Building and environmental acoustics in obsolete residential neighbourhoods: The case of San Pablo, Spain.

In order to establish an agreement between the objectives of acoustic quality in the outdoor environment and the acoustic insulation in a building as required in the current legislation in Spain, the acoustic insulation of typical social housing has been studied in the residential neighbourhood of San Pablo in Seville. Field measurements based on acoustic sonometry have been performed in its public areas, together with the consultations to the strategic noise maps prepared by the administration of the city and with data from a questionnaire answered by neighbours on the perception of environmental and domestic noise. These inputs have enabled calculations of airborne and impact noise insulation in a typical dwelling of the neighbourhood. The neighbourhood presents various kinds of obsolescence, as do many residential estates built in Europe in the same period, mainly in terms of its low quality of construction and structural solutions, its energy poverty, and its typology. Results on acoustic insulation indicate that the requirements of current Spanish legislation have not been met, Dnt,A = 49 dBA, L'nT,w = 80 dB. However, thanks not only to the urban layout of the various types of housing blocks in the neighbourhood, but also to the breadth and abundance of green and common areas and to their roads, the existing environmental sound levels remain below the established limit: Ld < 60 dBA. Hence, the calculation for the external noise insulation in façades indicates that the requirements are met, D2m,nT,Atr = 33 dBA. In the acoustic survey, most people consider the environmental acoustic conditions of the neighbourhood to be acceptable or good and believe that they are barely affected by the domestic noise of next-door neighbours. The research found that social heritage neighbourhoods of the 1960s and 1970s, laid out with cul-de-sacs, curved layouts, and small pockets of parking, significantly improve their urban acoustic performance.

Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial.

Importance: In large academic centers, medical residents work on multiple clinical floors with transient interactions with nursing colleagues. Although teamwork is critical in delivering high-quality medical care, little research has evaluated the effect of interprofessional familiarity on inpatient team performance. Objective: To determine the effectiveness of increased familiarity between medical residents and nurses on team performance, psychological safety, and communication. Design, Setting, and Participants: A 12-month randomized clinical trial in an inpatient general medical service at a large academic medical center was completed from June 25, 2019, to June 24, 2020. Participants included 33 postgraduate year (PGY)-1 residents in an internal medicine residency program and 91 general medicine nurses. Interventions: Fifteen PGY-1 residents were randomized to complete all 16 weeks of their general medicine inpatient time on 1 medical nursing floor (intervention group with 43 nurses). Eighteen PGY-1 residents completed 16 weeks on 4 different general medical floors as per usual care (control group with 48 nurses). Main Outcomes and Measures: The primary outcome was an assessment of team performance in physician-nurse simulation scenarios completed at 6 and 12 months. Interprofessional communication was assessed via a time-motion study of both work rounds and individual resident clinical work. Psychological safety and teamwork culture were assessed via surveys of both residents and nurses at multiple time points. Results: Of the intervention and control PGY-1 residents, 8 of 15 (54%) and 8 of 18 (44%) were women, respectively. Of the nurses in the intervention and control groups with information available, 37 of 40 (93%) and 34 of 38 (90%) were women, respectively, and more than 70% had less than 10 years of clinical experience. There was no difference in overall team performance during the first simulation. At the 12-month simulation, the intervention teams received a higher mean overall score in leadership and management (mean [SD], 2.47 [0.53] vs 2.17 [0.39]; P = .045, Cohen d = 0.65) and on individually rated items were more likely to work as 1 unit (100% vs 62%; P = .003), negotiate with the patient (61% vs 10%; P = .001), support other team members (61% vs 24%; P = .02), and communicate as a team (56% vs 19%; P = .02). The intervention teams were more successful in achieving the correct simulation case outcome of negotiating a specific insulin dose with the patient (67% vs 14%; P = .001). Time-motion analysis noted intervention teams were more likely to have a nurse present on work rounds (47% vs 28%; P = .03). At 6 months, nurses in the intervention group were more likely to report their relationship with PGY-1 residents to be excellent to outstanding (74% vs 40%; P = .003), feel that the input of all clinical practitioners was valued (95% vs 53%; P < .001), and say that feedback between practitioners was delivered in a way to promote positive interactions (90% vs 60%; P = .003). These differences diminished at the 12-month survey. Conclusions and Relevance: In this randomized clinical trial, increased familiarity between nurses and residents promoted more rapid improvement of nursing perception of team relationships and, over time, led to higher team performance on complex cognitive tasks in medical simulations. Medical centers should consider team familiarity as a potential metric to improve physician-nursing teamwork and patient care. Trial Registration: ClinicalTrials.gov Identifier: NCT05213117.

