltei, using changes in dissolved oxygen as a proxy for the seagrass carbon metabolism, and release of dissolved organic carbon (DOC) in a four-week experiment using an open-water outdoor mesocosm. Under current pH conditions, increasing current velocity had a positive effect on productivity, but this depended on shoot density. However, this positive effect of current velocity disappeared under OA conditions. OA conditions led to a significant increase in gross production rate and respiration, suggesting that Z. noltei is carbon-limited under the current inorganic carbon concentration of seawater. In addition, an increase in non-structural carbohydrates was found, which may lead to better growing conditions and higher resilience in seagrasses subjected to environmental stress. Regarding DOC flux, a direct and positive relationship was found between current velocity and DOC release, both under current pH and OA conditions. We conclude that OA and high current velocity may lead to favourable growth scenarios for Z. noltei populations, increasing their productivity, non-structural carbohydrate concentrations and DOC release. Our results add new dimensions to predictions on how seagrass ecosystems will respond to climate change, with important implications for the resilience and conservation of these threatened ecosystems.

Breast cancer is a disease that has emerged as the second leading cause of cancer deaths in women worldwide. The annual mortality rate is estimated to continue growing. Cancer detection at an early stage could significantly reduce breast cancer death rates long-term. Many investigators have studied different breast diagnostic approaches, such as mammography, magnetic resonance imaging, ultrasound, computerized tomography, positron emission tomography and biopsy. However, these techniques have limitations, such as being expensive, time consuming and not suitable for women of all ages. Proposing techniques that support the effective medical diagnosis of this disease has undoubtedly become a priority for the government, for health institutions and for civil society in general. In this paper, an associative pattern classifier (APC) was used for the diagnosis of breast cancer. The rate of efficiency obtained on the Wisconsin breast cancer database was 97.31%. The APC’s performance was compared with the performance of a support vector machine (SVM) model, back-propagation neural networks, C4.5, naive Bayes, k-nearest neighbor (k-NN) and minimum distance classifiers. According to our results, the APC performed best. The algorithm of the APC was written and executed in a JAVA platform, as well as the experimental and comparativeness between algorithms.

Xanthohumol (XN) is the main prenylated chalcone present in hops (Humulus lupulus) with high biological activity, and it is of great importance for human health because of its antioxidant, anti-inflammatory, immunosuppressive and chemopreventive properties. This polyphenol can be included in the diet through foods in which hops are used, such as beer or food supplements. Because of their health benefits and the increasing interest of using hops as a novel nutraceutical, the aim of this work was the identification and quantification of XN in different types of samples using a method based on high resolution liquid chromatography with a diode array detector (HPLC−DAD). The method was validated in terms of linearity, limits of detection (LOD) and quantification (LOQ), repeatability and recovery. Acceptable linearity (r2 0.9999), adequate recovery (>90% in the most of cases) and good sensitivity (LOD 16 µg/L) were obtained. Furthermore, the presence of XN in all samples was confirmed using liquid chromatography coupled to mass spectrometry (LC-MS/MS) operated in negative ESI (electrospray system ionization) mode. The concentrations of XN determined in hop flowers and food supplements were above the LOQ, in a range between 0.106 and 12.7 mg/g. Beer may also represent an important source of dietary prenylflavonoids, with between 0.028 and 0.062 mg/L of XN. The results showed that the methodology proposed was suitable for the determination of XN in the different types of samples studied, and the amounts of XN varied significantly according to the selected product.

Fundamentos: La cobertura de vacunación antigripal en personal sanitario es baja. Este estudio se realizó con la finalidad de conocer las razones por las que los estudiantes de medicina tienen previsto vacunarse o no de gripe cuando sean trabajadores sanitarios así como los factores asociados con dicha intención. Métodos: Estudio transversal en el que se incluyó a todos los alumnos matriculados en la Facultad de medicina de una Universidad española durante el curso académico 2011-2012. La información se obtuvo mediante un cuestionario autocumplimentado que recogía la intención de vacunación, motivos para ello y 8 preguntas sobre conocimientos de la vacuna. Se calcularon frecuencias absolutas y relativas. Para estudiar las asociaciones se utilizó la prueba chi-cuadrado y regresión logística múltiple. Resultados: De los 1.130 estudiantes respondieron el cuestionario 654 (57,9%). El 63,0% manifestaron tener intención de vacunarse. Las principales razones para prever vacunarse fueron: considerarlo conveniente (68,2%), riesgo de transmitir gripe a pacientes (65,5%) y riesgo de que los pacientes pudieran transmitírsela a ellos (64,8%). Las razones más frecuentes para no prever vacunarse fueron: bajo riesgo de padecer gripe (41,7%) y evitar inyecciones/medicación (27,7%). Conocer específicamente que la vacuna está indicada en trabajadores sanitarios se asoció con prever vacunarse (p=0,000). Conclusiones: La intención de vacunación fue elevada con respecto a la cobertura actual. El nivel de conocimientos fue mejorable. Conocer la indicación de la vacunación en trabajadores sanitarios se asoció con la intención de vacunarse.

