Search

Abstract Background Despite effective antiretroviral therapy, people with HIV (PWH) experience persistent systemic inflammation and increased morbidity and mortality. Modulating the gut microbiome through fecal microbiota transplantation (FMT) represents a novel therapeutic strategy. We aimed to evaluate proteomic changes in inflammatory pathways following repeated, low-dose FMT versus placebo. Methods This double-masked, placebo-controlled pilot study assessed the proteomic impacts of weekly FMT versus placebo treatment over 8 weeks on systemic inflammation in 29 PWH receiving stable antiretroviral therapy (ART). Three stool donors with high Faecalibacterium and butyrate profiles were selected, and their individual stools were used for FMT capsule preparation. Proteomic changes in 345 inflammatory proteins in plasma were quantified using the proximity extension assay, with samples collected at baseline and at weeks 1, 8, and 24. Concurrently, we characterized shifts in the gut microbiota composition and annotated functions through shotgun metagenomics. We fitted generalized additive models to evaluate the dynamics of protein expression. We selected the most relevant proteins to explore their correlations with microbiome composition and functionality over time using linear mixed models. Results FMT significantly reduced the plasma levels of 45 inflammatory proteins, including established mortality predictors such as IL6 and TNF-α. We found notable reductions persisting up to 16 weeks after the final FMT procedure, including in the expression of proteins such as CCL20 and CD22. We identified changes in 46 proteins, including decreases in FT3LG, IL6, IL10RB, IL12B, and IL17A, which correlated with multiple bacterial species. We found that specific bacterial species within the Ruminococcaceae, Succinivibrionaceae, Prevotellaceae families, and the Clostridium genus, in addition to their associated genes and functions, were significantly correlated with changes in inflammatory markers. Conclusions Targeting the gut microbiome through FMT effectively decreased inflammatory proteins in PWH, with sustained effects. These findings suggest the potential of the microbiome as a therapeutic target to mitigate inflammation-related complications in this population, encouraging further research and development of microbiome-based interventions. Video Abstract

The present work developed a first approach to the manufacturing of turning inserts using the emerging Additive Manufacturing (AM) technology, specifically employing the fused filament fabrication (FFF) process, based on the extrusion of material and deposition layer by layer. Traditionally, this type of cutting tools were manufactured by powder metallurgy and machining processes, but in this instance Additive Manufacturing processes allowed the customisation of the geometries and eliminated the need of dies to manufacture these tools, leading to economic savings. The study analysed, from different perspectives, the viability of these interchangeable inserts as cutting tools. These approaches included qualitative studies of chip formation and cutting-edge wear as well as thermal and roughness analysis of specimens tested under different conditions. The behaviour of H13 Tool Steel cutting inserts on cylindrical specimens of EN AW-2030 aluminium alloy was compared with commercial carbide inserts, being observed that the chip types produced were extremely similar between those obtained by commercial and those from Additive Manufacturing, particularly in dry conditions. The qualitative study of insert wear showed that AM inserts presented overall larger contribution of built-up edge (BUE) and plastic deformation of the tip, with greater incidence at cutting speeds of Vc = 60 m/min and feed rate of fz = 0.1 mm/r. Regarding thermal analysis, the AM inserts revealed a slightly more abrasive behaviour, resulting in a temperature increase throughout the machining process of approximately 70 °C, with no significant influence from the increase in cutting speed. The study of the surface finish offered average roughness results (Ra) of 0.58 µm for commercial inserts, 1.78 µm in AM inserts with dry tests and 2.06 µm in this same type of insert but tested with lubrication. These variations in average roughness were not significant.