Percutaneous closure of a ruptured right coronary sinus of Valsalva aneurysm that mimics severe aortic regurgitation.

A 34-year-old male was admitted with presumed acute, severe aortic regurgitation. Multimodal imaging was performed and showed a ruptured right coronary sinus of Valsalva aneurysm into the right atrium. He underwent a percutaneous closure of the ruptured sinus of Valsalva aneurysm. The patient had major clinical improvement.

Negative relationship between dry matter intake and the temperature-humidity index with increasing heat stress in cattle: a global meta-analysis.

Changes in frequency and severity of heat waves due to climate change pose a considerable challenge to livestock production systems. Although it is well known that heat stress reduces feed intake in cattle, effects of heat stress vary between animal genotypes and climatic conditions and are context specific. To derive a generic global prediction that accounts for the effects of heat stress across genotypes, management and environments, we conducted a systematic literature review and a meta-analysis to assess the relationship between dry matter intake (DMI) and the temperature-humidity index (THI), two reliable variables for the measurement of feed intake and heat stress in cattle, respectively. We analysed this relationship accounting for covariation in countries, breeds, lactation stage and parity, as well as the efficacy of various physical cooling interventions. Our findings show a significant negative correlation (r = - 0.82) between THI and DMI, with DMI reduced by 0.45 kg/day for every unit increase in THI. Although differences in the DMI-THI relationship between lactating and non-lactating cows were not significant, effects of THI on DMI varied between lactation stages. Physical cooling interventions (e.g. provision of animal shade or shelter) significantly alleviated heat stress and became increasingly important after THI 68, suggesting that this THI value could be viewed as a threshold for which cooling should be provided. Passive cooling (shading) was more effective at alleviating heat stress compared with active cooling interventions (sprinklers). Our results provide a high-level global equation for THI-DMI across studies, allowing next-users to predict effects of heat stress across environments and animal genotypes.

Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. / Infiltración comisural dorsal en el tratamiento del pulgar y los dedos en resorte. Estudio anatómico.

BACKGROUND AND OBJECTIVE: Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb. MATERIAL AND METHOD: This is an anatomical study in sixteen cadaveric hands. An injection through the dorsal web was performed on each digit. After careful resection of the palmar skin, the distance between the needle and the main anatomical structures was measured. The risk of major injury was considered high when the mean distance from the needle to the neurovascular bundle was below 1mm. RESULTS: The mean distance from the needle to the neurovascular bundle was 1.77mm. Two neurovascular injuries in 112 injections were observed, one nerve and one artery. The safest digit was the thumb while the most dangerous was the index finger. At the ring finger, the technique was safer when it was carried out from the dorso-radial. CONCLUSIONS: A subcutaneous injection near the flexor tendon sheath can be carried out through the dorsal web with a low, but present, risk of neurovascular injury. It could be useful for injection in the treatment of trigger finger and trigger thumb but it should be assessed in a clinical study.

Bell-shaped agonist activation of 5-HT1A receptor-coupled Gαi3 G-proteins: Receptor density-dependent switch in receptor signaling.

