Management of procalcitonin test overuse in an emergency department through a computer algorithm.

OBJECTIVES: To show the procalcitonin (PCT) test demand from an emergency department (ED) over several years, to decrease PCT measurement via a computerized algorithm based on C-reactive protein (CRP) value, and to evaluate the subsequent economic savings. STUDY DESIGN: A cross-sectional study was performed from January 1, 2018, to May 31, 2019, to evaluate an intervention to avoid PCT measurement in the ED of Hospital Universitario San Juan in Alicante in Spain, when CRP values are low. METHODS: A PCT result of at least 1.5 ng/mL was agreed upon with ED providers in our study as the value for clinical decision-making, with values less than 1.5 ng/mL considered negative. We retrospectively reviewed all PCT and CRP values for ED patients and calculated the diagnostic indicators for PCT at 4 different CRP cutoffs using the PCT quantification as the gold standard. From July 1, 2019, to April 30, 2021, the agreed-upon strategy was implemented, and we counted the PCT tests avoided and calculated the savings. RESULTS: PCT was not measured when CRP values were less than the selected CRP cutoff of 0.8 mg/dL, at which false-negative results were 1% and the 99th percentile of PCT was 1.5 ng/mL. In the postintervention period, 1091 PCT values were not measured and $11,553.69 was saved. CONCLUSIONS: An intervention to decrease PCT measurement in the ED designed by the clinical laboratory staff in consensus with requesting clinicians and based on CRP values decreased PCT testing and generated significant economic savings.

Factors that affect the health of immigrants: Qualitative meta synthesis.

BACKGROUND: Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care-related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta-synthesis was conducted. The results can be used to support health policy and clinical practice. OBJECTIVE: To describe how migrants perceive and experience the process of migrating and how it affects their health. SEARCH STRATEGY: Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty-four articles were selected for final meta-synthesis. INCLUSION CRITERIA: All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre-date the migration process were excluded. DATA EXTRACTION AND SYNTHESIS: The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in-depth interviews, both individual and group, were used for data collection and narrative synthesis. MAIN RESULTS: Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively. DISCUSSION AND CONCLUSIONS: Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems. PUBLIC OR PATIENT CONTRIBUTION: As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in-depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030.

Mutations of GEMIN5 are associated with coenzyme Q10 deficiency: long-term follow-up after treatment.

GEMIN5 exerts key biological functions regulating pre-mRNAs intron removal to generate mature mRNAs. A series of patients were reported harboring mutations in GEMIN5. No treatments are currently available for this disease. We treated two of these patients with oral Coenzyme Q10 (CoQ10), which resulted in neurological improvements, although MRI abnormalities remained. Whole Exome Sequencing demonstrated compound heterozygosity at the GEMIN5 gene in both cases: Case one: p.Lys742* and p.Arg1016Cys; Case two: p.Arg1016Cys and p.Ser411Hisfs*6. Functional studies in fibroblasts revealed a decrease in CoQ10 biosynthesis compared to controls. Supplementation with exogenous CoQ10 restored it to control intracellular CoQ10 levels. Mitochondrial function was compromised, as indicated by the decrease in oxygen consumption, restored by CoQ10 supplementation. Transcriptomic analysis of GEMIN5 patients compared with controls showed general repression of genes involved in CoQ10 biosynthesis. In the rigor mortis defective flies, CoQ10 levels were decreased, and CoQ10 supplementation led to an improvement in the adult climbing assay performance, a reduction in the number of motionless flies, and partial restoration of survival. Overall, we report the association between GEMIN5 dysfunction and CoQ10 deficiency for the first time. This association opens the possibility of oral CoQ10 therapy, which is safe and has no observed side effects after long-term therapy.

Photovoice: An active learning tool with community nursing students.

