Situating Preventive Action in a Moral and Clinical Context: A Qualitative Synthesis on Fall Prevention.

The prevention of falls is an integral part of the safety culture of health institutions with mandatory fall prevention programs set within health care facilities. Care providers are key in identifying the risks of falls and in implementing strategic actions to prevent them. With the aim to better understand practices of fall prevention, we conducted a synthesis of qualitative evidence on care providers' practices to prevent older people from falling in health care facilities. This synthesis is part of an integrative review of the role of care providers in fall prevention of adults aged 65 years and above. Primary studies were synthesized with the emerging core category of "a complex decision" and described by four emerging conditions that make that decision complex: (a) permanent threat of a fall, (b) continuous flow of information, (c) lack of control, and (d) ethical dilemmas and moral issues over the course of action. The present synthesis shows that before implementing preventive actions, care providers consider the conditions in which they are immersed, in this way situating their preventive actions in a clinical and a moral context.

The SUMAMOS EXCELENCIA Project.

AIM: The gap between research and clinical practice leads to inconsistent decision-making and clinical audits are an effective way of improving the implementation of best practice. Our aim is to assess the effectiveness of a model that implements evidence-based recommendations for patient outcomes and healthcare quality. DESIGN: National quasi-experimental, multicentre, before and after study. METHODS: This study focuses on patients attending primary care and hospital care units and associated socio-healthcare services. It uses the Joanna Brigg's Institute Getting Research into Practice model, which improves processes by referring to prior baseline clinical audits. The variables are process and outcome criteria for pain, urinary incontinence, and fall prevention, with data collection at baseline and key points over 12 months drawn from clinical histories and records. Project funding was received from the Spanish Strategic Health Action in November 2014. DISCUSSION: The project results will provide knowledge on the effectiveness of the Getting Research into Practice model, to apply evidence-based recommendations for the detection and management of pain, urinary incontinence, and fall prevention. It will also establish whether using research results, based on clinical audits and situation analysis, is effective for implementing evidence-based recommendations and improving patients' health. IMPACT: This nationwide Spanish project aims to detect and prevent high-prevalence healthcare problems, namely pain in patients at any age and falls and urinary incontinence in people aged 65 and over. Tailoring clinical practice to evidence-based recommendations will reduce unjustified clinical variations in providing healthcare services. Clinical Trial ID: NCT03725774.

Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico.

INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Validation of the Spanish version of Mackey childbirth satisfaction rating scale.

BACKGROUND: The "Mackey Childbirth Satisfaction Rating Scale" (MCSRS) is a complete non-validated scale which includes the most important factors associated with maternal satisfaction. Our primary purpose was to describe the internal structure of the scale and validate the reliability and validity of concept of its Spanish version MCSRS-E. METHODS: The MCSRS was translated into Spanish, back-translated and adapted to the Spanish population. It was then administered following a pilot test with women who met the study participant requirements. The scale structure was obtained by performing an exploratory factorial analysis using a sample of 304 women. The structures obtained were tested by conducting a confirmatory factorial analysis using a sample of 159 women. To test the validity of concept, the structure factors were correlated with expectations prior to childbirth experiences. McDonald's omegas were calculated for each model to establish the reliability of each factor. The study was carried out at four University Hospitals; Alicante, Elche, Torrevieja and Vinalopo Salud of Elche. The inclusion criteria were women aged 18-45 years old who had just delivered a singleton live baby at 38-42 weeks through vaginal delivery. Women who had difficulty speaking and understanding Spanish were excluded. RESULTS: The process generated 5 different possible internal structures in a nested model more consistent with the theory than other internal structures of the MCSRS applied hitherto. All of them had good levels of validation and reliability. CONCLUSIONS: This nested model to explain internal structure of MCSRS-E can accommodate different clinical practice scenarios better than the other structures applied to date, and it is a flexible tool which can be used to identify the aspects that should be changed to improve maternal satisfaction and hence maternal health.

p85ß phosphoinositide 3-kinase subunit regulates tumor progression.