A previous study observed bell-shaped concentration-response isotherms for activation of Gαi3 G-protein subunits by high efficacy 5-HT1A receptor agonists in a Chinese hamster ovary (CHO) cell line expressing high levels of these receptors. This suggested that a signaling switch took place in that cell line (from Gαi3 to activation of other G-proteins) but it was unclear if such effects are observed for 5-HT1A receptors in other cellular environments. Here, using an antibody capture-based [35S]GTPγS binding assay for Gαi3 activation, we investigated whether efficacious 5-HT1A receptor agonists (5-HT, F13714, befiradol, NLX-101), prototypical agonists ((+) and (-)8-OH-DPAT), and partial agonist, antagonists, inverse agonists (pindolol, WAY100635, spiperone) produced similar effects on 5 cell lines expressing different levels of human 5-HT1A receptors. In membranes from cell lines (HeLa, C6-glia and CHO-low) expressing moderate receptor levels (between 1 and 4 pmol/mg of protein), 5-HT, F13714, befiradol and NLX-101 elicited classical sigmoid concentration-response isotherms. In contrast, in cell lines (CHO-high, HEK-293F) expressing high receptor levels (>9 pmol/mg) these agonists elicited bell-shaped concentration-response isotherms that peaked at nanomolar-range concentrations and then returned to baseline or below. Spiperone elicited inverse agonist inhibitory sigmoid isotherms in all membrane preparations while WAY100635 was mostly 'silent' for Gαi3 activation. The other compounds elicited diverse responses in the different cell lines suggesting that other factors, in addition to receptor expression levels, could be influencing Gαi3 activation. These data indicate that Gαi3 G-protein activation by 5-HT1A receptor ligands is highly dependent on receptor expression levels and on cellular background. Moreover, the induction of bell-shape concentration-response isotherms by 5-HT and other high-efficacy agonists is consistent with a switch in signaling to other G-protein-mediated signaling cascades, possibly elicited by receptor conformational changes.

First fertilizing-value typology of digestates: A decision-making tool for regulation.

Defined as the residue from anaerobic digestion (AD), digestate refers to a set of materials with varied biochemical compositions. The objective of this study was to establish a digestate typology according to its fertilizing-value with data from literature and internal unpublished databases. To establish a relatively big database allowing the application of advanced statistics, usual fertilizing-value parameters were used: dry matter, volatile solids, C/N, C/Organic-N, total N (TN), total ammoniacal nitrogen (TAN), TAN/TN, total P and total K. Statistical analysis was performed on a dataset of 91 raw digestates, 34 solid fractions and 25 liquid fractions after separation. The resulting typology outlined that fertilizing-values are linked to AD feedstock and process. As case study regulations, no digestate (without any post-treatment) fulfilled French standards and the latest European Union regulation proposal on fertilizers. Options to reach regulations' product categories were discussed according to the typology. For the first time, a digestate typology was established based on fertilizing value, which can be a useful tool enhancing digestate management and policy making.

Antrodia cinnamomea reduces obesity and modulates the gut microbiota in high-fat diet-fed mice.

BACKGROUND: Obesity is associated with gut microbiota dysbiosis, disrupted intestinal barrier and chronic inflammation. Given the high and increasing prevalence of obesity worldwide, anti-obesity treatments that are safe, effective and widely available would be beneficial. We examined whether the medicinal mushroom Antrodia cinnamomea may reduce obesity in mice fed with a high-fat diet (HFD). METHODS: Male C57BL/6J mice were fed a HFD for 8 weeks to induce obesity and chronic inflammation. The mice were treated with a water extract of A. cinnamomea (WEAC), and body weight, fat accumulation, inflammation markers, insulin sensitivity and the gut microbiota were monitored. RESULTS: After 8 weeks, the mean body weight of HFD-fed mice was 39.8±1.2 g compared with 35.8±1.3 g for the HFD+1% WEAC group, corresponding to a reduction of 4 g or 10% of body weight (P<0.0001). WEAC supplementation reduced fat accumulation and serum triglycerides in a statistically significant manner in HFD-fed mice. WEAC also reversed the effects of HFD on inflammation markers (interleukin-1ß, interleukin-6, tumor necrosis factor-α), insulin resistance and adipokine production (leptin and adiponectin). Notably, WEAC increased the expression of intestinal tight junctions (zonula occludens-1 and occludin) and antimicrobial proteins (Reg3g and lysozyme C) in the small intestine, leading to reduced blood endotoxemia. Finally, WEAC modulated the composition of the gut microbiota, reducing the Firmicutes/Bacteroidetes ratio and increasing the level of Akkermansia muciniphila and other bacterial species associated with anti-inflammatory properties. CONCLUSIONS: Supplementation with A. cinnamomea produces anti-obesogenic, anti-inflammatory and antidiabetic effects in HFD-fed mice by maintaining intestinal integrity and modulating the gut microbiota.