ABSTRACT Aim To implement shared decision‐making (SDM) through a patient decision aid (PtDA) for the initiation of palliative care (PC) in end‐of‐life (EOL) cancer patients. Methodology A comprehensive Scoping Review was conducted on SDM in PubMed, CINAHL and PsycInfo. An evidence‐based implementation of PtDAs was created using the Joanna Briggs Institute framework, which followed rigorous pillars: (1) context, (2) facilitation and (3) evaluation. Results Fifteen studies were identified and categorised into (1) Implementation characteristics and (2) Strategies for implementing SDM in terminally ill cancer patients. SDM should consider the decision‐making location, optimal timing, participants and decision type. Strategies include professional training, PtDAs and implementation programmes. A PtDA implementation protocol in video format for deciding to initiate PC is proposed, following International Patient Decision Aid Standards (IPDAS) and Clinical Practice Guidelines (CPG). Conclusions SDM implementation should be guided by evidence‐based methodological models justifying and structuring its execution, especially in complex and interdisciplinary contexts. National or international frameworks facilitate the adoption of health innovations, such as PtDAs, benefiting patients and improving their usage. Practice Implications SDM is not just a concept but an important approach to the Care of cancer patients at EOL, enhancing patient satisfaction and improving care quality. The success and sustainability of SDM hinge on the fundamental aspects of staff training, interdisciplinary collaboration and ongoing evaluation. The lack of specific aid in Spanish underscores the immediate need for local development. Further research is needed in this area, as most reviewed studies did not measure SDM effectiveness in diverse hospital settings. Patient or Public Contribution This proposal was developed based on the experience and input of the nursing staff from the healthcare service where it is intended to be implemented.

Background: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a relatively common complication. Multiple studies described this relationship in critical patients, however its incidence and outcome in other risk groups such as immunosuppressed patients remains unknown. In this sense, we aimed to evaluate the rates and outcomes of CAPA in hematological patients and according to the different hematological malignances, comparing to invasive pulmonary aspergillosis (IPA) in non-COVID-19 ones. Methods: Nationwide, population-based and retrospective observational cohort study including all adult patients with hematological malignancies admitted in Spain since March 1, 2020 to December 31, 2021. The main outcome variable was the diagnosis of IPA during hospitalization in hematological patients with or without COVID-19 at admission. The rate of CAPA compared to IPA in non-COVID-19 patients in each hematological malignancy was also performed, as well as survival curve analysis. Findings: COVID-19 was diagnosed in 3.85 % (4367 out of 113,525) of the hematological adult inpatients. COVID-19 group developed more fungal infections (5.1 % vs. 3 %; p

BackgroundMortality among people with dependency to perform basic activities of daily living (ADL) is higher than that of non-dependent people of the same age. Understanding the evolutionary course and factors involved in non-institutionalized ADL dependency, including the influence of the family structure that supports this population, would contribute to improved health planning.MethodsA longitudinal study carried out in the ADL-dependent population of the Orcasitas neighborhood, Madrid (Spain), between June 2020, when the nationwide COVID-19 lockdown ended, and June 2023. A total of 127 patients participated in the study, 78.7% of whom were women and 21.3% were men. Risk analysis was performed via odds ratios (OR) and hazard ratios (HR). Survival analysis was performed using Cox regression.ResultsA total of 54.33% of the ADL-dependent persons did not live with their adult children and 45.67% did, being associated living independently with economic capacity and the married marital status but not with the dependency level. In women, being married increased the probability of living independently of their adult children (OR = 12.632; 95% CI = 3.312–48.178). Loss of mobility (OR = 0.398; 95% CI = 0.186–0.853), economic capacity of the dependent (HR = 0.596; 95% CI = 0.459–0.774), and living independently and having better economic capacity (HR = 0.471; 95% CI = 0.234–0.935) were associated with 3-year survival. Those who lived with their adult children had a worse autonomy profile and higher mortality (HR = 1.473; 95% CI = 1.072–2.024). Not being employed, not being married, and not owning a home were significantly associated with being an essential family caregiver. Caregivers were mostly women (OR = 1.794; 95% CI = 1.011–3.182).ConclusionAmong ADL-dependent persons, economic capacity influenced the ability to living independently and affected survival after 3 years. Loss of mobility (wheelchair use) was a predictor of mortality. Social inequalities promote that adult children end up as essential family caregivers. This generates reverse dependency and maintains a vulnerability that is transmitted from generation to generation, perpetuating social and gender inequalities. Dependent parent care in this cohort maintained an archaic pattern in which the eldest daughter cared for her parents. This study made it possible to show that ADL dependence is accompanied by complex interrelationships that must be considered in socio-health planning.