Global change, such as warming and ocean acidification, and local anthropogenic disturbances, such as eutrophication, can have profound impacts on marine organisms. However, we are far from being able to predict the outcome of multiple interacting disturbances on seagrass communities. Herbivores are key in determining plant community structure and the transfer of energy up the food web. Global and local disturbances may alter the ecological role of herbivory by modifying leaf palatability (i.e. leaf traits) and consequently, the feeding patterns of herbivores. This study evaluates the main and interactive effects of factors related to global change (i.e. elevated temperature, lower pH levels and associated ocean acidification) and local disturbance (i.e. eutrophication through ammonium enrichment) on a broad spectrum of leaf traits using the temperate seagrass Cymodocea nodosa, including structural, nutritional, biomechanical and chemical traits. The effect of these traits on the consumption rates of the generalist herbivore Paracentrotus lividus (purple sea urchin) is evaluated. The three disturbances of warming, low pH level and eutrophication, alone and in combination, increased the consumption rate of seagrass by modifying all leaf traits. Leaf nutritional quality, measured as nitrogen content, was positively correlated to consumption rate. In contrast, a negative correlation was found between feeding decisions by sea urchins and structural, biomechanical and chemical leaf traits. In addition, a notable accomplishment of this work is the identification of phenolic compounds not previously reported for C. nodosa. Our results suggest that global and local disturbances may trigger a major shift in the herbivory of seagrass communities, with important implications for the resilience of seagrass ecosystems.

Objetivos: Determinar las coberturas vacunales frente a la gripe estacional y frente a la nueva gripe A (H1N1) en la temporada 2009-2010 en trabajadores sanitarios y conocer sus factores determinantes. Métodos: Estudio transversal realizado en el Hospital General Universitario de Alicante en trabajadores sanitarios durante las campañas de vacunación antigripal 2008-2009 y 2009-2010. La campaña 2009-2010 se subdividió en dos fases: entre el 1-10-09 y el 13-11-09 se administró la vacuna de la gripe estacional 2009-2010; desde el 16-11-09 hasta el 30-12-09 se administró la vacuna frente al nuevo virus de la gripe A (H1N1). Cada fase estuvo precedida por una campaña promocional específica. En el momento de la vacunación, el trabajador sanitario cumplimentó un cuestionario que incluía un listado de motivos para vacunarse. Se calculó la frecuencia de vacunación y se compararon las coberturas vacunales de cada campaña, de manera global y por estamentos, utilizando la prueba de ji cuadrado. Resultados: La cobertura frente a la gripe estacional 2009-2010 fue del 31%, y frente a la nueva gripe A (H1N1) fue del 22,2% (pObjectives: To determine vaccination coverage against seasonal influenza and the new A (H1N1) influenza virus among healthcare personnel during the 2009-2010 season and to identify its determining factors. Methods: We performed a cross-sectional study among healthcare staff at the General University Hospital in Alicante (Spain) during the 2008-2009 and 2009-2010 influenza vaccination campaigns. The 2009-2010 vaccination campaign was subdivided into two phases. In the first phase, from 1st October to 19th November, 2009, the seasonal influenza vaccine was administered; in the second phase, from 16th November to 30th December, 2009, vaccination against the new A (H1N1) influenza virus was performed. Each of the vaccine programs was preceded by a specific vaccination promotion campaign. Healthcare staff were asked to complete a brief self-administered questionnaire containing a list of reasons for being vaccinated. Coverage during both vaccination campaigns was calculated, and the results, both overall and for each profession, were then compared using a Chi-square test. Results: Coverage against seasonal influenza was 31% and that against the new A (H1N1) influenza virus was 22.2% (p