OBJECTIVE: To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community. METHODS: A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data. RESULTS: Seventy eight percent of the students felt that photovoice was an interesting and useful tool for nurses, 89% affirmed it helped stimulate reflection on social and health inequities in times of pandemic, 82% described that it developed many emotions and feelings and 86% would like to disseminate their photographs directly to stakeholders, citizens, and politicians. Three themes were identified in the data: "stimulate critical reflection", "develop emotional skills", and "encourage action". CONCLUSIONS: Photovoice is a successful active learning pedagogical approach that engages nursing students to develop critical awareness while connecting with their communities, with the real world. It fosters students' sensitivity and motivation and encourages them to take action. Teachers need to introduce new scaffolds for active learning, such as photovoice, to provide innovative academic support that nurtures and develops the next generation of nurses appropriately.

Spin-Resolved Magneto-Tunneling and Giant Anisotropic g-Factor in Broken Gap InAs-GaSb Core-Shell Nanowires.

We experimentally and computationally investigate the magneto-conductance across the radial heterojunction of InAs-GaSb core-shell nanowires under a magnetic field, B, up to 30 T and at temperatures in the range 4.2-200 K. The observed double-peak negative differential conductance markedly blue-shifts with increasing B. The doublet accounts for spin-polarized currents through the Zeeman split channels of the InAs (GaSb) conduction (valence) band and exhibits strong anisotropy with respect to B orientation and marked temperature dependence. Envelope function approximation and a semiclassical (WKB) approach allow to compute the magnetic quantum states of InAs and GaSb sections of the nanowire and to estimate the B-dependent tunneling current across the broken-gap interface. Disentangling different magneto-transport channels and a thermally activated valence-to-valence band transport current, we extract the g-factor from the spin-up and spin-down dI/dV branch dispersion, revealing a giant, strongly anisotropic g-factor in excess of 60 (100) for the radial (tilted) field configurations.

[Reacciones de las mujeres ante el folleto del Programa de Detección Precoz del Cáncer de Mama.] / Women's reactions upon reading a leaflet on Breast Cancer Screening Program.

OBJECTIVE: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowing how women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was to explore women's reactions regarding BCS leaflet. METHODS: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age in Asturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematic analysis was carried out. RESULTS: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimed at prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalent attitudes towards BCS were detected, related to emotions. CONCLUSIONS: The emotional response after reading the brochure is ambivalent, although most of the women express positive emotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important to understand how certain emotions (especially negative ones) are closely related to the attitude towards BCS.

OBJETIVO: El folleto del Programa de Detección Precoz del Cáncer de Mama (PDPCM) es una importante herramienta de difusión de ese programa. Conocer la percepción de las mujeres sobre ese material informativo es relevante para entender mejor su actitud hacia el PDPCM. El objetivo del estudio fue explorar las reacciones de las mujeres respecto al folleto del PDPCM. METODOS: Se realizó un estudio cualitativo descriptivo en mujeres de entre cuarenta y sesenta años en Asturias (España). Se realizaron veintiséis entrevistas semiestructuradas a mujeres de diferentes perfiles socioeconómicos en 2018. Se realizó un análisis de contenido para identificar inductivamente las categorías emergentes. RESULTADOS: La lectura del folleto despertó emociones positivas como tranquilidad, bienestar o gratitud, pero también miedo o inquietud. Las mujeres expresaron diversas creencias sobre el CM (enfermedad muy prevalente y de elevada supervivencia), sobre el PDPCM (programa dirigido a la prevención y que suponía una actividad normalizada en su entorno) y sobre el relevante papel de los servicios de salud y los medios de comunicación. Se detectaron actitudes ambivalentes hacia el PDPCM y estas actitudes estaban relacionadas con las emociones. CONCLUSIONES: La respuesta emocional al leer el folleto es ambivalente, aunque la mayoría de las mujeres expresan emociones positivas. Las mujeres comparan la información con sus creencias previas, especialmente respecto al CM y al PDPCM. Es importante entender cómo ciertas emociones (especialmente las negativas) están estrechamente relacionadas con la actitud hacia este programa.

Immunometabolic Profile Associated with Progressive Damage of the Intestinal Mucosa in Adults Screened for Colorectal Cancer: Association with Diet.

