Exploring the mediating role of promoting school physical activity on the relationship between low socioeconomic status and academic achievement and school climate: evidence from 4,990 Chilean schools.

There is evidence that promoting school physical activity (PSPA) benefits children and adolescents, but little is understood about how this promotion may relate to academic achievement and school climate across varying levels of socioeconomic status (SES). Hence, the study aimed to address this knowledge gap by examining two main objectives: (1) determining the association between PSPA and academic achievement and school climate according to schools' SES and (2) exploring the potential mediating role of PSPA in the relationship between schools' SES and academic achievement and school climate. This cross-sectional study at the school level focused on 4,990 schools (including public, subsidized, and private schools) that participated in the National Educational Study 2018 (Chile), which was applied to primary schoolchildren (4th grade, aged 8-10 years). Schools were divided into non-PSPA (n = 4,280) and PSPA (n = 710) during the year 2018. Changes in academic achievement from 2017 to 2018 and school climate were considered. PSPA was associated with improvements in maths (low-SES OR: 1.80, p < 0.001) and reading (middle-SES OR: 1.45, p = 0.029; low-SES OR: 1.47, p < 0.001). The indirect effect (IE) showed that PSPA partially mediated the relationship between SES and academic achievement in reading (IE = 1.017; SE = 0.12; 95%CI, -1.27, -0.77), maths (IE = -1.019; SE = 0.12; 95%CI, -1.25, -0.78), and school climate (IE = -0.46; SE = 0.52; 95%CI, -0.56, -0.35). In conclusion, PSPA was linked to positive changes in academic achievement, especially among low SES, and PSPA presented a potential mediating role in the relationship between SES of schools and academic achievement and school climate.

Delving into public-expenditure elasticity: Evidence from a National Health Service acute-care hospital network.

INTRODUCTION: The sustainability of public hospital financing in Spain is a recurring issue, given its representativeness in annual public healthcare budgets which must adapt to the macroeconomic challenges that influence the evolution of spending. Knowing whether the responsiveness of hospital expenditure to its determinants (need, utilisation, and quasi-prices) varies according to the type of hospital could help better design strategies aimed at optimising performance. METHODS: Using SARIMAX models, we dynamically assess unique nationwide monthly activity data over a 14-year period from 274 acute-care hospitals in the Spanish National Health Service network, clustering these providers according to the average severity of the episodes treated. RESULTS: All groups showed seasonal patterns and increasing trends in the evolution of expenditure. The fourth quartile of hospitals, treating the most severe episodes and accounting for more than 50% of expenditure, is the most sensitive to quasi-price factors, particularly the number of beds per hospital. Meanwhile, the first quartile of hospitals, which treat the least severe episodes and account for 10% of expenditure, is most sensitive to quantity factors, for which expenditure showed an elasticity above one, while factors of production were not affected. CONCLUSIONS: Belonging to one or another cluster of hospitals means that the determinants of expenditure have a different impact and intensity. The system should focus on these differences in order to optimally modulate expenditure not only according to the needs of the population, but also according to the macroeconomic situation, while leaving hospitals room for manoeuvre in case of unforeseen events. The findings suggest strengthening a network of smaller hospitals (Group 1)-closer to their reference population, focused on managing and responding to chronicity and stabilising acute events-prior to transfer to tertiary hospitals (Group 4)-larger but appropriately sized, specialising in solving acute and complex health problems-when needed.

A Thermographic Disease Activity Index for remote assessment of rheumatoid arthritis.