Antecedentes: En Chile las malformaciones congénitas son la primera causa de mortalidad neonatal precoz, siendo las cardiopatías congénitas su principal factor. La incorporación de la ecocardiografía prenatal es de gran ayuda en su pesquisa precoz. Objetivos: Evaluar la ecocardiografía prenatal como prueba diagnóstica y su concordancia con la ecocardiografía posnatal. Métodos: Se analizaron embarazadas derivadas al Hospital de Niños Dr. Roberto del Río entre abril 2004 y abril 2008, por sospecha de cardiopatías congénitas con posterior control neonatal. Resultados: Se evaluaron 188 embarazadas tanto con diagnóstico de cardiopatía congénita como con ecocardiografía normal. La edad gestacional promedio de derivación fue de 32 semanas, siendo la principal causa la sospecha de cardiopatía congénita en el examen obstétrico de rutina. Como prueba diagnóstica se obtuvo una sensibilidad de 100% y especificidad de 40% con una moderada concordancia entre ésta y el examen postnatal. Como prueba diagnóstica la ecocardiografía prenatal, se obtuvo una sensibilidad de 100% y especificidad de 89% del examen, al ser evaluada como cardiopatías en general, con una muy buena concordancia entre ésta y el examen postnatal. Discusión: Existe una tardía derivación y diagnóstico prenatal de las cardiopatías congénitas a nivel nacional, siendo importante capacitar aún más a los obstetras que realizan este tamizaje. La ecocardiografía prenatal realizada en nuestro centro por cardiólogos es una confiable herramienta diagnóstica con una muy buena concordancia con la ecocardiografía posnatal.Background: In Chile, congenital malformations are the first cause of early neonatal mortality, the congenital heart defects its the main factor. The incorporation of antenatal echocardiography is very helpful in your research early. Objectives: To evalúate prenatal echocardiography as a diagnosis test and their concordance with postnatal echocardiography. Methods: We analyzed pregnancy who were derived to the Hospital de Niños Dr. Roberto del Rio, between April 2004 and April 2008, where studied because suspicion of having congenital heart defects with subsequent neonatal control. Results: 188 pregnancy were evaluated either with a diagnosis of congenital heart defect or with normal echocardiography. The mean gestational age of derivation was 32 weeks, the main causes the suspicion of congenital heart defect on routine obstetric examination. When being studied as diagnosis test it was obtained a sensitivity of 100% and a specificity of 40% with a modérate concordance between both echocardiographies. When analyzing with the diagnosis test prenatal echocardiography, it was obtained a sensitivity of 100% and a specificity of 89% of the review, when evaluated as general heart defect, with a very good concordance between it and the postnatal examination. Discussion: There is a late referral and prenatal diagnosis of congenital heart defect at national level, being important to train obstetricians who perform this screening. Prenatal echocardiography performed by cardiologists at our center is a reliable diagnosis tool with a very good concordance with postnatal echocardiography.

Fundamentos: El temor a las reacciones adversas (RA) constituye un motivo frecuente por el que los trabajadores sanitarios (TS) deciden no vacunarse de la gripe. Con los objetivos de conocer la frecuencia de RA y los factores asociados con las mismas tras la administración de las vacunas antigripales en la temporada 2009-2010 en TS se realizó esta investigación. Métodos: Estudio de cohortes que incluyó a los 969 trabajadores vacunados frente a la gripe estacional y a los 693 trabajadores vacunados frente al nuevo virus influenza en la temporada 2009-2010 en un hospital de tercer nivel. Resultados: Para detectar RA se telefoneó a las persoans vacunadas una semana después de la vacunación. La frecuencia de RA osciló entre el 24,5% de los TS que recibieron exclusivamente la vacuna de la gripe estacional y el 82,6% de los que recibieron la vacuna frente al nuevo virus influenza (H1N1) 2009. Las RA más frecuentes fueron dolor y malestar general. Ninguna RA fue considerada grave. La edad y el hecho de que la vacuna contuviera adyuvante se asociaron con la aparición de RA tras la administración de la vacuna frente al nuevo virus influenza (H1N1) 2009. Conclusiones: Las vacunas de la gripe estacional y del nuevo virus influenza (H1N1) 2009 son seguras: La frecuencia de RA relacionadas con esta última vacuna fue alta, especialmente si contenía adyuvante.

