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Abstract Objective This study investigated the effectiveness and tolerability of brivaracetam (BRV) monotherapy in a large series of patients with epilepsy. Method This was a multicenter, retrospective, observational, non‐interventional study in 24 hospitals across Spain. Patients aged ≥18 years who started on BRV monotherapy, either as first‐line or following conversion, at least 1 year before database closure were included. Patients were evaluated at baseline and at 3, 6 and 12 months after initiation of BRV monotherapy, in accordance with usual clinical practice at these centers. Data were collected retrospectively from patients' individual charts by participating physicians. The primary effectiveness and safety endpoints were the percentage of seizure‐free patients 1 year after initiation of BRV monotherapy and the proportion of patients reporting adverse events (AEs) over the complete follow‐up period. Retention rates and subpopulation analysis (levetiracetam switchers, elderly and different etiologies) were also investigated. Results A total of 276 patients were included (48 with BRV as first‐line monotherapy and 228 who converted to BRV monotherapy). The overall retention rate in monotherapy at 12 months was 89.9% (87.5% for first‐line monotherapy group; 90.4% for conversion‐to‐monotherapy group). Seizure‐freedom rates at 12 months were 77.8% (75% for first‐line monotherapy group; 78.4% for conversion‐to‐monotherapy group). AEs occurred in 39.5% of patients at 12 months (35.4% for first‐line monotherapy group; 40.4% for conversion‐to‐monotherapy group). Most AEs were mild‐to‐moderate. The most frequent AEs were irritability (12.3%) and dizziness (10.1%). The most frequent AEs leading to BRV withdrawal were dizziness (1.8%) and memory problems (1.4%). Similar outcomes in terms of effectiveness and tolerability of BRV monotherapy were observed in patients switching from levetiracetam, those with different epilepsy etiologies, and elderly patients. Significance BRV was effective and well tolerated both as first‐line monotherapy and following conversion to monotherapy in a real‐world setting of patients with epilepsy. Plain Language Summary The goal of the medical treatment of epilepsy is to ensure best possible patient quality of life, by maximizing seizure control and minimizing medication toxicity. Brivaracetam (BRV) is a new‐generation epilepsy treatment that is well tolerated by patients. In our study, monotherapy with BRV reduced seizures in patients who had not received other treatments and in patients who switched from a previous treatment to BRV monotherapy. BRV was well tolerated and also effective in sensitive patients (i.e., the elderly and those who had epilepsy caused by a brain tumor or a brain injury).

SoCs are required to maintain information private when requested by the Operating System (OS) or the application. From a high level point of view, there are time domains, typically processes or threads, and there should be no time information leak between them. At the same time, cores inside SoCs are supposed to be fast levering many predictors and resource sharing for efficiency. Using predictors like caches and branch predictors can have side effects that leak information across time domains. Specifically, the challenge is that the code executed by one time domain affects the performance of another. This time impact information leak can be exploited as a side channel attack.The goal of this work is to classify the different side channel \textbf{time} information leaks that result from different predictors available in typical high performance cores. The work focuses on side channels that result of changes in execution time, not other side channels like Electro-Magnetic Interference. The proposed classification points that time side effects or leaks can be due to program data, address, program counter, or just execution time. Each of those information leaks can happen during the speculative or the non-speculative execution. This work also goes over all the predictors in current out-of-order cores, and shows mechanisms to avoid the time-based information leak.