Environmental factors such as diet and lifestyle have been shown to influence the development of some intestinal mucosal lesions that may be precursors of colorectal cancer (CRC). The presence of these alterations seems to be associated with misbalanced immunological parameter levels. However, it is still unclear as to which immunological parameters are altered in each phase of CRC development. In this work, we aimed to study the potential relationships of immunological and metabolic parameters with diet in a CRC-related lesion context. Dietary information was obtained using an annual semi-quantitative food-frequency questionnaire (FFQ) from 93 volunteers classified via colonoscopy examination according to the presence of intestinal polyps or adenocarcinoma. Cytokines, chemokines, and adipokines were determined from serum samples. We observed a reduction in adiponectin according to the damage to the mucosa, accompanied by an increase and decrease in C-X-C motif chemokine ligand 10 (CXCL10) and resistin, respectively, in CRC cases. The presence of aberrant crypt foci (ACF) in the polyp group was associated with higher tumor necrosis factor-alpha (TNF-α) concentrations. Vegetables were directly correlated with adiponectin and resistin levels, while the opposite occurred with red meat. A bioactive compound, soluble pectin, showed a negative association with TNF-α. Future dietary strategies could be developed to modulate specific immunological parameters in the context of CRC.

Perception of care from the perspective of nursing students: A study using photovoice, storytelling and poetry.

BACKGROUND: The Higher Education in Nursing requires providing students with skills such as critical and reflective thinking about the actions to be carried out so that they are capable of providing humanised and quality care in an increasingly complex and technified society. Participatory teaching methodologies promote the development of these skills. OBJECTIVES: to explore the potential of photovoice, storytelling and poetry as instruments capable of encouraging reflection. To identify through images (photovoice) and poetic narratives (storytelling and poetry) the perception that students of the nursing degree express about nursing care. DESIGN: qualitative study in the framework of the socio-critical paradigm, using photovoice, storytelling and poetry in the field of care. PARTICIPANTS: first-year undergraduate nursing students at two Spanish universities in the academic year 2021-2022. METHODOLOGY: 48 images were shown and students were asked to select one, write a narrative and generate a short poem connected to the image. Subsequently, a content analysis was conducted of those poems evoked by the five photographs most chosen by the students. The analysis was supported by qualitative data analysis software. A total of 67 contributions from 67 students were analysed. RESULTS: the concepts addressed in the poems and the compositions generated reveal how critical humanist thinking and reflection on the subject of care developed. The topics identified were care, accompaniment throughout the life cycle, working on the basis of values and caring for small details as subcategories of nursing care. CONCLUSION: The combination of different tools in university education has encouraged reflection and enabled students to identify for themselves the importance of humanised care. Working on the theoretical foundation in an active way can reduce the gap between theory and practice and foster the empowerment of the nursing identity.

[Quality of life of Medicine students of the National University of Córdoba, Argentina] / Calidad de vida de estudiantes de la Facultad de Medicina de la Universidad Nacional de Córdoba.

Background: Quality of life (QoL), according to the WHO, includes the perception that a person has about their physical health, level of independence, social relationships, system of values ​​and goals, expectations, standards and concerns. The medical student faces a high level of competitiveness in the course of his academic training with an increase in the workload as he progresses; this causes symptoms such as anxiety, stress, sadness, among others. If these aspects are not treated or are masked, they can turn into depression, generalized anxiety, burnout and even suicide (2). Aim: To describe the QoL of the students of medicina at the National University of Córdoba, considering the complete training cycle divided into two groups from 1 to 3° and from 4 to 5°. Methods: Cross-sectional study, through the Guarani System of the UNC. The WHOQoL-BREF online questionnaire, which uses the Likert scale, was applied to all students. This assesses the global QoL and satisfaction regarding the state of physical and psychological health, interpersonal relationships and environment. p was considered significant <0.05. This work was approved by the Adult CIEIS. Results: 854 responses were obtained, 72% were female, 43% were from another province/country and 63% corresponded to the 1-3° group. Of these, 37% rated their QoL as "fairly good", while 36% of the 4-5th grade group perceived their QoL as "normal" (p:0.0469). The most influential variables correspond to the supply of money for their needs (p:0.0005), sexual satisfaction (p:0.0056) and access to health services (p:0.0042) . Cronbach's alpha was 0.8899. Conclusion: QoL is better perceived in the 1-3 year group and economic supply, sexual satisfaction and access to health services were the main points to take care of in this medicine students.

