Influence of water on the microscopic dynamics of 1-butyl-3-methylimidazolium tetrafluoroborate studied by means of quasielastic neutron scattering.

We present a systematic study on the effect of water on the microscopic dynamics of 1-butyl-3-methylimidazolium tetrafluoroborate by means of quasielastic neutron scattering. By mixing the ionic liquid with either heavy or light water, the different contributions to the quasielastic broadening could be identified and treated separately. This study was performed at room temperature, which is more than 15 °C above the demixing line. Our results show that even small amounts of water accelerate the diffusion mechanisms considerably. While samples with small water percentage reveal a diffusion process confined within ionic liquid nanodomains, an admixture of more than 15 wt. % water relieves the confinement. Furthermore, the presence of two water species was identified: one behaving as free water, whereas the other was interpreted as a component bound to the ionic liquid motion. Based on the fact that water preferentially binds to the BF4 anion, which itself has a negligible contribution to the scattered intensity, our experiments reveal unprecedented information about the microscopic anion dynamics.

Propagative Oscillations in Codirectional Polariton Waveguide Couplers.

We report on novel exciton-polariton routing devices created to study and purposely guide light-matter particles in their condensate phase. In a codirectional coupling device, two waveguides are connected by a partially etched section that facilitates tunable coupling of the adjacent channels. This evanescent coupling of the two macroscopic wave functions in each waveguide reveals itself in real space oscillations of the condensate. This Josephson-like oscillation has only been observed in coupled polariton traps so far. Here, we report on a similar coupling behavior in a controllable, propagative waveguide-based design. By controlling the gap width, channel length, or propagation energy, the exit port of the polariton flow can be chosen. This codirectional polariton device is a passive and scalable coupler element that can serve in compact, next generation logic architectures.

The accumulation of reproductive isolation in early stages of divergence supports a role for sexual selection.

Models of speciation by sexual selection propose that male-female coevolution leads to the rapid evolution of behavioural reproductive isolation. Here, we compare the strength of behavioural isolation to ecological isolation, gametic incompatibility and hybrid inviability in a group of dichromatic stream fishes. In addition, we examine whether any of these individual barriers, or a combined measure of total isolation, is predicted by body shape differences, male colour differences, environmental differences or genetic distance. Behavioural isolation reaches the highest values of any barrier and is significantly greater than ecological isolation. No individual reproductive barrier is associated with any of the predictor variables. However, marginally significant relationships between male colour and body shape differences with ecological and behavioural isolation are discussed. Differences in male colour and body shape predict total reproductive isolation between species; hierarchical partitioning of these two variables' effects suggests a stronger role for male colour differences. Together, these results suggest an important role for divergent sexual selection in darter speciation but raise new questions about the mechanisms of sexual selection at play and the role of male nuptial ornaments.

Collective fluid dynamics of a polariton condensate in a semiconductor microcavity.

Semiconductor microcavities offer unique systems in which to investigate the physics of weakly interacting bosons. Their elementary excitations, polaritons-mixtures of excitons and photons-can accumulate in macroscopically degenerate states to form various types of condensate in a wide range of experimental configurations, under either incoherent or coherent excitation. Condensates of polaritons have been put forward as candidates for superfluidity, and the formation of vortices as well as elementary excitations with linear dispersion are actively sought as evidence to support this. Here, using a coherent excitation triggered by a short optical pulse, we have created and set in motion a macroscopically degenerate state of polaritons that can be made to collide with a variety of defects present in the microcavity. Our experiments show striking manifestations of a coherent light-matter packet, travelling at high speed (of the order of one per cent of the speed of light) and displaying collective dynamics consistent with superfluidity, although one of a highly unusual character as it involves an out-of-equilibrium dissipative system. Our main results are the observation of a linear polariton dispersion accompanied by diffusionless motion; flow without resistance when crossing an obstacle; suppression of Rayleigh scattering; and splitting into two fluids when the size of the obstacle is comparable to the size of the wave packet. This work opens the way to the investigation of new phenomenology of out-of-equilibrium condensates.