OBJECTIVES: Remote assessment of patients with rheumatoid arthritis (RA) has increased during recent years. However, telematic consultations preclude the possibility of carrying out a physical examination and obtaining objective inflammation. In this study, we developed and validated two novel composite disease activity indexes (Thermographic Disease Activity Index (ThermoDAI) and ThermoDAI-CRP) based on thermography of hands and machine learning, in order to assess disease activity easily, rapidly and without formal joint counts. METHODS: ThermoDAI was developed as the sum of Thermographic Joint Inflammation Score (ThermoJIS), a novel joint inflammation score based on the analysis of thermal images of the hands by machine learning, the Patient Global Assessment (PGA) and, for ThermoDAI-CRP, the C reactive protein (CRP). Construct validity was tested in 146 patients with RA by using Spearman's correlation with ultrasound-determined grey-scale synovial hypertrophy (GS) and power Doppler (PD) scores, CDAI, SDAI and DAS28-CRP. RESULTS: Correlations of ultrasound scores with ThermoDAI (GS=0.52; PD=0.56) and ThermoDAI-CRP (GS=0.58; PD=0.61) were moderate to strong, while the correlations of ultrasound scores with PGA (GS=0.35; PD=0.39) and PGA+CRP (GS=0.44; PD=0.46) were weak to moderate. ThermoDAI and ThermoDAI-CRP also showed strong correlations with Clinical Disease Activity Index (ρ>0.83), Simplified Disease Activity Index (ρ>0.85) and Disease Activity Score with 28-Joint Counts-CRP (ρ>0.81) and high sensitivity for detecting active synovitis using remission criteria. CONCLUSIONS: ThermoDAI and ThermoDAI-CRP showed stronger correlations with ultrasound-determined synovitis than PGA and PGA + CRP, thus presenting an opportunity to improve remote consultations with patients with RA.

Assessment of inflammation in patients with rheumatoid arthritis using thermography and machine learning: a fast and automated technique.

OBJECTIVES: Sensitive detection of joint inflammation in rheumatoid arthritis (RA) is crucial to the success of the treat-to-target strategy. In this study, we characterise a novel machine learning-based computational method to automatically assess joint inflammation in RA using thermography of the hands, a fast and non-invasive imaging technique. METHODS: We recruited 595 patients with arthritis and osteoarthritis, as well as healthy subjects at two hospitals over 4 years. Machine learning was used to assess joint inflammation from the thermal images of the hands using ultrasound as the reference standard, obtaining a Thermographic Joint Inflammation Score (ThermoJIS). The machine learning model was trained and tuned using data from 449 participants with different types of arthritis, osteoarthritis or without rheumatic disease (development set). The performance of the method was evaluated based on 146 patients with RA (validation set) using Spearman's rank correlation coefficient, area under the receiver-operating curve (AUROC), average precision, sensitivity, specificity, positive and negative predictive value and F1-score. RESULTS: ThermoJIS correlated moderately with ultrasound scores (grey-scale synovial hypertrophy=0.49, p<0.001; and power Doppler=0.51, p<0.001). The AUROC for ThermoJIS for detecting active synovitis was 0.78 (95% CI, 0.71 to 0.86; p<0.001). In patients with RA in clinical remission, ThermoJIS values were significantly higher when active synovitis was detected by ultrasound. CONCLUSIONS: ThermoJIS was able to detect joint inflammation in patients with RA, even in those in clinical remission. These results open an opportunity to develop new tools for routine detection of joint inflammation.

A comprehensive assessment of long-term SARS-CoV-2-specific adaptive immune memory in convalescent COVID-19 Solid Organ Transplant recipients.

Long-term adaptive immune memory has been reported among immunocompetent individuals up to eight months following SARS-CoV-2 infection. However, limited data is available in convalescent patients with a solid organ transplant. To investigate this, we performed a thorough evaluation of adaptive immune memory at different compartments (serological, memory B cells and cytokine [IFN-γ, IL-2, IFN-γ/IL12 and IL-21] producing T cells) specific to SARS-CoV-2 by ELISA and FluoroSpot-based assays in 102 convalescent patients (53 with a solid organ transplants (38 kidney, 5 liver, 5 lung and 5 heart transplant) and 49 immunocompetent controls) with different clinical COVID-19 severity (severe, mild and asymptomatic) beyond six months after infection. While similar detectable memory responses at different immune compartments were detected between those with a solid organ transplant and immunocompetent individuals, these responses were predominantly driven by distinct COVID-19 clinical severities (97.6%, 80.5% and 42.1%, all significantly different, were seropositive; 84% vs 75% vs 35.7%, all significantly different, showed IgG-producing memory B cells and 82.5%, 86.9% and 31.6%, displayed IFN-γ producing T cells; in severe, mild and asymptomatic convalescent patients, respectively). Notably, patients with a solid organ transplant with longer time after transplantation did more likely show detectable long-lasting immune memory, regardless of COVID-19 severity. Thus, our study shows that patients with a solid organ transplant are capable of maintaining long-lasting peripheral immune memory after COVID-19 infection; mainly determined by the degree of infection severity.