Due to the impact of urban growth on the environment, especially in developing countries, decision-making tools are needed to help locate the ideal areas for urban use. This study aims to identify the areas most suitable for urban use, minimizing their impact on forest land use in an area with high urban sprawl. As a new development, the study also considers the connectivity between forest-use patches and the loss of forest area as decision variables. The methodology used to determine these areas was AHP (Analytic Hierarchy Process) with GIS (Geography Information System). Twenty experts evaluated the criteria, considering forest conservation in addition to urban suitability. Socio-economic, physical, and environmental criteria and sub-criteria were scored with values from 1 to 5, with 5 indicating the maximum potential of the pixel to accommodate urban use. The study area was the Machachi Valley and the conurbation of Quito in Ecuador. The results indicate that the most suitable urban areas are located in the buffer that surrounds the initial urban use, and the land along the Pan-American Highway. The most vulnerable forest zone was in the south center of Quito and on the hillsides of the Pasochoa volcano. The results were also compared with maps that estimate the evolution of the land uses in this valley in the coming years. Based on this comparison, maintenance of current trends will result in a significant loss of native forest and fragmentation of forest patches in the lower valley. The information provided by maps of suitable urban use is a useful tool to protect the natural resources that land use policies should take into consideration.

BackgroundProlonged confinement can lead to personal deterioration at various levels. We studied this phenomenon during the nationwide COVID-19 lockdown in a functionally dependent population of the Orcasitas neighborhood of Madrid, Spain, by measuring their ability to perform basic activities of daily living and their mortality rate.MethodsA total of 127 patients were included in the Orcasitas cohort. Of this cohort, 78.7% were female, 21.3% were male, and their mean age was 86 years. All participants had a Barthel index of ≤ 60. Changes from pre- to post-confinement and 3 years afterward were analyzed, and the effect of these changes on survival was assessed (2020–2023).ResultsThe post-confinement functional assessment showed significant improvement in independence over pre-confinement for both the Barthel score (t = −5.823; p < 0.001) and the classification level (z = −2.988; p < 0.003). This improvement progressively disappeared in the following 3 years, and 40.9% of the patients in this cohort died during this period. These outcomes were associated with the Barthel index (z = −3.646; p < 0.001) and the level of dependence (hazard ratio 2.227; CI 1.514–3.276). Higher mortality was observed among men (HR 1.745; CI 1.045–2.915) and those with severe dependence (HR 2.169; CI 1.469–3.201). Setting the cutoff point of the Barthel index at 40 provided the best detection of the risk of death associated with dependence.ConclusionsHome confinement and the risk of death due to the COVID-19 pandemic awakened a form of resilience in the face of adversity among the population of functionally dependent adults. The Barthel index is a good predictor of medium- and long-term mortality and is a useful method for detecting populations at risk in health planning. A cutoff score of 40 is useful for this purpose. To a certain extent, the non-institutionalized dependent population is an invisible population. Future studies should analyze the causes of the high mortality observed.

Objectives: Dating violence is a widespread social problem with increasing prevalence among adolescents. The perceived severity of dating violence is an important factor related to key aspects of this type of violence, such as acceptability, justification, attitudes toward intervention, and victims’ willingness to seek help. The aim of this study was to validate an instrument to assess the perceived severity of dating violence in a sample of adolescents: the Perceived Severity of Adolescent Dating Violence (PS-ADV) scale. Method: Two groups of high school students, one with 621 adolescents (47.2% females) and another with 300 (50% females), aged 13-18 years were selected by a two-stage stratified sampling procedure. Results: The results indicated that the PS-ADV scale has excellent internal consistency (α = .89) and a clear one-factor latent structure (CFI = .96, TLI = .94, RMSEA [90% CI] = .074 [.062, .087]). For validity, the PS-ADV scores were related negatively to victim-blaming attitudes and ambivalent sexism (hostile and benevolent sexism), and positively to empathy (empathic concern, perspective taking, fantasy). Conclusions: This study provides evidence that the PS-ADV scale is a psychometrically sound measure for assessing the perceived severity of dating violence among adolescents.