MALDI-TOF MS, a useful instrument for differentiating metallo-ß-lactamases in Enterobacteriaceae and Pseudomonas spp.

UNLABELLED: We have evaluated a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) method for the identification of carbapenemases and for distinguishing metallo-ß-lactamases (MBLs). A total of 49 noncarbapenemase-producing and 14 carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa clinical strains, previously characterized by PCR, were included in the study. With MALDI-TOF MS, the presence of carbapenemases was confirmed by the detection of ertapenem hydrolysis (lost of molecular peaks: 476·5 Da, 498·5 Da, 520·5 Da and presence of degradation products) in the mixture of the bacteria with the antibiotic, and classification was achieved by selective inhibition of carbapenemase activity (the ertapenem molecular peak was maintained) with ethylenediaminetetraacetic acid (EDTA). We obtained a good concordance among the results of PCR and MALDI-TOF MS. This method appears to be simple, fast and reliable for distinguishing in few hours different classes of carbapenemases, which can be very useful for epidemiological studies or to establish a specific antimicrobial therapy. SIGNIFICANCE AND IMPACT OF THE STUDY: MALDI-TOF mass spectrometry is increasingly present in microbiology laboratories due to its increasing use for bacterial identification. This study describes a method for detection of carbapenemase activity using MALDI-TOF, which is similar to the reference method: the detection of imipenem hydrolysis using UV spectrometry.

Build up of off-diagonal long-range order in microcavity exciton-polaritons across the parametric threshold.

We report an experimental study of the spontaneous spatial and temporal coherence of polariton condensates generated in the optical parametric oscillator configuration, below and at the parametric threshold, and as a function of condensate area. Above the threshold we obtain very long coherence times (up to 3 ns) and a spatial coherence extending over the entire condensate (40 µm). The very long coherence time and its dependence on condensate area and pump power reflect the suppression of polariton-polariton interactions by an effect equivalent to motional narrowing.

Health care costs of complex perianal fistula in Crohn's disease.

AIM: To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective. METHODS: We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review. RESULTS: We recorded 527 treatments: 73.1% pharmacological (32.3% antibiotic, 20.5% immunomodulator, 20.3% biological) and 26.9% surgical. Mean annual global cost was €8,289/patient, 75.3% (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4% (€1,027) by hospitalizations and surgery, 7.7% (€640) by medical visits, 4.2% (€350) by laboratory/diagnostic tests, and 0.4% (€30) by emergency department visits. CONCLUSIONS: Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.

Incomplete behavioural isolation and asymmetric female preference in darter sister species (Percidae: Etheostoma).

In this study, female preferences and behavioural isolation were estimated in a pair of allopatric sister species, Etheostoma duryi and Etheostoma flavum. Dichotomous mate preference trials were conducted to determine whether females prefer to associate with conspecific over heterospecific males and free-spawning assays were conducted to determine whether those preferences translated into behavioural isolation. Dichotomous mate choice trials revealed asymmetric female preference, as female E. flavum preferred conspecific males, whereas female E. duryi showed no preference. Free-spawning assays indicated that behavioural isolation remains incomplete between E. duryi and E. flavum (IB = 0·19). In addition to female mating preferences, male behaviour also appeared to influence mating outcomes as male E. flavum consistently courted conspecific females more often in free-spawning assays whereas male E. duryi did not. The data therefore suggest that despite marked divergence in male nuptial colour, divergence in female preferences between these species may not be sufficient to maintain species boundaries upon secondary contact. These results contrast with similar work in a sympatric darter species pair and may be explained by considering the contributions of reinforcement and differences in colour pattern as well as colour value.

Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey.

OBJECTIVE: While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group. METHODS: Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements. RESULTS: 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001). CONCLUSION: Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.

[Impact of social network use on anorexia and bulimia in female adolescents: a systematic review].