PIK3R2 encodes a ubiquitous regulatory subunit (p85ß) of PI3K, an enzyme that generates 3-polyphosphoinositides at the plasma membrane. PI3K activation triggers cell survival and migration. We found that p85ß expression is elevated in breast and colon carcinomas and that its increased expression correlates with PI3K pathway activation and tumor progression. p85ß expression induced moderate PIP(3) generation at the cell membrane and enhanced cell invasion. In accordance, genetic alteration of pik3r2 expression levels modulated tumor progression in vivo. Increased p85ß expression thus represents a cellular strategy in cancer progression.

Physicochemical Changes and Antioxidant Activity of Juice, Skin, Pellicle and Seed of Pomegranate (cv. Mollar de Elche) at Different Stages of Ripening.

In the present work, we investigate how the degree of ripeness (low, low-medium, medium and medium-high) affects the physical and compositional changes, as well as antioxidant properties of pomegranate fruit (cv. Mollar de Elche). The skin, pellicle, seed and juice were analysed. The fruit mass increased and the fruit skin became reddish (higher a* and lower h*) as the fruit ripening progressed. The lowest concentrations of flavonoids and hydrolysable tannins were recorded in skin and pellicles at medium-high maturity stage, which explains the decrease in the total phenols and reducing power during ripening of pomegranate. On the contrary, the highest concentration of flavonoids (165 mg of quercetin equivalents per 100 mL of juice) was determined in the juice at the most advanced ripening stage, concomitant with the highest total phenols (1695 mg of gallic acid equivalents per 100 mL of juice). Higher DPPH scavenging activity and an increase in the reducing power of juice were also observed during ripening. The trend of the above-mentioned properties allowed describing the fruit development and maturity.

Selection of initiatives to improve the management of patients with hereditary angioedema by the hospital pharmacy using the nominal group technique.

OBJECTIVE: To identify and promote hospital pharmacy initiatives to improve the management of patients with hereditary angioedema (HAE) within the Spanish healthcare system. METHOD: A panel of experts comprising hospital pharmacists, an allergist and a nurse/member of the Spanish Hereditary Angioedema Association (Asociación Española de Angioedema Familiar) highlighted initiatives to improve care for patients with HAE after identifying, evaluating and prioritising them. Prioritisation was assessed based on the impact on patient care and the feasibility of their implementation on a scale of 1-5. RESULTS: Seven key areas of activity for the role of hospital pharmacists in the management of patients with HAE were identified: evaluation and selection of medicines; hospital pharmacy dispensation and telepharmacy; pharmacotherapy follow-up and telemedicine; coordination with other healthcare teams involved in the care of patients with HAE; patient health education and training; research on HAE; and continuous education and training of hospital pharmacy service personnel. Ten initiatives with a mean impact score of 5 and a mean feasibility score of ≥4.1 were considered as high-priority initiatives. Half of the initiatives belong to the area concerning patient education and training (50%), followed by care coordination initiatives (30%) and continuous education and training (20%). CONCLUSIONS: Ten high-priority initiatives for the management of patients with HAE were identified by a panel of experts. The implementation of such initiatives by the hospital pharmacy service should enhance the management of patients with HAE in the Spanish healthcare system.

Attributes of sensory and instrumental analysis that determine overall liking of fresh orange varieties with different maturity index.