Background/Objective: The aim of this study was to analyse whether the association between adherence to the Mediterranean diet and health-related quality of life (HRQoL) is mediated by physical fitness components (i.e., cardiorespiratory fitness, lower-limb strength, upper-limb strength and motor competence) in adolescents. Methods: This is a cross-sectional study including mediation analyses. This study involved 181 adolescents (86 girls) aged 15.8 ± 0.3 years recruited from secondary schools and sport clubs located in Castellon (Spain). Adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. HRQoL was assessed with the KIDSCREEN-10 questionnaire. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Lower-limb strength was assessed through the standing broad jump test. Upper-limb strength was evaluated using a handgrip dynamometer. Motor competence was assessed using the 4 × 10 m shuttle run test. Mediation analyses were performed for each physical fitness component in order to assess its mediating effect on the association between adherence to the Mediterranean diet and HRQoL. Indirect effects (IE) with confidence intervals (CI) not including zero were interpreted as statistically significant. Results: Cardiorespiratory fitness and lower-limb strength had a mediating effect on the positive association between adherence to the Mediterranean diet and HRQoL (IE = 0.11, 95 % CI = 0.01; 0.27 and IE = 0.07, 95 % CI = 0.01; 0.19). Upper-limb strength and motor competence did not act as mediators in the association between adherence to the Mediterranean diet and HRQoL (IE = 0.00, 95 % CI = −0.04; 0.07 and IE = 0.01, 95 % CI = −0.03; 0.07, respectively). Conclusion: Our findings showed that the positive association of adherence to the Mediterranean diet on adolescents' HRQoL was mediated by physical fitness. Educational and public health strategies aiming to improve Spanish adolescents’ HRQoL should focus on diet and physical fitness.

The path that student-athletes follow to pursue their dual careers is both complex and demanding. However, an increasing number of elite athletes enroll in higher education today. To explore the current situation of elite university athletes in Spain, a study was conducted with the main objective of identifying their characteristics, concerns, interests, and challenges when combining their sporting and academic careers. To this end, a survey consisting of 27 items was distributed among a group of Spanish universities belonging to the Spanish University Sports Committee. A total of 563 responses were collected, of which 411 were ultimately processed from 27 different Spanish universities, providing us with insight into pursuing a dual career in Spanish universities. Descriptive data were gathered on various aspects such as age, field of study, hours dedicated to sports and studies, sports level, most relevant sports disciplines, interest in transnational mobility, and the perception and use of the benefits student-athletes receive when pursuing a dual career. Ultimately, this work aims to assist higher education institutions in developing tools that facilitate the program design for elite athletes.

Objectives While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU.Design, setting and patients We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI’s BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US).Results 191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio.Conclusions Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge.

Introduction: Our aim was to determine which foetal or neonatal growth curves discriminate the probability of dying of newborns with low birth weight for their gestational age (small for gestational age, SGA) and sex (weight < 10th percentile) and to establish the curves that are presumably most useful for monitoring growth through age 10 years. Material and methods: The analysis included every neonate (15 122) managed in our hospital (2013–2022) and all neonates born preterm before 32 weeks (6913) registered in the SEN1500 database (2019–2022). We considered most useful those curves with the highest likelihood ratio (LR) for dying with or without a history of SGA in each subgroup of gestational ages. Theoretically, the optimal curves for monitoring growth would be those with a higher R2 in the quantile regression formulas for the 50th percentile. Results: The growth curves exhibiting the strongest association between SGA and hospital mortality are the Intergrowth fetal curves and the Fenton neonatal curves in infants born preterm before 32 weeks. However, the optimal curves for premature babies and neonates overall were those of Olsen and Intergrowth. The most useful curves to monitor anthropometric values alone until age 10 years of age are the longitudinal Intergrowth curves followed by the WHO standards, but if a single reference is desired from birth through age 10 years, the best option is the Fenton curves followed by the WHO standards. Conclusions: The Intergrowth reference provides the most discriminating foetal growth curves. In neonatal clinical practice, the optimal references are the Fenton followed by the WHO charts. Resumen: Introducción: Se pretende determinar qué curvas de crecimiento fetal o neonatal discriminan la probabilidad de fallecer de los recién nacidos de bajo peso para su edad gestacional (BPEG) y sexo (peso inferior al percentil 10) y conocer las curvas teóricamente más útiles para seguir el crecimiento hasta los 10 años. Material y método: Se estudian todos los neonatos (15.122) atendidos en nuestro hospital (2013-2022) y todos los prematuros menores de 32 semanas (6.913) incluidos en la base de datos SEN1500 (2019-2022). Las curvas más útiles serán las que tengan un mayor cociente de probabilidad (LHR=likelihood ratio) de fallecer siendo o no BPEG en cada subgrupo de edades gestacionales. Las curvas más indicadas teóricamente en el seguimiento serán las que tengan una mayor R2 en las fórmulas de regresión de las tendencias del percentil 50. Resultados: Las curvas de crecimiento que mejor relacionan BPEG con mortalidad hospitalaria son las fetales de Intergrowth y las neonatales de Fenton en los prematuros menores de 32 semanas. Sin embargo, en todos los prematuros y neonatos en su conjunto, son las de Olsen e Intergrowth. Las curvas más útiles para seguir sólo la evolución antropométrica hasta los 10 años son las longitudinales de Intergrowth más OMS, pero si se desea una curva única desde el nacimiento hasta los 10 años son las de Fenton más OMS. Conclusiones: Las curvas de crecimiento fetal más discriminante son las de Intergrowth fetales. En la práctica clínica del neonatólogo, las curvas más indicadas son las de Fenton más OMS.