Serological reactivity against T. cruzi-derived antigens: Evaluation of their suitability for the assessment of response to treatment in chronic Chagas disease.

Chagas disease, caused by the protozoan Trypanosoma cruzi, affects more than 6 million people worldwide. Following a mostly asymptomatic acute phase, the disease progresses to a long-lasting chronic phase throughout which life-threatening disorders to the heart and/or gastrointestinal tract will manifest in about 30% of those chronically infected. During the chronic phase, the parasitemia is low and intermittent, while a high level of anti-T. cruzi antibodies persist for years. These two features hamper post-chemotherapeutic follow-up of patients with the tools available. The lack of biomarkers for timely assessment of therapeutic response discourages a greater use of the two available anti-parasitic drugs, and complicates the evaluation of new drugs in clinical trials. Herein, we investigated in a blinded case-control study the serological reactivity over time of a group of parasite-derived antigens to potentially address follow up of T. cruzi chronically infected subjects after treatment. We tested PFR2, KMP11, HSP70, 3973, F29 and the InfYnity multiplexed antigenic array, by means of serological assays on a multi-national retrospective collection of samples. Some of the antigens exhibited promising results, underscoring the need for further studies to determine their potential role as treatment response biomarkers.

Risk Assessment of Cd, Cu, and Pb from the consumption of hunted meat: red-legged partridge and wild rabbit.

The objective was to assess that potential health risk from Cd, Cu, and Pb, through the consumption of hunted red-legged partridge and wild rabbit meat, with special focus on the population of hunters and their relatives. Mineral content was analyzed by atomic absorption methods (F-AAS for Cu and GF-AAS for Cd and Pb) after microwave digestion of lyophilized samples. The average concentrations of these elements were 0.008 and 0.01 mg/kg for Cd; 1.41 and 1.63 mg/kg for Cu and 0.98 and 1.28 mg/kg for Pb in wild rabbit and red-legged partridge meat respectively. The dietary, risk assessment was performed by assuming two intake scenarios based on the obtained results of the survey on game meat consumption and the current maximum recommended intakes of Cd, Cu, and Pb, and then, the hazard quotients (THQ and TTHQ) were calculated. The data show that exposure to these metals from eating red-legged partridge and wild rabbit meat from a hunting provenance is relatively low and generally greater in the hunter population. The risk assessment revealed that moderate or low consumption of meat of these species does not offer a significant public health risk. Moreover, hazard quotients values for these metals of red-legged partridge and rabbit meat consumption in hunters and nonhunters are below 1. However, a high Pb content in the meat of these species and a high consumption may pose a greater health risk to hunters.

¿Se puede permitir la gente pagar por la atención sanitaria? Nueva evidencia sobre la protección financiera en España

Este estudio forma parte de una serie de informes nacionales que han generado nueva evidencia sobre la protección financiera en los sistemas sanitarios europeos. La protección financiera es fundamental para la cobertura sanitaria universal y es una dimensión básica del desempeño de los sistemas sanitarios. A pesar de haber empeorado durante la crisis económica entre los años 2008 y 2014, la incidencia de los gastos catastróficos en salud en España es mucho menor de lo que cabría esperar dada la dependencia relativamente elevada de los pagos directos en España. Esto puede explicarse por los puntos fuertes de las políticas decobertura en el Sistema Nacional de Salud (SNS): cobertura sanitaria basada en la residencia, con la misma cobertura para los inmigrantes en situación no regularizada; una cartera de servicios completa en general; uso limitado de los copagos, y diferentes mecanismos para proteger a los usuarios de los copagos. Sin embargo, la cobertura presenta algunas deficiencias. Las causas principales del gasto catastrófico son la atención dental y los productos sanitarios en todos los quintiles de consumo, principalmente porque la atención dental y óptica están excluidas en gran medida de la cobertura del SNS. En el quintil más pobre, la causa del gasto catastrófico son los medicamentos de dispensación ambulatoria debidoa los copagos y a una protección inadecuada de los hogares de bajos ingresos con personas en edad de trabajar. Para reducir las necesidades insatisfechas y las dificultades financieras, las políticas deben centrarse en ampliar la cobertura del SNS para la atención dental y la atención óptica, así como seguir mejorando las modalidades de copago para reforzar la protección de los hogares más pobres en todos los grupos de edad.