Introducción: La calidad de vida (CV), según la OMS, comprende la percepción que tiene una persona sobre su salud física, nivel de independencia, relaciones sociales, sistema de valores y metas, expectativas, estándares y preocupaciones (1). El estudiante de medicina se enfrenta con un alto nivel de competitividad en el transcurso de su formación académica con aumento de la carga horaria a medida que avanza; esto origina síntomas como ansiedad, estrés, tristeza, entre otros.  Si tales aspectos no son tratados o son enmascarados pueden transformarse en depresión, ansiedad generalizada, burnout y hasta suicidio (2). Objetivo: Describir la CV de los estudiantes de medicina de la Universidad Nacional de Córdoba, considerando el ciclo completo de formación divididos en dos grupos de 1-3° y 4-5°. Métodos: Estudio transversal, mediante el Sistema Guaraní de la UNC se aplicó el cuestionario online WHOQOL-BREF, que utiliza escala de Likert a todos los alumnos. Este valora la CV global y satisfacción respecto al estado de salud física, psicológica, relaciones interpersonales y entorno. Se consideró significativo una p<0.05. Este trabajo fue aprobado por el CIEIS del Adulto. Resultados: Se obtuvieron 854 respuestas, el 72% fue de género femenino, el 43% es originario de otra provincia/país y el 63% correspondió al grupo de 1-3°. De estos, el 37% calificó su CV como "bastante buena", mientras que el 36% del grupo de 4-5° percibió su CV como "normal" (p:0,0469). Las variables más influyentes corresponden al abastecimiento de dinero para sus necesidades (p:0,0005), satisfacción sexual (p:0,0056) y el acceso a los servicios sanitarios (p:0,0042). El alfa de Cronbach fue 0.8899. Conclusión: La CV es mejor percibida en el grupo de 1-3° año y se destacan el suministro económico, la satisfacción sexual y el acceso a los servicios sanitarios.

Reacciones de las mujeres ante el folleto del Programa de Detección Precoz del Cáncer de Mama / Women’s reactions upon reading a leaflet on Breast Cancer Screening Program

Fundamentos: El folleto delPrograma de Detección Precoz del Cáncer de Mama (PDPCM) es una importante herramienta dedifusión de ese programa. Conocer la percepción de las mujeres sobre ese material informativo es relevante para entender mejor suactitud hacia el PDPCM. El objetivo del estudio fue explorar las reacciones de las mujeres respecto al folleto del PDPCM. Métodos: Se realizó un estudio cualitativo descriptivo en mujeres de entre cuarenta y sesenta años en Asturias (España). Serealizaron veintiséis entrevistas semiestructuradas a mujeres de diferentes perfiles socioeconómicos en 2018. Se realizó un análisisde contenido para identificar inductivamente las categorías emergentes. Resultados: La lectura del folleto despertó emociones positivas como tranquilidad, bienestar o gratitud, pero también miedo oinquietud. Las mujeres expresaron diversas creencias sobre el CM (enfermedad muy prevalente y de elevada supervivencia), sobreel PDPCM (programa dirigido a la prevención y que suponía una actividad normalizada en su entorno) y sobre el relevante papel delos servicios de salud y los medios de comunicación. Se detectaron actitudes ambivalentes hacia el PDPCM y estas actitudes estabanrelacionadas con las emociones. Conclusiones: La respuesta emocional al leer el folleto es ambivalente, aunque la mayoría de las mujeres expresan emocionespositivas. Las mujeres comparan la información con sus creencias previas, especialmente respecto al CM y al PDPCM. Es importanteentender cómo ciertas emociones (especialmente las negativas) están estrechamente relacionadas con la actitud hacia este programa.(AU)

Background: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowinghow women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was toexplore women’s reactions regarding BCS leaflet. Methods: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age inAsturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematicanalysis was carried out. Results: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimedat prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalentattitudes towards BCS were detected, related to emotions. Conclusions: The emotional response after reading the brochure is ambivalent, although most of the women express positiveemotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important tounderstand how certain emotions (especially negative ones) are closely related to the attitude towards BCS. KEYWORDS: Early detection of cancer; Leaflet; Breast cancer; Emotions; Qualitative research; Health knowledge, attitudes, practice.(AU)

From contigs towards chromosomes: automatic improvement of long read assemblies (ILRA).