Spain is the leading exporter of fresh citrus for consumption. In order to adapt to market needs, it is key to analyze the attributes that most influence each variety, the time of ripening and the color of the fruit. In this way, the producer can select the right fruit for each moment of the season. The main objective was to evaluate the fruit quality of three interesting orange tree varieties for fresh consumption: "Washington Navel," "Navelate," and "Lanelate" sweet orange. To achieve this goal, sensory analysis was combined with instrumental analysis. In Washington Navel, the maturity index provided a positive contribution to overall liking. Both herbaceous and fruity aroma have a negative influence on the overall liking score. In Navelina, the color and aromas (herbaceous and fruity) played an important positive role in overall liking. The importance of this smell could be related to the freshness of the oranges. In contrast, the maturity index provided a negative contribution. Lanelate is the only variety in which vitamin C provided a positive contribution to overall liking. However, L* value showed a negative contribution. Therefore, there were clearly different characteristics among varieties that were detected. So far, different orange varieties have not been compared according to their maturity index and using sensory analysis. Descriptive analysis and the variables that influence overall liking are fundamental to adapt to consumer expectations. The results obtained would help to select the fruit with better acceptability in the market.

Hereditary angioedema in Spain: medical care and patient journey.

BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1INH) is a genetic rare disease characterized by recurrent, transient and unpredictable episodes of cold, non-pruriginous oedema without associated urticaria. The characteristics of the disease have a considerable impact on the quality of life of patients. The aim of this study was to increase understanding of the patient journey of HAE in Spain. METHODS: A multidisciplinary committee of 16 HAE experts (allergy, immunology, emergency department, hospital pharmacy and nursing) and 3 representatives of the Spanish Hereditary Angioedema Patient Association (AEDAF) who were patients or caregivers participated in the study. A review of the publications on HAE treatment was performed. Semi-structured interviews were performed to HAE experts, patients, or caregivers. Three meetings with the experts, patients and caregivers were held to share, discuss, and validate data obtained from literature and interviews and to build the model. RESULTS: Throughout the project, the patient journey has been drawn up, dividing it into the stages of pre-diagnosis, diagnosis and treatment/follow-up. Some areas for improvement have been identified. Firstly, there is a need to enhance awareness and training on HAE among healthcare professionals, with a particular emphasis on primary care and emergency department personnel. Secondly, efforts should be made to minimize patient referral times to allergy/immunology specialists, ensuring timely access to appropriate care. Thirdly, it is crucial to encourage the study of the relatives of diagnosed patients to early identify potential cases. Fourthly, equitable access to self-administered treatments should be ensured, facilitated by systems that enable medication delivery at home and proper education and training for patients. Equitable access to long-term prophylactic treatment should also be prioritized for all patients in need. To standardize HAE management, the development of consensus guidelines that reduce variability in clinical practice is essential. Lastly, promoting research studies to enhance knowledge of the disease and align its treatment with new developments in the healthcare field should be encouraged. CONCLUSIONS: The knowledge of the patient journey in HAE allowed us to identify improvement areas with the final aim to optimize the disease management.

p85beta phosphoinositide 3-kinase regulates CD28 coreceptor function.

CD28 is a receptor expressed on T cells that regulates their differentiation after antigen stimulation to long-term-survival memory T cells. CD28 enhances T-cell receptor signals and reduces expression of CBL ubiquitin ligases, which negatively control T-cell activation. In the absence of CD28 ligation during the primary stimulation, CBL levels remain high and T cells fail to mount an efficient secondary response. CD28 associates with p85alpha, one of the regulatory subunits of phosphoinositide-3-kinase (PI3K), but the relevance of this interaction is debated. We examined here the contribution of the other ubiquitous PI3K regulatory subunit, p85beta, in CD28 function. We describe that p85beta bound to CD28 and to CBL with greater affinity than p85alpha. Moreover, deletion of p85beta impaired CD28-induced intracellular events, including c-CBL and CBL-b down-regulation as well as PI3K pathway activation. This resulted in defective differentiation of activated T cells, which failed to exhibit an efficient secondary immune response. Considering that p85beta-deficient T cells fail in recall responses and that p85beta binds to and regulates CD28 signals, the presented observations suggest the involvement of p85beta in CD28-mediated activation and differentiation of antigen-stimulated T cells.

Proposal of a New Orange Selection Process Using Sensory Panels and AHP.