IntroductionThe project Student Athletes Erasmus+ Mobility in Europe identified and defined a total of 31 benefits offered to dual-career student athletes who are combining their university studies with high-level training. The project was co-funded by the European Union and carried out by five universities: Chalmers University of Technology (Sweden), Institut national des sciences appliquées de Lyon (France), University of Jyväskylä (Finland), Karlsruhe Institute of Technology (Germany), and Universitat Jaume I (Spain).MethodsThe purpose of the study was to rank these benefits by combining the perspectives of the university staff and the student athletes from each university in the consortium. The university staff included experts from sports services and the international relations office. A questionnaire was also sent to the dual-career athletes enrolled at the consortium's universities. Of the 514 dual-career athletes, 208 (116 women) completed the questionnaire. The overall response rate was 40.47%. The university staff assessed the importance of each benefit, how easy it was to implement at the institution, and whether or not the university offered the benefit to its students. The dual-career students rated each of the 31 benefits and indicated whether or not they had used them. A specific methodology was designed to rank these benefits using the ratings of the university staff and the student athletes. Intra-group and inter-group Pearson correlations were performed.ResultsThe results show a strong and significant correlation between the benefits from the perspective of the university staff (r = 0.710, p = 7.76E-7) and from the perspective of the students (r = 0.715, p = 2.44E-6). The correlation is moderate and significant when the benefits are correlated from the perspective of the two groups as a whole (0.363, p = 0.045), with the three most important benefits being the free use of sports facilities, justification for absences, and the adaptation of the pace of studies.DiscussionThe study makes visible the commitment of higher education institutions to facilitating the dual career of student athletes and identifies those benefits that may be of greater interest to European universities as a whole. The European perspective has been considered, while respecting the specificities of each university and the country in which it is located.

In the present study, a revision of the phylogeny and taxonomy of the family Dorididae is carried out focusing on the genus Doris Linnaeus, 1758. The type species D. verrucosa Linnaeus, 1758 and a blueish and yellow morphotype of D. ocelligera collected in different localities in the Mediterranean Sea and the North-East Atlantic were sequenced, as well as D. bertheloti and the elusive D. marmorata for the first time. The genetic markers include the cytochrome c oxidase subunit I, 16S rRNA, and histone 3. The phylogenetic results suggest that the genus Doris is paraphyletic, and D. ocelligera morphotypes separate into two species, as confirmed with species delimitation tests. To complement the phylogenetic evidence with morphoanatomical data, the dissection of two specimens of each morphotype is conducted. Significant differences in morphological traits such as body shape, colouration patterns, and mantle tubercles come to light, together with anatomical differences in the relative shape and size of the radular teeth and reproductive structures. Considering the modern and old descriptions of D. ocelligera, it is finally concluded that the blueish morphotype belongs to D. ocelligera. In contrast, the yellow morphotype responds to the actual synonym Aldisa berghi (Vayssière, 1901), which is resurrected here as Doris berghi comb. rest. Considering the broad phylogeny of the family, some systematic notes at the genus level are here provided.

