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BACKGROUND: A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill this gap, we developed and validated an e-learning ICU Delirium Playbook consisting of eight videos and a 44-question knowledge assessment quiz. Given the increasing Spanish-speaking population worldwide, we translated and cross-culturally adapted the playbook from English into Spanish. OBJECTIVE: To translate and culturally adapt the ICU Delirium Playbook into Spanish, the second most common native language worldwide. METHODS: The translation and cross-cultural adaptation process included double forward and back translations and harmonization by a 14-person interdisciplinary team of ICU nurses and physicians, delirium experts, methodologists, medical interpreters, and bilingual professionals representing many Spanish-speaking global regions. After a preeducation quiz, a nurse focus group completed the playbook videos and posteducation quiz, followed by a semistructured interview. RESULTS: The ICU Delirium Playbook: Spanish Version maintained conceptual equivalence to the English version. Focus group participants posted mean (standard deviation) pre- and post-playbook scores of 63% (10%) and 78% (12%), with a 15% (11%) pre-post improvement (P = 0.01). Participants reported improved perceived competency in performing the Confusion Assessment Method for the ICU and provided positive feedback regarding the playbook. CONCLUSION: After translation and cultural adaptation, the ICU Delirium Playbook: Spanish Version yielded significant knowledge assessment improvements and positive feedback. The Spanish playbook is now available for public dissemination.

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer, characterized by late diagnosis and poor treatment response. Surgery is the only curative approach, only available to early‐diagnosed patients. Current therapies have limited effects, cause severe toxicities, and minimally improve overall survival. Understanding of splicing machinery alterations in PDAC remains incomplete. Here, we comprehensively examined 59 splicing machinery components, uncovering dysregulation in pre‐mRNA processing factor 8 (PRPF8) and RNA‐binding motif protein X‐linked (RBMX). Their downregulated expression was linked to poor prognosis and malignancy features, including tumor stage, invasion and metastasis, and associated with poorer survival and the mutation of key PDAC genes. Experimental modulation of these splicing factors in pancreatic cancer cell lines reverted their expression to non‐tumor levels and resulted in decreased key tumor‐related features. These results provide evidence that the splicing machinery is altered in PDAC, wherein PRPF8 and RBMX emerge as candidate actionable therapeutic targets.

The dynamic behavior of the tensegrity structure (helix) of a rotary airborne wind energy (RAWE) machine was investigated by combining experimental and numerical techniques. Taking advantage of the slenderness of the helix, a dynamic model for the evolution of its center line and the torsional deformation was developed by using Cosserat theory. The constitutive relations for the axial, bending, and torsional stiffness, which are a fundamental component of the model, were obtained experimentally by carrying out laboratory tests. Three scenarios of increasing complexity were then studied with the numerical tool. Firstly, a stationary solution of the model, i.e., with fixed ends and no rotation, was found numerically and used to verify the correct implementation of a numerical code based on finite elements. The stability analysis of this solution, which corresponds to the state of the structure just after deployment but before operation, showed that the natural periods of longitudinal, lateral, and torsional modes of the RAWE structure under consideration are around 0.03, 0.2, and 0.4 s, respectively. Secondly, the dynamics in nominal operation was investigated by keeping both end tips fixed and implementing a controller that adjusts the torque at the ground to reach a target angular velocity of 120 rpm. Key characteristic variables like the tension and the response times of the helix were obtained. Thirdly, the dynamics of the helix when the lower end is fixed and the upper end is driven in a circular motion of frequency f1 was studied experimentally and numerically. The tension of the helix in the experiment increased for f1 above a certain threshold, and the structure collapsed at f1≈5 Hz. Simulation analysis revealed a resonance of the structure at a higher frequency (around 13 Hz).