Recent advances in long read technologies not only enable large consortia to aim to sequence all eukaryotes on Earth, but they also allow individual laboratories to sequence their species of interest with relatively low investment. Long read technologies embody the promise of overcoming scaffolding problems associated with repeats and low complexity sequences, but the number of contigs often far exceeds the number of chromosomes and they may contain many insertion and deletion errors around homopolymer tracts. To overcome these issues, we have implemented the ILRA pipeline to correct long read-based assemblies. Contigs are first reordered, renamed, merged, circularized, or filtered if erroneous or contaminated. Illumina short reads are used subsequently to correct homopolymer errors. We successfully tested our approach by improving the genome sequences of Homo sapiens, Trypanosoma brucei, and Leptosphaeria spp., and by generating four novel Plasmodium falciparum assemblies from field samples. We found that correcting homopolymer tracts reduced the number of genes incorrectly annotated as pseudogenes, but an iterative approach seems to be required to correct more sequencing errors. In summary, we describe and benchmark the performance of our new tool, which improved the quality of novel long read assemblies up to 1 Gbp. The pipeline is available at GitHub: https://github.com/ThomasDOtto/ILRA.

Novel systems to study vector-pathogen interactions in malaria.

Some parasitic diseases, such as malaria, require two hosts to complete their lifecycle: a human and an insect vector. Although most malaria research has focused on parasite development in the human host, the life cycle within the vector is critical for the propagation of the disease. The mosquito stage of the Plasmodium lifecycle represents a major demographic bottleneck, crucial for transmission blocking strategies. Furthermore, it is in the vector, where sexual recombination occurs generating "de novo" genetic diversity, which can favor the spread of drug resistance and hinder effective vaccine development. However, understanding of vector-parasite interactions is hampered by the lack of experimental systems that mimic the natural environment while allowing to control and standardize the complexity of the interactions. The breakthrough in stem cell technologies has provided new insights into human-pathogen interactions, but these advances have not been translated into insect models. Here, we review in vivo and in vitro systems that have been used so far to study malaria in the mosquito. We also highlight the relevance of single-cell technologies to progress understanding of these interactions with higher resolution and depth. Finally, we emphasize the necessity to develop robust and accessible ex vivo systems (tissues and organs) to enable investigation of the molecular mechanisms of parasite-vector interactions providing new targets for malaria control.

Felicidad / Felicidade / Happiness

The purpose of this editorial is to reflect, as micro-story, on the spaces where we seek happiness in our culture immersed in the digital age.(AU)

El propósito de esta editorial es reflexionar, en forma de micro-relato, sobre los espaciosdonde buscamos la felicidad en nuestra cultura sumergida en la era digital.(AU)

O objetivo deste editorial é refletir, sob a forma de uma micro-história, sobre os espaçosonde procuramos a felicidade na nossa cultura imersa na era digital

Exploring SARS-CoV-2 and Plasmodium falciparum coinfection in human erythrocytes.

The co-occurrence and the similarities between malaria and COVID-19 diseases raise the question of whether SARS-CoV-2 is capable of infecting red blood cells and, if so, whether these cells represent a competent niche for the virus. In this study, we first tested whether CD147 functions as an alternative receptor of SARS-CoV-2 to infect host cells. Our results show that transient expression of ACE2 but not CD147 in HEK293T allows SARS-CoV-2 pseudoviruses entry and infection. Secondly, using a SARS-CoV-2 wild type virus isolate we tested whether the new coronavirus could bind and enter erythrocytes. Here, we report that 10,94% of red blood cells had SARS-CoV-2 bound to the membrane or inside the cell. Finally, we hypothesized that the presence of the malaria parasite, Plasmodium falciparum, could make erythrocytes more vulnerable to SARS-CoV-2 infection due to red blood cell membrane remodelling. However, we found a low coinfection rate (9,13%), suggesting that P. falciparum would not facilitate the entry of SARS-CoV-2 virus into malaria-infected erythrocytes. Besides, the presence of SARS-CoV-2 in a P. falciparum blood culture did not affect the survival or growth rate of the malaria parasite. Our results are significant because they do not support the role of CD147 in SARS-CoV-2 infection, and indicate, that mature erythrocytes would not be an important reservoir for the virus in our body, although they can be transiently infected.