(1) Background: Intimate partner violence (IPV) remains a pervasive issue, particularly among adolescents. Its prevalence is still high despite intervention efforts, especially for younger generations. Empathy and sexism are factors linked with IPV that have shown gender differences. This study focuses on how gender moderates the association of empathy and sexist attitudes among adolescents in Spain; (2) Methods: A two-stage stratified cluster sampling method for collecting data from 516 adolescents (219 boys, 297 girls) aged 12–18 years was used. Participants completed the Ambivalent Sexism Inventory and the Interpersonal Reactivity Index. Hierarchical multiple regression analyzed the moderating role of gender in the relation between empathy and ambivalent sexism; (3) Results: Boys exhibited higher sexism levels than girls. Perspective taking negatively predicted hostile sexism. Empathic concern positively predicted hostile and benevolent sexism. Significant gender-specific patterns emerged: more empathic concern was linked with increased hostile sexism in boys; higher perspective taking was linked with increased benevolent sexism in boys, but was lower in girls; (4) Conclusions: There is a complex interplay among empathy, gender, and sexism, suggesting that IPV prevention programs should be tailored differently for boys and girls by considering broader socio-political contexts, addressing traditional gender norms, and promoting gender equality.

En el complejo contexto en que se desarrolla la actividad turística cubana, se hace necesario atemperar la gestión del sector a las tendencias internacionales para con ello elevar la competitividad del destino país. En los últimos años, se ha señalado que se carece, a nivel de país, de estudios vinculados con la planeación estratégica e integrada del sector. En este escenario, y como parte del proyecto: Desarrollo y Competitividad del producto turístico cubano, se desarrolla la presente investigación con el objetivo de diseñar las pautas estratégicas para la gestión de los destinos turísticos cubanos. En la misma se desarrolló una etapa previa vinculada con el estudio teórico-conceptual y la descripción de los elementos vinculados al turismo en el destino. Posteriormente, se desarrollaron tres etapas donde fueron utilizados métodos y técnicas como análisis bibliográfico, encuestas a expertos y grupos de discusión. Lo anterior permitió exponer el análisis situacional de Cuba en cuanto a la gestión de sus destinos, perspectivas futuras, buenas prácticas de dos de los países que constituyen competencia directa, así como formular un total de cinco objetivos estratégicos y 30 pautas a tener en cuenta para el diseño de estrategias. En el estudio realizado sobresale la necesidad de que se reconozca y asuma la gestión de los destinos desde el territorio.

Primary brain neoplasms are associated with elevated mortality and morbidity rates. Brain tumour surgery aims to achieve maximal tumour resection while minimizing damage to healthy brain tissue. Research on Neuromodulation Induced Cortical Prehabilitation (NICP) has highlighted the potential, before neurosurgery, of establishing new brain connections and transfer functional activity from one area of the brain to another. Nonetheless, the neural mechanisms underlying these processes, particularly in the context of space-occupying lesions, remain unclear. A patient with a left frontotemporoinsular tumour underwent a prehabilitation protocol providing 20 sessions of inhibitory non-invasive neuromodulation (rTMS and multichannel tDCS) over a language network coupled with intensive task training. Prehabilitation resulted in an increment of the distance between the tumour and the language network. Furthermore, enhanced functional connectivity within the language circuit was observed. The present innovative case-study exposed that inhibition of the functional network area surrounding the space-occupying lesion promotes a plastic change in the network’s spatial organization, presumably through the establishment of novel functional pathways away from the lesion’s site. While these outcomes are promising, prudence dictates the need for larger studies to confirm and generalize these findings.

Meaning and understanding are didactic notions appropriate to work on concept comprehension, curricular design, and knowledge assessment. This document aims to delve into the meaning of school mathematical concepts through their semantic analysis. This analysis is used to identify and establish the basic meaning of a mathematical concept and to value its understanding. To illustrate the study, we have chosen the trigonometric notions of sine and cosine of an angle. The work exemplifies some findings of an exploratory study carried out with high school students between 16 and 17 years of age; it collects the variety of emergent notions and elements related to the trigonometric concepts involved when answering on the categories of meaning which have been asked for. We gather the study data through a semantic questionnaire and analyze the responses using an established framework. The subjects provide a diversity of meanings, interpreted and structured by semantic categories. These meanings underline different understandings of the sine and cosine, according to the inferred themes, such as length, ratio, angle and the calculation of a magnitude.