Vários estudos têm alertado para as dificuldades de adaptação e para um maior abandono nos cursos da área da Engenharia, sobretudo durante o 1.º ano do Ensino Superior (ES). Esta situação revela-se um problema para os(as) estudantes, para as instituições de ensino e para a economia em geral. Assim, o presente estudo tem como objetivo central analisar as diferenças na adaptação ao ES em função do género e do rendimento académico dos(as) estudantes de Engenharia, de forma a contribuir para a identificação de grupos vulneráveis e para a implementação de estratégias de intervenção. Neste estudo, participaram 461 estudantes primeiranistas de Engenharia de uma instituição de ensino superior politécnico público do norte de Portugal, com uma idade média de 17,91 anos; 33,8% eram mulheres e 66,2% eram homens. Para avaliar a adaptação ao ES, empregou-se o Student Adaptation to College Questionnaire e, para avaliar o rendimento académico, foram utilizadas as classificações obtidas nas unidades curriculares do 1.º semestre. Os resultados deste estudo indicaram que os(as) estudantes que obtiveram um melhor rendimento também se adaptaram melhor académica e pessoalmente ao ES e que, apesar de o rendimento académico ser similar para ambos os géneros, os homens adaptaram-se melhor a nível académico e pessoal-emocional. Concluiu-se, assim, que as mulheres se encontravam numa situação de maior vulnerabilidade neste contexto de estudos e que poderão beneficiar de programas de orientação para promover a sua adaptação. Palavras-chave: Adaptação ao ensino superior; Rendimento académico; Estudantes de engenharia; Ensino superior politécnico; Sexo.

Patients with obstructive sleep apnea (OSA) show autonomic, mood, cognitive, and breathing dysfunctions that are linked to increased morbidity and mortality, which can be improved with early screening and intervention. The gold standard and other available methods for OSA diagnosis are complex, require whole-night data, and have significant wait periods that potentially delay intervention. Our aim was to examine whether using faster and less complicated machine learning models, including support vector machine (SVM) and random forest (RF), with brain diffusion tensor imaging (DTI) data can classify OSA from healthy controls. We collected two DTI series from 59 patients with OSA [age: 50.2 ± 9.9 years; body mass index (BMI): 31.5 ± 5.6 kg/m2 ; apnea-hypopnea index (AHI): 34.1 ± 21.2 events/h 23 female] and 96 controls (age: 51.8 ± 9.7 years; BMI: 26.2 ± 4.1 kg/m2 ; 51 female) using a 3.0-T magnetic resonance imaging scanner. Using DTI data, mean diffusivity maps were calculated from each series, realigned and averaged, normalised to a common space, and used to conduct cross-validation for model training and selection and to predict OSA. The RF model showed 0.73 OSA and controls classification accuracy and 0.85 area under the curve (AUC) value on the receiver-operator curve. Cross-validation showed the RF model with comparable fitting over SVM for OSA and control data (SVM; accuracy, 0.77; AUC, 0.84). The RF ML model performs similar to SVM, indicating the comparable statistical fitness to DTI data. The findings indicate that RF model has similar AUC and accuracy over SVM, and either model can be used as a faster OSA screening tool for subjects having brain DTI data.

BackgroundGlioblastoma is one of the most devastating cancer worldwide based on its locally aggressive behavior and because it cannot be cured by current therapies. Defects in alternative splicing process are frequent in cancer. Recently, we demonstrated that dysregulation of the spliceosome is directly associated with glioma development, progression, and aggressiveness.MethodsDifferent human cohorts and a dataset from different glioma mouse models were analyzed to determine the mutation frequency as well as the gene and protein expression levels between tumor and control samples of the splicing-factor-3B-subunit-1 (SF3B1), an essential and druggable spliceosome component. SF3B1 expression was also explored at the single-cell level across all cell subpopulations and transcriptomic programs. The association of SF3B1 expression with relevant clinical data (e.g., overall survival) in different human cohorts was also analyzed. Different functional (proliferation/migration/tumorspheres and colonies formation/VEGF secretion/apoptosis) and mechanistic (gene expression/signaling pathways) assays were performed in three different glioblastomas cell models (human primary cultures and cell lines) in response to SF3B1 blockade (using pladienolide B treatment). Moreover, tumor progression and formation were monitored in response to SF3B1 blockade in two preclinical xenograft glioblastoma mouse models.ResultsOur data provide novel evidence demonstrating that the splicing-factor-3B-subunit-1 (SF3B1, an essential and druggable spliceosome component) is low-frequency mutated in human gliomas (~ 1 %) but widely overexpressed in glioblastoma compared with control samples from the different human cohorts and mouse models included in the present study, wherein SF3B1 levels are associated with key molecular and clinical features (e.g., overall survival, poor prognosis and/or drug resistance). Remarkably, in vitro and in vivo blockade of SF3B1 activity with pladienolide B drastically altered multiple glioblastoma pathophysiological processes (i.e., reduction in proliferation, migration, tumorspheres formation, VEGF secretion, tumor initiation and increased apoptosis) likely by suppressing AKT/mTOR/ß-catenin pathways, and an imbalance of BCL2L1 splicing.ConclusionsTogether, we highlight SF3B1 as a potential diagnostic and prognostic biomarker and an efficient pharmacological target in glioblastoma, offering a clinically relevant opportunity worth to be explored in humans.