Systematic review of published studies on the impact of social networks (SN) use on anorexia and bulimia in female adolescents. We selected articles published over the past 10 years, written in English, Spanish or Portu-guese found in The Cochrane Library Plus, PubMed, WOS, PsycINFO, and Scopus databases and with enough methodological quality. Nine studies were included in this review with a sample of 2,069 adolescents; 75.3% were female, mean age was 18 years, and mostly used Facebook and Instagram. Despite some positive aspects, SNs promote beauty standards in terms of thinness, allow comparisons between peers increasing concerns about weight, and create spaces that encourage anorexia and bulimia. Therefore, SN use plays a role in the development of eating disorders. The promotion of extreme thinness in girls makes this population more vulnerable.

Motion of spin polariton bullets in semiconductor microcavities.

The dynamics of optical switching in semiconductor microcavities in the strong coupling regime is studied by using time- and spatially resolved spectroscopy. The switching is triggered by polarized short pulses which create spin bullets of high polariton density. The spin packets travel with speeds of the order of 10(6) m/s due to the ballistic propagation and drift of exciton polaritons from high to low density areas. The speed is controlled by the angle of incidence of the excitation beams, which changes the polariton group velocity.

External validation and applicability of the EORTC risk tables for non-muscle-invasive bladder cancer.

PURPOSE: To perform an external validation of the EORTC risk tables and to evaluate their applicability in the patients of our institution by comparing the actual risk of recurrence and progression in our series to those obtained through the application of the EORTC tables. METHODS: Retrospective study, based on a prospective cohort of 417 patients in follow-up with primary TaT1 bladder tumors, operated on in our center between 1998 and 2008 and collected in our database. Risk scores were assigned depending on the tumor characteristics to divide our series into four risk groups according to these ratings. An analysis of survival was carried out to calculate the probability of recurrence by the method of Kaplan-Meier. RESULTS: A total of 417 patients with a median follow-up of 59 months were studied. The overall recurrence and progression rates of our series were 25.95% (21.97-30.49) and 4.86% (3.16-7.43) at 1 year and 53.46% (48.06-59.05) and 8.43% (5.95-11.86) at 5 years, respectively. When we compare our rates of recurrence and progression by groups with the corresponding values from Sylvester's publication, an overlapping of the confidence intervals between both populations is detected. CONCLUSIONS: In terms of the applicability of the EORTC risk tables in our patients' population, we conclude that these tables predict accurately the clinical course of patients with NMIBC. Due to the sample size of our study, we can only validate the recurrence model of the EORTC tables.

[Knowledge and attitude regarding previous instructions for the patients of a public hospital of Madrid]. / Conocimiento y actitudes ante las instrucciones previas entre los pacientes de un hospital público de la Comunidad de Madrid.

INTRODUCTION: The level of knowledge and attitudes of patients towards the previous instructions is a little known subject given that their introduction in the Community of Madrid (CM) is recent. AIMS: To assess the level of knowledge and implementation of advance directives in patients admitted to an Internal Medicine Service of a public hospital in the CM, the attitudes of patients regarding these documents and their correlation with demographic variables. PATIENTS AND METHODS: A cross-sectional study through structured survey of opinion, closed and voluntarily given to all patients admitted in the Internal Medicine Unit of the University Hospital Alcorcon Foundation on the dates May 20 and June 3, 2008 was carried out. RESULTS: A total of 155 patients were included, the questions being answered by the patients per se by 57% and by members of theirs families in 42%. Mean age of the patients was 77 years, 50.9% were male and 86.45% were Catholic. Only 7 patients (4.5%) knew what the advance directives were and only one patient had done them. On learning of their existence, 49 patients (31.6%) would like to do the advance instructions. Of the respondents, 80.6% were in favor of having the advance directives document in their medical history and 72.9% do not believe that having these advance directives would change the attitude of their doctor. CONCLUSIONS: Although the regulation of advance directives in the Community of Madrid has already been in force for 5 years, little is known about these documents and they are still in a period of diffusion.

Satisfaction of patients and family caregivers in adult intensive care units: Literature Review.