Diversity and structure of feather mite communities on seabirds from the north-east Atlantic and Mediterranean Sea.

The richness and structure of symbiont assemblages are shaped by many factors acting at different spatial and temporal scales. Among them, host phylogeny and geographic distance play essential roles. To explore drivers of richness and structure of symbiont assemblages, feather mites and seabirds are an attractive model due to their peculiar traits. Feather mites are permanent ectosymbionts and considered highly host-specific with limited dispersal abilities. Seabirds harbour species-rich feather mite communities and their colonial breeding provides opportunities for symbionts to exploit several host species. To unravel the richness and test the influence of host phylogeny and geographic distance on mite communities, we collected feather mites from 11 seabird species breeding across the Atlantic Ocean and Mediterranean Sea. Using morphological criteria, we identified 33 mite species, of which 17 were new or recently described species. Based on community similarity analyses, mite communities were clearly structured by host genera, while the effect of geography within host genera or species was weak and sometimes negligible. We found a weak but significant effect of geographic distance on similarity patterns in mite communities for Cory's shearwaters Calonectris borealis. Feather mite specificity mainly occurred at the host-genus rather than at host-species level, suggesting that previously inferred host species-specificity may have resulted from poorly sampling closely related host species. Overall, our results show that host phylogeny plays a greater role than geography in determining the composition and structure of mite assemblages and pinpoints the importance of sampling mites from closely-related host species before describing mite specificity patterns.

Life cycle assessment of a novel strategy based on hydrothermal carbonization for nutrient and energy recovery from food waste.

In this work, a novel strategy for food waste valorization was evaluated from an environmental life-cycle perspective. A system based on acid-assisted hydrothermal carbonization of food waste combined with the exploitation of hydrochar by combustion and process water through nutrient recovery stage and subsequent anaerobic digestion, was assessed and compared with stand-alone anaerobic digestion as the reference system. This combination of processes aims to recover both nutrients in a stage of struvite precipitation from process water and energy through hydrochar and biogas combustion. Both systems were modeled in Aspen Plus® to identify and quantify their most relevant input and output flows and subsequently evaluate their environmental performance through the life cycle assessment methodology. The novel combined system was found to generally involve a more favorable environmental performance than the reference stand-alone configuration, which would be closely linked to the substitution of hydrochar for fossil fuels. In addition, the impacts associated with soil application of the struvite produced in the integrated process would also be reduced compared to the use of the digestate generated in the stand-alone anaerobic digestion process. Following these results and the evolving regulatory framework for biomass waste management, mainly in the field of nutrient recovery, combined process based on acid-assisted hydrothermal treatment plus nutrient recovery stage and anaerobic digestion is concluded to be a promising circular economy concept for food waste valorization.

Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes.

Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%, p < 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%, p = 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637-1.107) or adverse events (1.035, 0.914-1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409-1.397; and 0.858, 0.645-1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.

Nursing Students' Perception about Gender Inequalities Presented on Social Networks: A Qualitative Study.

During the COVID-19 pandemic, gender inequalities in nurses have been exacerbated through the images shown on social networks. This study aimed to explore and describe nursing students' experiences and perceptions about gender inequalities in nurses during the COVID-19 pandemic. A descriptive qualitative study was carried out in two universities in 264 undergraduate nursing students. The photovoice method was used to guide the study. Results: Two main categories and four subcategories were described from the data: "gender-related stereotypes", with "male leadership in a female profession" and "sexualization of female nurses" and "women's vulnerability in the pandemic" with "the gender gap in the face of increased risk of contagion " and "women's emotional fragility". Over the years, care has been considered a female task, and nursing continues to be thought of in this way. The nurse has been discriminated against, poorly considered as a professional, and, as a woman, subjected to gender roles.