RESUMEN Introducción El síndrome de úlcera rectal solitaria es una patología poco estudiada. Su diagnóstico se establece por la combinación de hallazgos clínicos, endoscópicos, histopatológicos y microbiológicos. El objetivo de este trabajo es describir las principales características clínicas y de los pacientes con úlcera rectal solitaria atendidos en el Complejo Asistencial Universitario de Salamanca (CAUSA). Material y métodos Estudio descriptivo observacional retrospectivo, entre los años 2010 y 2020. Resultados De los 157 pacientes estudiados, 52,9 % (83) fueron hombres, con edad media de 68,8 18,2 años. El retraso diagnóstico fue de 6,85± 16,56 meses (1-84). La etiología no infecciosa se describió en el 93,6% de los casos, siendo más frecuente la úlcera rectal inespecífica (36%), úlcera rectal solitaria (14,9%) y proctitis actínica (14,2%). Se estudiaron infecciones en 56 pacientes, objetivándose un agente infeccioso en 10 pacientes, los patógenos más frecuentes fueron Clostridoides difficile (40%), Citomegalovirus (20%), Chlamydia trachomatis (10%) y Virus de Epstein Barr (10%). El síntoma más frecuente fue rectorragia (43,3%), seguido de anemia (15,3%), estreñimiento (10,8%), y diarrea (6,37%). La resolución de los síntomas tuvo lugar un 30,6% (48) de los pacientes y la recurrencia de la sintomatología estuvo presente en 10,2% (16). Conclusiones En la mayoría de las ocasiones no se realiza de forma exhaustiva el estudio del síndrome de úlcera rectal, lo que condiciona una baja tasa del diagnóstico etiológico. En nuestra serie predominan varones adultos sin diagnóstico etiológico. Es imprescindible coordinar a los diferentes servicios implicados y protocolizar su manejo para optimizar su diagnóstico y tratamiento. ABSTRACT Introduction Solitary rectal ulcer syndrome is a poorly studied pathology. Its diagnosis is established by the combination of clinical, endoscopic, histopathological and microbiological findings. The objective of this work is to describe the main clinical characteristics and characteristics of patients with solitary rectal ulcer treated at the Salamanca University Assistance Complex (CAUSA). Material and methods Retrospective observational descriptive study, between 2010 and 2020. Results Of the 157 patients studied, 52.9% (83) were men, with a mean age of 68.8 ± 18.2 years. The diagnostic delay was 6.85±16.56 months (1-84). Non-infectious etiology was described in 93.6% of cases, with nonspecific rectal ulcer (36%), solitary rectal ulcer (14.9%) and actinic proctitis (14.2%) being the most frequent. Infections were studied in 56 patients, objectifying an infectious agent in 10 patients, the most frequent pathogens were Clostridoides difficile (40%), Cytomegalovirus (20%), Chlamydia trachomatis (10%) and Epstein Barr Virus (10%). The most frequent symptom was rectal bleeding (43.3%), followed by anemia (15.3%), constipation (10.8%), and diarrhea (6.37%). Symptom resolution occurred in 30.6% (48) of the patients and symptom recurrence was present in 10.2% (16). Conclusions In most cases, the study of rectal ulcer syndrome is not carried out exhaustively, which determines a low rate of etiological diagnosis. In our series, adult males without etiological diagnosis predominate. It is essential to coordinate the different services involved and protocolize their management to optimize their diagnosis and treatment.