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known. OBJECTIVE: To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature. METHODOLOGY: A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases. SEARCH STRATEGY: "Personal Satisfaction" and (patients or caregivers) and "Intensive Care Units". INCLUSION CRITERIA: studies published between 2013-2018, population aged between 19-64 years, English and Spanish language. RESULTS: 760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n = 5), the quality of care (n = 4), and the cleanliness and environment of the units (n = 2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n = 5), inadequate communication (n = 4), and the involvement of families and patients in decision-making (n = 4). Training of professionals (n = 5), inclusion of the family during the process of hospitalization (n = 2) and redesigning the waiting room (n = 2) are some of the suggestions for improvement. CONCLUSIONS: Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

[Non-drug treatments for chronic non-malignant pain: patients' perceptions].

BACKGROUND: The prevalence of chronic pain in Spain is 17%. There is a need for more scientific data on non-drug treat-ments that can be effectively used to treat chronic pain. The aim of this study is to analyze how patients with chronic non-malignant pain perceive non-drug approaches. METHOD: Mixed, descriptive and phenomenological study. Nineteen patients enrolled in a workshop on pain management and non-drug treatments that consisted of four sessions (one session a week). Each session lasted four hours. The patients then participated in a reflective writing activity about their personal experiences. Data from this activity was then ana-lyzed. Atlas.ti 8 software was used for the qualitative data analysis. RESULTS: Sixteen participants tried an alternative therapy and fourteen assessed its benefits. The participants' expecta-tions were divided into three groups of similar size: relief from physical pain, emotional pain management and tools for use in daily life. All the participants were satisfied with the workshop. Perceived personal benefits were better pain and sleep management, reduced fatigue, reduced drug consumption; a more positive approach to life, better mood, more positive energy, more motivation and improved capacity to cope. CONCLUSIONS: The participants commented that the workshop had helped them to reduce pain levels and consume to fewer analgesics, and had reduced other symptoms associated with chronic disease, thus improving their perceived health. They also expressed great satisfaction with the organization and teachers.

Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks.

BACKGROUND: Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHOD: A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of "clean" and "contaminated" areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS: Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, 83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR = 15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR = 28 [5-160]). All outbreaks were controlled in 39 [37-42] days. CONCLUSIONS: A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.

NARP syndrome in a patient harbouring an insertion in the MT-ATP6 gene that results in a truncated protein.

BACKGROUND: Neurogenic muscle weakness, ataxia and retinitis pigmentosa (NARP) syndrome have been associated to m.8993T>G/C mutations in the subunit 6 of the ATP synthase (p.MT-ATP6). METHODS: We have performed a mutational screening of the mitochondrial DNA gene encoding for this protein in 62 patients with the disease, that do not carry any of the common mutations described to date. RESULTS: We report clinical and molecular data in one patient who harbours a de novo insertion in the MT-ATP6 gene that results in a truncated subunit. The mutation was heteroplasmic (85%) in muscle DNA and the BN-PAGE analysis showed a clear decrease in the amount of ATP synthase. CONCLUSION: Molecular analysis of NARP patients cannot be limited to the search of the m.8993T>G/C and either the ATP6 or the whole mtDNA should be sequenced.

Satisfaction of patients and family caregivers in adult intensive care units: Literature Review. / Satisfacción de pacientes y cuidadores familiares en unidades de cuidados intensivos de adultos: revisión de la literatura.

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known. OBJECTIVE: To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature. METHODOLOGY: A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases. SEARCH STRATEGY: "Personal Satisfaction" and (patients or caregivers) and "Intensive Care Units". INCLUSION CRITERIA: studies published between 2013-2018, population aged between 19-64 years, english and spanish language. RESULTS: 760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n=5), the quality of care (n=4), and the cleanliness and environment of the units (n=2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n=5), inadequate communication (n=4), and the involvement of families and patients in decision-making (n=4). Training of professionals (n=5), inclusion of the family during the process of hospitalization (n=2) and redesigning the waiting room (n=2) are some of the suggestions for improvement. CONCLUSIONS: Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks.

Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75-0.87])) and PROFUND (AUC-ROC = 0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.

Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.

OBJECTIVES: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.