Although the consumption of fruits and vegetables is being promoted by different institutions as a key question of public health, their consumption is decreasing and their waste is increasing. To address this situation, we propose to include the consumer's perception of the quality (from a sensory point of view) of a fruit, in particular Valencian oranges, in the supplier's selection process by retailers. To do so, we use a combination of consumer and trained sensory panels and Analytic Hierarchy Process (AHP). This approach is completely novel in the literature. According to the expert panel, the most important criteria when evaluating the quality of an orange are fruity smell, juiciness, sweetness and acidity. These criteria are related to the freshness and taste of the oranges. Consumers found the methodology proposed useful and easy to develop. The application of the AHP methodology has helped to facilitate a participatory discussion among consumers on the concept of the quality of the oranges. The methodology proposed can help the agrifood sector in different ways up and down the supply chain. Specially, it can contribute to better meet consumer's demands, increasing the consumption of fruits and vegetables and reducing its waste.

Delayed voluntary physical exercise restores "when" and "where" object recognition memory after traumatic brain injury.

Physical exercise has been associated with improved cognition and may even reduce memory deficits after brain injuries. The aims of this work were to: 1) assess whether voluntary physical exercise can reduce the deficits associated with traumatic brain injury (TBI) in two different components of episodic-like memory based on object recognition, temporal order memory ("when"), and object location memory ("where"); and 2) determine whether changes in levels of brain-derived neurotrophic factor (BDNF) in the hippocampus and prefrontal cortex, as well as alterations in hippocampal cytokines, insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF), may influence the effects exercise has on either or both tasks. The rats were distributed into a sham group, a TBI group that remained sedentary (TBI-sed), and a TBI group that had access to a running wheel for a 25-day period from post-injury day 11 (TBI-exe). The rats were sacrificed after the "where" memory task, at post-injury day 37. Physical exercise restored the "when" and "where" memories, which had been impaired by the TBI, and increased the concentration of BDNF in the hippocampus, but not the prefrontal cortex. Neither TBI nor exercise were found to significantly affect hippocampal cytokines, IGF-1 or VEGF at this time post-injury. BDNF levels showed significant positive correlations with exercise, and with "when" (but not "where") memory. These results indicate that post-injury physical exercise restores "when" and "where" object recognition memory tasks after TBI, and that increased BDNF seems to be involved in this effect, particularly with regard to "when" memory.

Deuterium Adsorption on Free-Standing Graphene.

A suitable way to modify the electronic properties of graphene-while maintaining the exceptional properties associated with its two-dimensional (2D) nature-is its functionalisation. In particular, the incorporation of hydrogen isotopes in graphene is expected to modify its electronic properties leading to an energy gap opening, thereby rendering graphene promising for a widespread of applications. Hence, deuterium (D) adsorption on free-standing graphene was obtained by high-energy electron ionisation of D2 and ion irradiation of a nanoporous graphene (NPG) sample. This method allows one to reach nearly 50 at.% D upload in graphene, higher than that obtained by other deposition methods so far, towards low-defect and free-standing D-graphane. That evidence was deduced by X-ray photoelectron spectroscopy of the C 1s core level, showing clear evidence of the D-C sp3 bond, and Raman spectroscopy, pointing to remarkably clean and low-defect production of graphane. Moreover, ultraviolet photoelectron spectroscopy showed the opening of an energy gap in the valence band. Therefore, high-energy electron ionisation and ion irradiation is an outstanding method for obtaining low defect D-NPG with a high D upload, which is very promising for the fabrication of semiconducting graphane on large scale.

The benefits of voluntary physical exercise after traumatic brain injury on rat's object recognition memory: A comparison of different temporal schedules.