IntroductionPrevalence and mortality of the acute respiratory distress syndrome (ARDS) in intensive care units (ICU) are unacceptably high. There is scarce literature on post-operative sepsis-induced ARDS despite that sepsis and major surgery are conditions associated with ARDS. We aimed to examine the impact of post-operative sepsis-induced ARDS on 60-day mortality.MethodsWe performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups depending on whether they met criteria for ARDS. Primary outcome was 60-day mortality of post-operative sepsis-induced ARDS. Secondary outcome measures were potential risk factors for post-operative sepsis-induced ARDS, and for 60-day mortality.ResultsHigher SOFA score (OR 1.1, 95% CI 1.0–1.3, p = 0.020) and higher lactate (OR 1.9, 95% CI 1.2–2.7, p = 0.004) at study inclusion were independently associated with ARDS. ARDS patients (n = 45) had higher ICU stay [14 (18) vs. 5 (11) days, p < 0.001] and longer need for mechanical ventilation [6 (14) vs. 1 (5) days, p < 0.001] than non-ARDS patients (n = 409). Sixty-day mortality was higher in ARDS patients (OR 2.7, 95% CI 1.1–6.3, p = 0.024). Chronic renal failure (OR 4.0, 95% CI 1.2–13.7, p = 0.026), elevated lactate dehydrogenase (OR 1.7, 95% CI 1.1–2.7, p = 0.015) and higher APACHE II score (OR 2.7, 95% CI 1.3–5.4, p = 0.006) were independently associated with 60-day mortality.ConclusionPost-operative sepsis-induced ARDS is associated with higher 60-day mortality compared to non-ARDS post-operative septic patients. Post-operative septic patients with higher severity of illness have a greater risk of ARDS and worse outcomes. Further investigation is needed in post-operative sepsis-induced ARDS to prevent ARDS.

Recensión del libro de Gianluca Gardini: Le regole dell’informazione: verso la Gigabit Society, con la colaboración de Marina Caporale, Giappichelli Editore, 2021, (5.ª ed.), 437 pp.

The huge cadre of genes regulated by Myc has obstructed the identification of critical effectors that are essential for Myc-driven tumorigenesis. Here, we describe how only the lack of the receptor Fzd9, previously identified as a Myc transcriptional target, impairs sustained tumor expansion and β-cell dedifferentiation in a mouse model of Myc-driven insulinoma, allows pancreatic islets to maintain their physiological structure and affects Myc-related global gene expression. Importantly, Wnt signaling inhibition in Fzd9-competent mice largely recapitulates the suppression of proliferation caused by Fzd9 deficiency upon Myc activation. Together, our results indicate that the Wnt signaling receptor Fzd9 is essential for Myc-induced tumorigenesis in pancreatic islets.

The Least Absolute Shrinkage and Selection Operator (LASSO) regression technique has proven to be a valuable tool for fitting and reducing linear models. The trend of applying LASSO to compositional data is growing, thereby expanding its applicability to diverse scientific domains. This paper aims to contribute to this evolving landscape by undertaking a comprehensive exploration of the L1-norm for the penalty term of a LASSO regression in a compositional context. This implies first introducing a rigorous definition of the compositional Lp-norm, as the particular geometric structure of the compositional sample space needs to be taken into account. The focus is subsequently extended to a meticulous data-driven analysis of the dimension reduction effects on linear models, providing valuable insights into the interplay between penalty term norms and model performance. An analysis of a microbial dataset illustrates the proposed approach.

Following European directives, asbestos–cement corrugated roofing tiles must be eliminated by 2025. Therefore, identifying asbestos–cement rooftops is the first necessary step to proceed with their removal. Unfortunately, asbestos detection is a challenging task. Current procedures for identifying asbestos require human exploration, which is costly and slow. This has motivated the interest of governments and companies in developing automatic tools that can help to detect and classify these types of materials that are dangerous to the population. This paper explores multiple computer vision techniques based on Deep Learning to advance the automatic detection of asbestos in aerial images. On the one hand, we trained and tested two classification architectures, obtaining high accuracy levels. On the other, we implemented an explainable AI method to discern what information in an RGB image is relevant for a successful classification, ensuring that our classifiers’ learning process is guided by the right variables—color, surface patterns, texture, etc.—observable on asbestos rooftops.