Can people afford to pay for health care? New evidence on financial protection in Spain

This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimensionof health system performance. Despite worsening during the economic crisis from 2008 to 2014, the incidence of catastrophic health spending in Spain is much lower than would be expected given Spain’s relatively heavy reliance on out-of-pocket payments. This can be explained by strengths in the design of coverage policy in the National Health System (NHS): entitlement to the NHS based on residence, with the same degree of entitlement for undocumented migrants; a generally comprehensive benefits package; limited use of co-payments; and multiple mechanisms to protect people from co-payments. There are gaps in coverage, however. Catastrophic spending is driven by dental care and medical products in all consumption quintiles, mainly because dental and optical care for eyesight problems are largely excluded from NHS coverage. Catastrophic spending in the poorest quintile is also driven by outpatient medicines, reflecting co-payments and inadequate protection for low-incomehouseholds of working age. To reduce unmet need and financial hardship, policy should focus on expanding NHS coverage of dental care and optical care and further improving the design of co-payments to strengthenprotection for poorer households in all age groups.

Propuesta de sistema innovador de comunicación digital utilizando IoT para equipo biomédico de monitoreo de pacientes: de interés sector salud pública / Innovative digital communication system proposal using IoT in biomedical equipment for patient monitoring: interest in public health sector

La presente propuesta de diseño busca la interoperabilidad de datos en salud por medio de la integración de un sistema de comunicación a equipos especializados, utilizando las TI (Tecnologías de la Información) y el IoT (Internet de las Cosas) en los equipos biomédicos especializados o monitor que está siendo utilizado actualmente en los centros hospitalarios público a nivel nacional para la medición de signos vitales, con el objetivo de poder brindar una atención sanitaria a pacientes con padecimientos médicos y que necesitan de una constante supervisión y vigilancia. En los centros hospitalarios se cuenta con equipo biomédico especializado que carece de dichas funcionalidades. Esto repercute u obliga al responsable especialista a tener que estar frente al monitor y paciente para poder observar las mediciones o lecturas que presenta un paciente.

This design proposal seeks the interoperability of health data through the integration of a communication system to specialized equipment, using IT (Information Technology) and IoT (Internet of Things) in specialized biomedical equipment or monitor that is currently being used in public hospitals nationwide for the measurement of vital signs, in order to provide health care to patients with medical conditions and who need constant surveillance. Hospitals have specialized biomedical equipment that lacks these functionalities. This forces the responsible specialist to have to be in front of the monitor and the patient to be able to observe the measurements or readings that a patient presents.

OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized open label trial.

BACKGROUND: Conservative surgery followed by breast and nodal irradiation is the standard loco-regional early breast cancer (BC) treatment for patients with four or more involved lymph nodes. However, the treatment strategy when fewer nodes are involved remains unclear, especially when lymphadenectomy has not been performed. Sensitive nodal status assessment molecular techniques as the One-Step Nucleic Acid Amplification (OSNA) assay can contribute to the definition and standardization of the treatment strategy. Therefore, the OPTIMAL study aims to demonstrate the feasibility of incidental irradiation of axillary nodes in patients with early-stage BC and limited involvement of the SLN. METHODS: BC patients who underwent conservative surgery and whose SLN total tumour load assessed with OSNA ranged between 250-15,000 copies/µL will be eligible. Patients will be randomized to receive irradiation on the breast, tumour bed, axillary and supraclavicular lymph node areas (intentional arm) or only on the breast and tumour bed (incidental arm). All areas, including the internal mammary chain, will be contoured. The mean, median, D5% and D95% doses received in all volumes will be calculated. The primary endpoint is the non-inferiority of the incidental irradiation of axillary nodes compared to the intentional irradiation in terms of 5-year disease free survival. Secondary endpoints comprise the comparison of acute and chronic toxicity and loco-regional and distant disease recurrence rates. DISCUSSION: Standardizing the treatment and diagnosis of BC patients with few nodes affected is crucial due to the lack of consensus. Hence, the quantitative score for the metastatic burden of SLN provided by OSNA can contribute by improving the discrimination of which BC patients with limited nodal involvement can benefit from incidental radiation as an adjuvant treatment strategy. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02335957; https://clinicaltrials.gov/ct2/show/NCT02335957.