Objetivos: Conocer las necesidades de información de los usuarios en relación a la oferta de servicios de Atención Primaria desde la perspectiva de los profesionales sanitarios. Métodos: Se ha utilizado la técnica Delphi como método de consenso. Se solicitó la participación de 70 expertos: 35 médicos de familia, 32 enfermeras y tres pediatras de centros de salud urbanos y rurales del Área de Salud de Salamanca, entre mayo y diciembre de 2006. Los cuestionarios estaban estructurados en seis apartados: conocimientos sobre su salud, oferta de su centro de salud, aspectos administrativos, medios de difusión, expectativas sobre información y barreras en la comunicación. Las respuestas priorizadas en el tercer cuestionario se puntuaron según una escala que otorga cinco puntos a la sentencia más importante y un punto a la seleccionada en quinto lugar. Resultados: Contestaron los tres cuestionarios 44 (62,8%) expertos. Las necesidades de información más puntuadas fueron la información sobre su enfermedad (4,0 puntos), los aspectos relacionados con la responsabilidad sobre su salud (3,8) y los consejos preventivos (3,6), seguidos de aspectos relativos a la accesibilidad (4,2), urgencias (3,4), oferta de servicios de médico/a y enfermera/o (3,6) y sitios donde dirigirse para obtener información (4,0). La falta de coordinación entre niveles (4,1) y la burocratización (3,5) se consideraron barreras en la comunicación y la información. Conclusiones: Los factores identificados se centran en contenidos que permitan a los pacientes implicarse en su propio proceso y participar en la toma de decisiones que les incumben. También destacaron la información sobre los servicios y el acceso a éstos.Objective: To determine the information needed by patients in relation to the supply of primary care services from the perspective of health professionals. Methods: The Delphi technique was used as a consensus method. Seventy experts were asked to participate: 35 primary care physicians, 32 nurse practitioners, and three pediatricians in rural and non-rural health centers in the Health Area of Salamanca between May and December 2006. The questionnaires used were structured into six sections: patients' knowledge of their health, services in their health centers, administrative topics, the media, information expectations, and communication barriers. In the third questionnaire, prioritized answers were scored between 5 points and 1 point according to their importance. Results: All three questionnaires were completed by 44 experts (62.8%). The information needs with the highest scores were information on patients' diseases (4.0 points), subjects related to patients' responsibility for their health (3.8) and preventive advice (3.6), followed by subjects relating to access (4.2), emergencies (3.4), physicians' and nurse practitioners' services (3.6), and places to go to get information (4.0). The lack of coordination between primary and hospital care (4.1) and excessive bureaucracy (3.5) were considered to limit communication and information. Conclusions: The factors identified focus on contents that allow patients to get involved in their own process and to take active part in the decision-making that concerns them. Other important factors were information about services and the access to them.

A disgruntled former subway motorman, a mercenary soldier, an ex-mafia thug, and a fourth criminal decide to hijack a New York subway train and threaten to kill a passenger per minute if they are not given a ransom of a million dollars. Garber, head of the New York City Transit Police, is given the case; he will find out how a simple cold will play a key role in the film’s denouement.

P align=justify>Cymodocea nodosa plants were dark incubated for four months. The potential of reactivating photosynthesis was tested in an experiment in which half of the plants were reilluminated (HL) while the other half were grown under very low irradiance levels (LL). Photosynthesis was measured using PAM fluorescence and tissue nutrient and carbohydrate contents were analysed. Photosynthetic efficiency (Fv/Fm) in HL plants increased from 0 to 0.58, whereas LL plants remained inactive. Photosynthetic parameters also increased, resulting in a final Ik of 97.5 µmol m-2 s-1. Leaf shedding led to a negative mean RGR in HL plants. Tissue C and N dropped considerably during dark incubation in both rhizomes and shoots. Starch content was nearly equal for rhizomes and shoots (4.3 mg /g DW) and was not affected by dark incubation. In contrast, sucrose content dropped from 40.0 mg /g DW to zero in shoots and from 240 to 40.0 mg /g DW in rhizomes in HL plants. We conclude that C. nodosa is capable of recovering photosynthetic activity after four months darkness, which is considerably longer than the 80 d recorded so far for a seagrass. Stored carbohydrates, more specifically sucrose, play an important role in both survival and reactivation.