Physical exercise can reduce the cognitive decline associated with traumatic brain injury, yet little is known about the optimal administration schedules. Here, different protocols of voluntary wheel running were evaluated for their effects on object recognition memory (ORM), neuroprotection (NeuN+ cells), microglial reactivity (Iba1 staining) and neurogenesis (DCX+ cells) after controlled cortical impact injury (CCI). CCI-lesioned rats were divided into a sedentary group and three exercise groups: early discontinued exercise (3 weeks of exercise initiated 4 days post-injury, followed by 4 weeks in a sedentary state); delayed exercise (3 weeks of exercise initiated 4 weeks post-injury), and early continuous exercise (7 weeks of exercise starting 4 days post-injury). The deficits induced by CCI in a 24 h ORM test were reversed in the delayed exercise group and reduced in the early discontinued and early continuous groups. The early discontinued protocol also reduced the loss of NeuN+ cells in the hilus, while attenuated microglial reactivity was found in the dorsal hippocampus of both the early exercising groups. Running at the end of the experiment increased the number of DCX+ cells in the early continuous and delayed groups, and an inverted U-shaped relationship was found between the mean daily exercise time and the amount of neurogenesis. Thus, exercise had benefits on memory both when it was commenced soon and later after injury, although the neural mechanisms implicated differed. Accordingly, the effects of exercise on memory and neurogenesis appear to not only depend on the specific temporal schedule but also, they may be influenced by the amount of daily exercise.

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01.

BACKGROUND: Low-cardiac output syndrome (LCOS) after cardiac surgery secondary to systemic hypoperfusion is associated with a higher incidence of renal and neurological damage. A range of effective therapies are available for LCOS. The beneficial systemic effects of levosimendan persist even after cardiac output is restored, which suggests an independent cardioprotective effect. METHODS: A double-blind clinical trial was conducted in patients with a confirmed diagnosis of LCOS randomized into two treatment groups (levosimendan vs. dobutamine). Monitoring of hemodynamic (cardiac index, systolic volume index, heart rate, mean arterial pressure, central venous pressure, central venous saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP, troponin I); and renal parameters was performed using acute kidney injury scale (AKI scale) and renal and brain ultrasound measurements [vascular resistance index (VRI)] at diagnosis and during the first 48 h. RESULTS: Significant differences were observed between groups in terms of cardiac index, systolic volume index, NT-proBNP, and kidney injury stage at diagnosis. In the levosimendan group, there were significant variations in AKI stage after 24 and 48 h. No significant differences were observed in the other parameters studied. CONCLUSION: Levosimendan showed a beneficial effect on renal function in LCOS patients after cardiac surgery that was independent from cardiac output and vascular tone. This effect is probably achieved by pharmacological postconditioning. CLINICAL TRIAL REGISTRATION: EUDRA CT, identifier 2014-001461-27. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-27.

A dedicated system for in situ testing of gamma ray induced optical absorption and emission in optical materials.

Serious radiation damage due to the high energy neutron/gamma fluxes is expected for optical materials such as scintillators, windows, and lenses which will be part of the plasma diagnostics in future fusion devices. Radiation induced absorption represents a major concern for these components for which experimental validation under as near as possible reactor conditions becomes essential. A new experimental system has been developed at the CIEMAT Nayade 60Co gamma irradiation facility for in situ radiation induced optical absorption measurements, covering a spectral range between 370 and 730 nm. This setup consists in a rotating sample holder which allows one to collect incident light (reference signal) and transmitted light through the material to be tested as a function of irradiation dose. This is an advanced and robust system which overcomes the important experimental difficulties that radiation involves providing a valuable testing capability for transmission components and scintillators under realistic fusion conditions. A detailed description of the experimental arrangement, together with preliminary tests carried out for system validation is given in this paper.

Effects of posttraining damage to the pedunculopontine tegmental nucleus on conditioned stimulus transfer in two-way active avoidance in rats.