Clinical, pharmacokinetic and economic analysis of the first switch to an extended half-life factor IX (albutrepenonacog alfa, rFIX-FP) in Spain.

Extended half-life of factor IX (FIX) demonstrated clinical benefit and lower treatment burden than standard half-life FIX products in clinical trials. We analysed the impact in efficacy, pharmacokinetics (PKs) and costs of the switch from nonacog alfa (rFIX) to albutrepenonacog alfa (rFIX-FP) in the first patient with haemophilia B (HB) treated in Spain outside clinical trials. A 7-year-old boy presented with HB with poor venous access and repetition infections using rFIX, which was switched to rFIX-FP. Prophylaxis was adjusted by PKs using WAPPS-Hemo tailoring from 100 IU/kg/week of rFIX to 80 IU/kg/3 weeks of rFIX-FP. Comparing 6 months before, rFIX-FP reduced 68.5% FIX consumption/kg and 58.3% infusion frequency, but total costs/weight showed a slight increase. Ratio of half-life between rFIX and rFIX-FP was 3.4-3.7. This case report revealed that switch to rFIX-FP decreased frequency and FIX consumption, without adverse events and bleeds.

10B Conformal Doping for Highly Efficient Thermal Neutron Detectors.

This paper reports a simple and novel conformal doping strategy for microstructured silicon diodes using enriched 10B for sidewall doping while enabling enhanced neutron sensitivity. Monte-Carlo nuclear particle (MCNP) code simulations were initially used to calculate the neutron detection efficiency in the microstructured diodes as a function of geometry and pitch. A high-temperature anneal in 10B-filled diodes results in a conformal silicon p+ layer along the side walls of the trenches in the diodes. This results in large neutron detection areas and enhanced neutron detection efficiency when compared with planar detectors. With the method discussed here, a thermal neutron detection of ∼21% efficiency is achieved, which is significantly higher than the efficiency achieved in planar detectors (∼3.5%). The higher efficiency is enabled by the 10B acting as a source for conformal doping in the trenches, resulting in lower leakage current while also enabling neutron sensitivity in the microstructured diodes.

Factors underlying the growth of hospital expenditure in Spain in a period of unexpected economic shocks: A dynamic analysis on administrative data.

AIMS: We sought to understand the evolution of Spanish public hospital expenditure by assessing its elasticity to volume versus price, controlling for need and case severity, from January 2003 to December 2015, a period of unexpected economic shocks. METHOD: Observational study of administrative data characterising hospitals in the Spanish National Health System. Public hospital expenditure was modelled using SARIMAX in a two-step approach aiming at: a) eliciting structural changes in the monthly time-series; and, b) analysing the reaction of expenditure to the behaviour of its direct underlying factors over the sub-periods identified in the first step. RESULTS: From January 2003 to December 2015, two structural changes were elicited, splitting this time-span into three sub-periods. The quantities of hospital services offered (mainly inpatient medical and surgical activity) were consistently shown as the main drivers of expenditure. Overall, hospital expenditure was inelastic to all the factors analysed, specially to quasi-prices; similar results were obtained across sub-periods of analysis. CONCLUSION: Factors associated to quantities (as compared to quasi-prices) were the main drivers of hospital expenditure in the period analysed, particularly after the economic shock. However, hospital expenditure was inelastic to both factors giving prominence to the economic cycle fluctuations as a strong inducer of the hospital expenditure trends in Spain.