Este artículo destaca el potencial de las familias y sus asociaciones de madres y padres (AMPA) para promover la cultura democrática y participativa en los centros escolares. Se aborda el recorrido de la participación de las familias, en general, y de estas asociaciones, en particular, al amparo de las leyes educativas españolas y otros desarrollos normativos hasta la legitimación actual de su presencia en los centros. Asimismo, con el apoyo de diversas investigaciones, se analizan las barreras que obstaculizan el funcionamiento eficaz de las AMPA y les impiden avanzar más en la participación colectiva de las familias. Por último, se señalan los principales retos a los que se enfrentan los centros para reforzar la participación colectiva de las familias —especialmente en los procesos de toma de decisiones. Se pone de relieve el papel de los equipos directivos para mantener una cultura de funcionamiento democrática y participativa.

The Jambato Harlequin toad (Atelopus ignescens), a formerly abundant species in the Andes of Ecuador, faced a dramatic population decline in the 1980s, with its last recorded sighting in 1988. The species was considered Extinct by the IUCN until 2016, when a fortuitous discovery of one Jambato by a local boy reignited hope. In this study, we present findings from an investigation conducted in the Angamarca parish, focusing on distribution, abundance, habitat preferences, ecology, disease susceptibility, and dietary habits of the species. In one year we identified 71 individuals at different stages of development in various habitats, with a significant presence in agricultural mosaic areas and locations near water sources used for crop irrigation, demonstrating the persistence of the species in a complex landscape, with considerable human intervention. The dietary analysis based on fecal samples indicated a diverse prey selection, primarily comprising arthropods such as Acari, Coleoptera, and ants. Amphibian declines have been associated with diseases and climate change; notably, our study confirmed the presence of the pathogen Batrachochytrium dendrobatidis (Bd), but, surprisingly, none of the infected Jambatos displayed visible signs of illness. When analyzing climatic patterns, we found that there are climatic differences between historical localities and Angamarca; the temporal analysis also exposes a generalized warming trend. Finally, in collaboration with the local community, we developed a series of management recommendations for terrestrial and aquatic environments occupied by the Jambato.

While people 65 years of age and older represent 16% of the population in the United States, they account for >40% of surgical procedures performed each year. Maintaining brain health after anesthesia and surgery is not only important to our patients, but it is also an increasingly important patient safety imperative for the specialty of anesthesiology. Aging is a complex process that diminishes the reserve of every organ system and often results in a patient who is vulnerable to the stress of surgery. The brain is no exception, and many older patients present with preoperative cognitive impairment that is undiagnosed. As we age, a number of changes occur in the human brain, resulting in a patient who is less resilient to perioperative stress, making older adults more susceptible to the phenotypic expression of perioperative neurocognitive disorders. This review summarizes the current scientific and clinical understanding of perioperative neurocognitive disorders and recommends patient-centered, age-focused interventions that can better mitigate risk, prevent harm, and improve outcomes for our patients. Finally, it discusses the emerging topic of sleep and cognitive health and other future frontiers of scientific inquiry that might inform clinical best practices.

Este artículo reseña: Kevin Fredy HINTERBERGER, Regularisations of Irregularly Staying Migrants in the EU. A comparative Legal Analysis of Austria, Germany and Spain, Hart Publishing/Nomos, Baden-Baden (Germany), 2023, 398 pp.