The effects of posttraining excitotoxic lesions of the pedunculopontine tegmental nucleus (PPTg) on two-way active avoidance after changing the conditioned stimulus (CS) used during prelesion training were examined. Prelesion training was carried out with either a tone or a light as the CS, and this CS was changed during postlesion training. Replacing the tone with a light reduced the performance of control and lesioned rats, but the degree of reduction was higher in the latter. Replacing the light with a tone had slight detrimental effects in lesioned rats but not in controls. Thus, posttraining PPTg lesions slowed down the reacquisition of shuttle-box avoidance under conditions of CS transfer, an effect that may be attributable to disruption of attention and/or gating of sensory stimuli.

Posttraining epinephrine treatment reduces the need for extensive training.

We studied whether posttraining epinephrine accelerates the process of acquisition, and whether this effect leads to an enduring high level of performance on a long-term memory test (20 days). Rats were submitted to daily massed (30 trials) two-way active avoidance conditioning sessions followed by systemic epinephrine (0.01 mg/kg) or vehicle, until achieving a learning criterion (80% avoidances in one single session, maximum 14 sessions). By the sixth session, 78% of the animals with posttraining epinephrine attained the learning criterion compared to only the 23% of the rats in the vehicle group. Considering the whole acquisition phase, all the epinephrine treated animals, but only 66.67% in the vehicle group, reached the criterion. On the retention test, both groups maintained the level of performance reached at the end of the acquisition phase. We conclude that epinephrine accelerates the process of acquisition by enhancing memory consolidation, and that this effect might be especially useful in high demanding learning tasks, or for animals with low learning capacities.

Lymphocyte apoptosis in the inflammatory reaction around Taenia solium metacestodes in porcine cysticercosis.

In the current research, we report apoptosis of lymphocytes in the inflammatory reaction around metacestodes in muscle tissue from cysticercotic pigs. Two events, high metacestode viability (100%) and high cysteine protease activity were found to be closely related to a high phosphatydilserine expression by inflammatory lymphocytes (56%). Testing the RPMI medium used for washing away inflammatory cells from metacestodes with 100% viability, with the fluorescent substrate Z-Phe-Ala-AFC for measuring cysteine protease activity, significant fluorescent values were found. In contrast, tests performed with RPMI medium used for washing away inflammatory cells from metacestodes with 90% viability or less, showed low fluorescence values. Flow cytometry analyses of inflammatory cells obtained from four naturally cysticercotic pigs, and stained with Annexin-V/PI, showed lymphocytes expressing phosphatidylserine with values of 0, 6, 41 and 56% on their outer surfaces. Electron microscopy studies of inflammatory cells from metacestodes with 100% viability, showed lymphocytes with strangled and fragmented nuclei, and heterochromatin displaced to the nuclear periphery. In addition, DNA from these cells showed fragmentation in electrophoresis assays. Apoptosis of lymphocytes in the inflammatory reaction around Taenia solium metacestodes, might have been induced by the parasite cysteine protease, and may be involved in impairing cell-mediated immune responses in human and porcine cysticercosis.

Posttraining Epinephrine Reverses Memory Deficits Produced by Traumatic Brain Injury in Rats.

The aim of this research is to evaluate whether posttraining systemic epinephrine is able to improve object recognition memory in rats with memory deficits produced by traumatic brain injury. Forty-nine two-month-old naïve male Wistar rats were submitted to surgical procedures to induce traumatic brain injury (TBI) or were sham-operated. Rats were trained in an object recognition task and, immediately after training, received an intraperitoneal injection of distilled water (Sham-Veh and TBI-Veh group) or 0.01 mg/kg epinephrine (TBI-Epi group) or no injection (TBI-0 and Sham-0 groups). Retention was tested 3 h and 24 h after acquisition. The results showed that brain injury produced severe memory deficits and that posttraining administration of epinephrine was able to reverse them. Systemic administration of distilled water also had an enhancing effect, but of a lower magnitude. These data indicate that posttraining epinephrine and, to a lesser extent, vehicle injection reduce memory deficits associated with TBI, probably through induction of a low-to-moderate emotional arousal.