Low-cost and precise inline pressure sensor housing and DAQ for use in laboratory experiments.

There are many applications for inline pressure sensors, including fluid flow experiments, sensor field deployments, pumps, and Internet of Things systems. We developed a low-cost (~US$56), open-source, customizable inline pressure sensor system with operational flexibility and simple data logging. Most pressure sensors are expensive, not customizable, specific to a single tubing size, provide only analog readings, have poor stability and precision, or are incomplete without a data logger. These issues limit the usefulness of such hardware. Our system addresses all of these concerns. The customizability of both the hardware and firmware (via options or code modification) allows for the device to be tailored easily to each application. Tubing diameter, adapter dimensions, sensor used, logging behavior, and integration with other systems can be configured with ease. Much of the practicality and configurability of the software and hardware arise from the use of our Loom code and ecosystem. We present experimental data for the flow of a viscous fluid between two parallel plates that shows that sudden changes in fluid properties are not always discernible in static images, but are detectable as pressure signals with our inline pressure sensor.

An assessment of vegetation management practices and burrow fumigation with aluminum phosphide as tools for managing voles within perennial crop fields in California, USA.

Voles (Cricetidae) cause extensive damage to a variety of crops throughout much of the Northern Hemisphere. The removal of vegetation from crop fields at the end of the growing season, combined with a subsequent burrow fumigant application of aluminum phosphide, has the potential to substantially curtail vole activity but has not been thoroughly examined. We set up a study to test the impact of these management tools in perennial globe artichoke (Cynara cardunculus var. scolymus) fields in Monterey County, CA, during 2010 and 2011, to determine their potential utility as part of an integrated pest management (IPM) program for managing California voles (Microtus californicus). We used both chewing indices and mortality estimates derived via radiotelemetry to assess the efficacy of aboveground vegetation removal and aluminum phosphide applications on vole abundance. We determined the impact of plowing artichoke fields on vole activity as well. Both removal of vegetation and applications of aluminum phosphide substantially reduced vole presence within treated fields. Plowing also reduced vole abundance to the point of little residual activity following treatment. These management practices appear to be effective at eliminating voles from crop fields. Combining these tools with management practices designed to slow down reinvasion by neighboring vole populations (e.g., barriers, repellents, traps) has the potential to substantially reduce farmer reliance on rodenticides for vole management, although rodenticides will still be needed to curtail populations that reestablish within crop fields. Such an IPM approach should substantially benefit both farmers and agro-ecosystems.

Toxicological Assessment of Cross-Linked Beads of Chitosan-Alginate and Aspergillus australensis Biomass, with Efficiency as Biosorbent for Copper Removal.

Sorbent materials of biological origin are considered as an alternative to the use of traditional methods in order to remove heavy metals. Interest in using these materials has increased over the past years due to their low cost and friendliness to the environment. The objective of this study was to synthesize and characterize cross-linked beads made of chitosan, alginate, and mycelium of a copper-tolerant strain of Aspergillus australensis. The acute toxicity of the biocomposite beads was assessed using brine shrimp Artemia salina nauplii and the phytotoxicity was determined using lettuce (Lactuca sativa) and chili pepper 'Anaheim' (Capsicum annuum) seeds. The biosorption capacity for copper removal in simulated wastewater was also evaluated. Results showed that the biosorbent obtained had a maximal adsorption of 26.1 mg of Cu2+ per g of biocomposite, and removal efficiency was around 79%. The toxicity of simulated residual water after treatment with the biocomposite showed low toxicity toward seeds, which was highly dependent on the residual copper concentration. The toxicity of the biocomposite beads to A. salina was considered medium depending on the amount of the biocomposite, which was attributed to low pH. Biocomposite shows promise as biosorbent for the removal process of heavy metals.

Document on a comprehensive approach to type 2 diabetes mellitus. / Documento de abordaje integral de la diabetes tipo 2.

OBJECTIVE: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. METHODS: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. CONCLUSIONS: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.