Taurine is considered a non-essential amino acid because it is synthesized by most mammals. However, dietary intake of taurine may be necessary to achieve the physiological levels required for the development, maintenance, and function of certain tissues. Taurine may be especially important for the retina. The concentration of taurine in the retina is higher than that in any other tissue in the body and taurine deficiency causes retinal oxidative stress, apoptosis, and degeneration of photoreceptors and retinal ganglion cells. Low plasma taurine levels may also underlie retinal degeneration in humans and therefore, taurine administration could exert retinal neuroprotective effects. Taurine has antioxidant, anti-apoptotic, immunomodulatory, and calcium homeostasis-regulatory properties. This review summarizes the role of taurine in retinal health and disease, where it appears that taurine may be a promising nutraceutical.

Background and Objectives: The aim was to compare the activity of the masseter muscles in children with different types of breathing. Materials and Methods: A cross-sectional study was conducted including patients aged 6–12 years with mixed dentition, who came for oral care at the Master’s Degree in Pediatric Dentistry program at the Complutense University of Madrid (UCM), according to inclusion and exclusion criteria. The sample was divided into three groups: nasal breathers without dental alterations (control group), oral breathers with dental malocclusion, and oral breathers with previous orthodontic treatment. An electromyography was performed, and statistic methods were conducted with a 95% confidence to contrast hypothesis. Results: A total of 122 children were analyzed and distributed into three groups. The electrical muscle activity of masseters was significantly different between the study groups (p < 0.001 for all comparisons). Pairwise comparisons revealed a significantly higher electrical muscle activity in the control group (nasal breathers) during chewing compared to both groups of oral breathers (p < 0.001 for both comparisons). Orthodontic treatment decreased electrical muscle activity during isometric contraction in oral breathers compared to nasal breathers (p < 0.001), but did not significantly affect electrical muscle activity during chewing. Higher decompensation values were obtained in oral breathers without previous orthodontic treatment compared the other study groups (p < 0.001 for both comparisons), although electrical muscle activity values were similar in both groups of oral breathers (p > 0.05 for both comparisons). Conclusions: Differences in electrical muscle activity between nasal and oral breathers can be confirmed. Oral breathers with and without orthodontic treatment showed lower electrical muscle activity of masseters during chewing than nasal breathers, while at isometric contraction, only oral breathers with previous orthodontic treatment showed lower electrical activity. Higher decompensation values were found in oral breathers without previous orthodontic treatment, in comparison to the control group and oral breathers with previous orthodontic treatment.

Purpose: The aim was to analyze the accuracy of digital models and 3D-printed casts from full-arch digital impressions using two intraoral scanners (iTeroTM and PrimescanTM). Materials and methods: A crossover reliability study was designed, scanning children and teenagers with iTeroTM and PrimescanTM. Accuracy was evaluated by measuring intercanine, intermolar, and ipsilateral canine–molar distances intraorally and comparing these measurements with those from plaster casts, digital models obtained with intraoral scanners, and 3D-printed casts. A paired comparison and a general linear model with a one-way repeated measures ANOVA procedure were carried out with a confidence level of 95% (p ≤ 0.05). Results: A total of 51 subjects were analyzed (mean age 12.35 ± 2.57). Statistical differences (p < 0.05) were found in the upper and lower arch regarding accuracy in comparison to intraoral measurements, except for the iTeroTM-printed cast and canine–molar upper right and intercanine lower distances (p > 0.05 for all comparisons). Regarding a comparison between reproduction methods, the plaster cast oversized the intercanine upper distance in comparison with both intraoral scanners’ digital models and the PrimescanTM-printed cast (p = 0.001), but there were no differences in the lower arch (p > 0.05 for all comparisons). Conclusion: Intraoral scanners reproduce tooth structures with similar accuracy to conventional methods.

The invasive mealybug Delottococcus aberiae De Lotto (Hemiptera: Pseudococcidae) has rapidly spread in the Mediterranean basin since its detection in 2009 in the Valencia Community in eastern Spain. The use of sticky traps baited with its sex pheromone, (4,5,5-trimethyl-3-methylenecyclopent-1-en-1-yl)methyl acetate, has allowed to determine the geographical distribution of D. aberiae by means of the surveillance network described in the present work. The population monitoring of the pest over a five-year period (2019–2023) has revealed an increase from 31% to 70% of the affected citrus-growing area. The monitoring network has also allowed a better understanding of the pests’ biological cycle throughout the year. The populations start growing from March to June and reach their maximum in July–August. During autumn, there is a gradual decline in the population. Although the highest annual populations were detected in 2022 and 2023, the greatest crop losses were recorded in 2020 and 2021, with mean values near 18%. Data suggest that the damage responsible for fruit deformation, and thus the economic losses, are related to the population levels in spring (April–May) rather than those in summer (July–August). The findings of this study can be valuable for future research and development of effective pest control strategies.