Invasive management of significant tricuspid regurgitation in clinical practice.

BACKGROUND: Tricuspid regurgitation (TR) is a prevalent condition inside valvular heart disease (VHD) with relevant prognosis implications. However, concordance between real management in clinical practice and invasive treatment recommendations of European Society of Cardiology (ESC) guidelines is unknown. METHODS: A substudy of ESC VHD II survey was performed to evaluate the real treatment of TR compared to the clinical ESC guidelines recommendations published in 2012, 2017 and 2021 was performed. TR cases with surgical indication were divided in 3 groups: 1: severe isolated TR without previous left VHD; 2: moderate/severe TR and concomitant severe left VHD; 3: severe TR plus previous left VHD surgery. RESULTS: Of 902 patients assessed, 123 had significant TR. Fifty (41%) cases demonstrated ESC guidelines 2012-2017 Class I or IIa recommendations for invasive treatment: 9(18%) of group 1, 37(74%) of group 2 and 4(8%) of group 3. Surgery was performed in 24 patients (48%); 1 in group 1(4%), 22 in group 2(92%) and 1 in group 3(4%). Overall concordance was 48% (group 1: 11%; group 2: 59%; group 3: 25%). Regarding the 2021 ESC guidelines only one patient changed groups with an overall concordance of 47% (group 1: 10%; group 2: 59%; group 3: 25%). CONCLUSION: Concordance between 2012, 2017 and 2021 ESC guidelines recommendations and clinical practice for TR surgical intervention is low, especially in those without concomitant severe left VHD. These results suggest the need to improve further guideline implementation and alternative treatments, such as percutaneous, which could resolve potential discrepancies in those clinical scenarios.

El Análisis de Redes Sociales desde la perspectiva Enfermera: una aproximación teórico-empírica / Social Network Analysis from the nurse perspective: A theoretical-empirical approach

El ámbito de la salud es uno de los entornos más relacionales que la ciencia conoce, pero raramente se analizan los contactos entre actores. La Teoría de Redes conceptualiza al individuo como parte de una estructura a la cual nutre y de la cual se nutre. El Análisis de Redes Sociales (ARS) es el método que da soporte a la Teoría de Redes. En el siguiente trabajo se plantean los objetivos de (i) dar a conocer la Teoría de Redes y su justificación en el contexto de salud, (ii) describir el ARS, (iii) mostrar investigación en salud con aplicación del ARS, (iv) presentar la evolución del ARS en la Enfermería Española. Entre las principales conclusiones se resalta que (i) el ARS se centra en la estructura y la entidad social como unidad de análisis, (ii) las redes son causa y efecto de los resultados de salud, (iii) existen investigaciones con ARS aplicadas al cuidado y lideradas por enfermeras, y (iv) para consolidar el conocimiento y el uso del paradigma del ARS es necesario crear redes cohesivas de investigadores y profesionales multidisciplinares.(AU)

The field of health is one of the most relational environments that science knows, but the contacts between actors are rarely analyzed. The Theory of Networks conceptualizes the individual as part of a structure to which he nourishes, and from which he nourishes himself. Social Network Analysis (SNA) is the method that supports Network Theory. In the following work the objectives of (i) to present the Theory of Networks and their justification in the health context are presented, (ii) to describe the SNA, (iii) to showresearch in health with application of the SNA, (iv) present the evolution of SNA in Spanish Nursing. Among the main conclusions it is highlighted that (i) the SNA focuses on the structure and the social entity as the unit of analysis, (ii) the networks are the cause and effect of the health outcomes, (iii) there are SNA investigations applied to the care and led by nurses, and (iv) to consolidate the knowledge and use of the SNA paradigm, it is necessary to create cohesive networks of researchers and multidisciplinary professionals.(AU)