Resumen: El eje tobillo-pie es una estructura compleja, cuya biodinámica permite una marcha eficiente. Las variantes anatómicas pueden alterar esta biodinámica y ser causa de dolor crónico. Sin embargo, con frecuencia no son tenidas en cuenta en la valoración del dolor de tobillo, pasándose por alto en la valoración radiológica, implicando retrasos diagnósticos que afectan a la calidad de vida del paciente y disminuyen la calidad asistencial. Abstract: The ankle-foot axis is a complex structure, whose biodynamics allow efficient march. Anatomical variants can alter this biodynamic and be the cause of chronic pain. However, they are frequently not taken into account in the assessment of ankle pain, being overlooked in the radiological assessment, implying diagnostic delays that affect the patient's quality of life and decrease the quality of care.

IntroductionNeurosurgery for brain tumors needs to find a complex balance between the effective removal of targeted tissue and the preservation of surrounding brain areas. Neuromodulation-induced cortical prehabilitation (NICP) is a promising strategy that combines temporary inhibition of critical areas (virtual lesion) with intensive behavioral training to foster the activation of alternative brain resources. By progressively reducing the functional relevance of targeted areas, the goal is to facilitate resection with reduced risks of neurological sequelae. However, it is still unclear which modality (invasive vs. non-invasive neuromodulation) and volume of therapy (behavioral training) may be optimal in terms of feasibility and efficacy.Methods and analysisPatients undertake between 10 and 20 daily sessions consisting of neuromodulation coupled with intensive task training, individualized based on the target site and neurological functions at risk of being compromised. The primary outcome of the proposed pilot, single-cohort trial is to investigate the feasibility and potential effectiveness of a non-invasive NICP protocol on neuroplasticity and post-surgical outcomes. Secondary outcomes investigating longitudinal changes (neuroimaging, neurophysiology, and clinical) are measured pre-NICP, post-NICP, and post-surgery.Ethics and disseminationEthics approval was obtained from the Research Ethical Committee of Fundació Unió Catalana d'Hospitals (approval number: CEI 21/65, version 1, 13/07/2021). The results of the study will be submitted to a peer-reviewed journal and presented at scientific congresses.Clinical trial registrationClinicalTrials.gov, identifier NCT05844605.

Abstract Background Hypertension is responsible for a huge burden of disease. The aim of this study was to evaluate the impact of newly diagnosed hypertension on the occurrence of kidney or cardiovascular events (K/CVEs) and on mortality among community dwellers. Methods Retrospective cohort study, conducted from January, 2007, to December, 2018. All patients (age > 18) newly diagnosed with hypertension and no previous K/CVEs in 2007 and 2008, in the primary care centers of Madrid (Spain) (n = 71,770), were enrolled. The control group (n = 72,946) included patients without hypertension, matched by center, sex and age. The occurrence of kidney or CV events, including mortality from these causes and total mortality were evaluated using Cox regression and multistate models. Data were collected from three sources: personal data from administrative records, clinical data from medical records, and mortality data from regional and national databases. Results The median follow-up was 138.61 months (IQR: 124.68–143.97 months). There were 32,896 K/CVEs (including 3,669 deaths from these causes) and 12,999 deaths from other causes. Adjusted for sex, smoking, diabetes and socioeconomic status, K/CVEs HR was 4.36 (95% CI: 3.80–5.00) for diagnoses before 45 years of age, 2.45(95% CI: 2.28- 2.63) for diagnosis between 45 to 54 years, and HR decreased to 1.86 (95% CI: 1.64–210) for diagnoses over age 85. Total mortality risk was only higher for hypertension diagnosed before 55 years of age (HR: 2.47, 95% CI: 1.90–3.19 for ages 18 to 44; and HR: 1.14, 95% CI: 1.02–1.28 for ages 45 to 54). Conclusion The diagnosis of hypertension in the community environment, in patients without evidence of previous kidney or CV disease, is associated with a large increase in the risk of K/CVEs, but especially in individuals diagnosed before the age of 55. This diagnosis is only associated with an increase in kidney or cardiovascular mortality or overall mortality when it occurs before age 55.

Abstract Background Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed. Methods A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods. Results Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15–0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5–55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02–1.21). Conclusions The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate. Trial registration ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.