Collaborative learning (CL) is the instructional use of small groups in such a way that students work together to maximize their own and others’ learning. In this study, the aim was to implement online collaborative learning (OCL) using the Microsoft Teams (MT) platform and to analyze the students’ preferences regarding presential or online learning. Material and Methods: A descriptive and analytical cross-sectional study was conducted with 79 students from the Degree in Dentistry. Four groups were created with MT and clinical cases or problems were uploaded for online discussion with each group. Additionally, as part of the course program, the students were divided into the same groups for to carry out Problem-Based Learning (PBL) in person. Afterwards, students completed a project assessment and satisfaction survey. Results: The survey revealed that the students found participation in this project to be useful or very useful. Their experiences with MT were rated as positive or very positive. However, a significant portion of the students (42.6%) preferred conventional face-to-face (FF) problem-solving, while 27.9% preferred using online tools. Based on the execution of this project and the open feedback on the use of MT, we have outlined a series of recommendations to enhance the use of this platform. Conclusions: MT is a highly useful platform for online teaching, offering multiple tools to promote learning in a virtual and asynchronous manner. However, when comparing CL through PBL conducted FF versus online, students still prefer in-person teaching to virtual methods.

Background The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll.Objective The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs).Methods We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs.Results We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p

Summary: Insect physiology and reproduction depend on several terpenoid compounds, whose biosynthesis is mainly unknown. One enigmatic group of insect monoterpenoids are mealybug sex pheromones, presumably resulting from the irregular coupling activity of unidentified isoprenyl diphosphate synthases (IDSs). Here, we performed a comprehensive search for IDS coding sequences of the pest mealybug Planococcus citri. We queried the available genomic and newly generated short- and long-read P. citri transcriptomic data and identified 18 putative IDS genes, whose phylogenetic analysis indicates several gene family expansion events. In vitro testing confirmed regular short-chain coupling activity with five gene products. With the candidate with highest IDS activity, we also detected low amounts of irregular coupling products, and determined amino acid residues important for chain-length preference and irregular coupling activity. This work therefore provides an important foundation for deciphering terpenoid biosynthesis in mealybugs, including the sex pheromone biosynthesis in P. citri.

Patients with obstructive sleep apnea (OSA) reveal functional changes in brain sites involved in autonomic, cognitive, and mood regulations. However, it is unclear whether these brain changes reverse with short-term positive airway pressure (PAP) treatment. Our aim was to examine brain functional changes in response to 3-months of PAP treatment using regional homogeneity (ReHo) measures, where increased and decreased ReHo value indicates hyper- and hypo-local neural activities, respectively, and considered as functional deficits. We collected brain magnetic resonance imaging data as well as mood, cognitive, and sleep variables from 17 treatment-naïve OSA at baseline and after 3-months of PAP treatment and 25 age- and gender-matched healthy controls. Whole-brain ReHo maps were calculated and compared between OSA and controls and OSA subjects before and after PAP treatment. At baseline, treatment-naïve OSA subjects showed higher ReHo in the bilateral thalamus, putamen, postcentral gyrus, paracentral lobule, supplementary motor area, and right insula, and lower ReHo in the frontal and parietal cortices, compared to controls. After 3-months of PAP treatment, abnormal sleep and mood scores decreased significantly to normal levels. ReHo decreased in the autonomic and somatosensory control areas, including the thalamus, putamen, postcentral gyrus, and insula, and increased in the cognitive and affective regulatory parietal regions. The normalized ReHo was correlated with improved sleep quality and reduced anxiety symptoms. These findings suggest that 3-months of PAP use can improve sleep, mood issues, and partly recover brain activities, however, longer PAP treatment may be required to fully and permanently reverse brain functional deficits.