El Maestrazgo y la Sierra de Gúdar en Teruel tienen una gran diversidad de ecosistemas, entre los que destacan, además del bosque de ribera y los ecosistemas acuáticos sobre los que nos centraremos en este trabajo, ecosistemas forestales repartidos en varios pisos bioclimáticos. El objetivo de este trabajo es doble. Por un lado, se pretende evaluar el estado de conservación de uno de los territorios de mayor riqueza natural del sur de Aragón como es el ecosistema fluvial del río Guadalope en su tramo alto, y por otro lado proponer un marco de protección con mayor imperativo legal como es el parque natural, figura que en la actualidad no tiene esta provincia. Para ello, la metodología empleada por un lado consistirá en la consulta de la escasa bibliografía especializada sobre esta zona de estudio, y por otro lado en la determinación de la calidad de los hábitats fluviales a partir de la construcción de dos índices: el QBR sobre calidad del bosque de ribera, y el IHF sobre hábitats fluviales. Los resultados muestran que, pese a que este territorio no tiene en estos momentos ningún marco de protección ambiental más allá de tres monumentos naturales, una ZEPA y una ZEC, reúne valores suficientes como para que sea declarado como parque natural, que sería, además, el primero de este territorio.

In coastal regions, groundwater is often the only freshwater resource available for human consumption, agriculture, and other productive activities. From a management point of view, it is essential to understand the processes that occur in a coastal aquifer affected by seawater intrusion and upconing processes and evaluate their potential response to climate change as these scenarios usually indicate a decrease in aquifer recharge. Therefore, the dynamics of seawater intrusion and the upconing process in the Plana de Castellón aquifer on the Mediterranean coast were analysed by building and calibrating a new numerical model of flow and transport using the MODFLOW and SEAWAT codes. The model was used to examine two Shared Socioeconomic Pathway (SSP) climate change scenarios (SSP1–2.6 and SSP5–8.5) when considering field data with constant extraction conditions. The results suggest that by 2050, groundwater levels could rise by 0.18 m (on average) in the SSP1–2.6 scenario and by 0.12 m for the SSP5–8.5 scenario. In these cases, aquifer recharge and groundwater discharge to the sea could increase compared to the historical period, as precipitation is not expected to decrease significantly during this timeframe, even in the most unfavourable scenario (SSP5–8.5). The result would be the attenuation of seawater intrusion and a decrease in the volume of the aquifer that is affected by the upconing process, resulting in total dissolved solids values below 2000 mg/L. The innovation of this research lies in the fact that the numerical model allowed the dynamics of seawater intrusion and the upconing process to be adequately represented, especially in the latter process, as it was not possible to model it with real data in another study. These results can improve and facilitate decision-making for the management of the aquifer and contribute to plans for future exploitation strategies.

One of the most significant complications of diabetes mellitus is diabetic sensory neuropathy. A reduction in pain perception increases the risk of diabetic patients developing foot ulcers and requiring amputation, which in turn results in impaired mobility and a diminished quality of life. Despite recent advances in our understanding of the aetiology of diabetic foot ulcers (DFUs), there remains a significant gap in the clinical prevention and management of these ulcers. Given that inflammation represents the initial stage in the formation of skin wounds, the utilisation of infrared thermography for the early detection of inflammatory tissue, the analysis of plantar pressures and the monitoring of controlled physical activity (PA) may facilitate the close observation of plantar skin alterations that are susceptible to the development of DFUs, thereby enabling the implementation of timely interventions such as personalised PA for these patients. It is recommended that an integrated approach be adopted which encompasses the utilisation of all emerging technologies in order to enhance outcomes in the prevention and management of DFUs. The aim of this study is to examine the existing literature on the relationship between temperature, pressure and physical activity in the diabetic foot. To this end, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format across the PubMed, Scopus and Web of Science databases, with no temporal restriction. A total of 14 studies were included in the review. The use of infrared thermography for the early detection of inflammatory tissue, plantar pressures and the monitoring of controlled PA can facilitate the close monitoring of changes that may pose a risk for the formation of UFDs and provide timely intervention, thereby personalising the PA of the diabetic patient.