El proceso de comercialización hotelera constituye un componente importante en el ámbito de la gestión de destinos turísticos. El objetivo de la investigación consiste en diseñar una estrategia de comercialización para las organizaciones hoteleras en el destino sol y playa de Crucita, provincia de Manabí, Ecuador, a partir de un conjunto de actividades de promoción y ventas. La metodología para el estudio se estructuró en etapas, iniciando con la revisión bibliográfica, identificación de estrategias y actividades de comercialización, prueba del coeficiente de concordancia de Kendall, aplicación de la Técnica de Grupo Nominal, ficha técnica de la investigación y evaluación de las actividades de promoción y ventas. Entre los principales resultados obtenidos del estudio preliminar, se han identificado un conjunto de nueve actividades reconocidas con los requerimientos comerciales para el servicio de alojamiento. Para concluir, se reafirma la inclusión de actividades como medios impresos, audiovisuales y digitales, la gestión de ventas de capacidades directamente con el cliente, direccionar el proceso de información y comunicación mediante la herramienta de correo electrónico; por último, desarrollar una gestión sostenible y responsable en el ámbito de los servicios hoteleros.

IntroductionCOVID-19 transmission has been characterized by the presence of asymptomatic patients. Additionally, most studies evaluating costs focus on symptomatic COVID-19 cases.ObjectiveTo describe the prevalence, characteristics, and costs of asymptomatic COVID-19 cases at admission in Spanish hospitals in 2020.MethodsA nationwide study was performed, and data of hospitalized patients were collected of the Minimum Basic Data Set in Spain during 2020. Patients with COVID-19 codes as a primary and as a secondary diagnosis at admission were selected. Variables collected included age, sex, length of stay, in-hospital death, admission, length of stay and death in intensive care unit, mechanical ventilation and ventilatory assistance. COVID-19 related hospital costs were calculated using diagnosis-related groups from the Minimum Basic Data Set. Patients and costs were disaggregated by sex, age group, intensive care unit admission and epidemic wave (first or second) and main diagnosis.ResultsA total of 14,742 patients were admitted with asymptomatic COVID-19 in Spanish hospitals representing 6.35% of all COVID-19 admitted patients. The total cost of admissions with asymptomatic COVID-19 was €105,933,677.6 with a mean cost per patient of €7,185.8 with higher mean cost in the first wave despite only 2.7% of cases were found during that time. Based on primary diagnosis, the higher number of cases of asymptomatic COVID-19 were found in “Pregnancy, childbirth and the puerperium” followed by “diseases of the circulatory system”.ConclusionsThere was a high prevalence of asymptomatic cases during screening at admission process in Spanish hospitals in 2020. The highest number of cases was found among the group of “pregnancy, childbirth, and puerperium” followed by “diseases of the circulatory system.” The higher costs might be due not only to the main pathology at admission but to the associated healthcare provisions needed in case of positive COVID-19 testing.

Cardiac CINE, a form of dynamic cardiac MRI, is indispensable in the diagnosis and treatment of heart conditions, offering detailed visualization essential for the early detection of cardiac diseases. As the demand for higher-resolution images increases, so does the volume of data requiring processing, presenting significant computational challenges that can impede the efficiency of diagnostic imaging. Our research presents an approach that takes advantage of the computational power of multiple Graphics Processing Units (GPUs) to address these challenges. GPUs are devices capable of performing large volumes of computations in a short period, and have significantly improved the cardiac MRI reconstruction process, allowing images to be produced faster. The innovation of our work resides in utilizing a multi-device system capable of processing the substantial data volumes demanded by high-resolution, five-dimensional cardiac MRI. This system surpasses the memory capacity limitations of single GPUs by partitioning large datasets into smaller, manageable segments for parallel processing, thereby preserving image integrity and accelerating reconstruction times. Utilizing OpenCL technology, our system offers adaptability and cross-platform functionality, ensuring wider applicability. The proposed multi-device approach offers an advancement in medical imaging, accelerating the reconstruction process and facilitating faster and more effective cardiac health assessment.