Técnica de Bristow-Latarjet en la inestabilidad glenohumeral anterior / Bristow-Latarjet Technique for anterior glenohumeral instability

Resumen: Antecedentes: En el tratamiento de la inestabilidad glenohumeral anterior se han descrito multitud de técnicas quirúrgicas, todas ellas con ventajas e inconvenientes. Nuestro objetivo es analizar los resultados obtenidos a medio plazo en los pacientes que hemos intervenido mediante la técnica de Bristow-Latarjet teniendo en cuenta el valor del ISIS preoperatorio. Material y métodos: Estudio retrospectivo de 33 pacientes intervenidos entre 2005 y 2012 con edad media de 33.2 años y seguimiento medio de 75 meses. Se recogió el resultado con las escalas de Rowe y Constant, cuestionario DASH y una encuesta de valoración subjetiva del resultado por parte de cada paciente. Resultados: No se presentaron recidivas. La puntuación media postoperatoria en la escala de Rowe fue de 74.6 puntos y de 70 puntos en la escala de Constant. En el cuestionario DASH el valor promedio fue 22.9 puntos. En 78.8% de los pacientes se valoró positivamente el resultado. Se produjo la migración del tornillo en un paciente, encontrándose asintomático. No se identificaron otras complicaciones. Conclusiones: La técnica de Bristow-Latarjet en el tratamiento de la inestabilidad glenohumeral anterior es una técnica fiable y con una mínima tasa de recidivas, por lo que debe emplearse como cirugía de elección en determinados casos y, para ello, la valoración preoperatoria con la escala ISIS es una buena guía a la hora de indicar el tipo de cirugía.

Abstract: Background: In treatment of anterior shoulder instability, many surgical techniques have been described, all of them with advantages and disadvantages. Our goal is to study the half term results on patients that underwent open Bristow-Latarjet surgery considering the preoperative ISIS value. Material and methods: This is a retrospective study of 33 patients which underwent open Bristow-Latarjet surgery in our center between 2005 and 2012. Average age of 33.2 years and follow up of 75 months. Results were taken by Rowe and Constant scores, DASH questionnaire and we also recorded a subjective assessment of the result by each patient. Results: No recurrence was reported. No reoperations. Mean Rowe score was 74.6 points and mean Constant score was 70 points. In the disability questionnaire (DASH), the mean value was 22.9 points. The outcome assessment by the patients was positive in 78.8%. The migration of a screw occurred in one patient but he still asymptomatic. No other complication was identified. Conclusions: The Bristow-Latarjet technique is a reliable technique, with few complications and with an excellent rate of recurrence in treatment of chronic shoulder instability as reported in literature; it should be used as primary surgery in some cases and the preoperative ISIS score is an excellent and simple guide to select correctly the surgical technique for each patient.

[Bristow-Latarjet Technique for anterior glenohumeral instability]. / Técnica de Bristow-Latarjet en la inestabilidad glenohumeral anterior.

BACKGROUND: In treatment of anterior shoulder instability, many surgical techniques have been described, all of them with advantages and disadvantages. Our goal is to study the half term results on patients that underwent open Bristow-Latarjet surgery considering the preoperative ISIS value. MATERIAL AND METHODS: This is a retrospective study of 33 patients which underwent open Bristow-Latarjet surgery in our center between 2005 and 2012. Average age of 33.2 years and follow up of 75 months. Results were taken by Rowe and Constant scores, DASH questionnaire and we also recorded a subjective assessment of the result by each patient. RESULTS: No recurrence was reported. No reoperations. Mean Rowe score was 74.6 points and mean Constant score was 70 points. In the disability questionnaire (DASH), the mean value was 22.9 points. The outcome assessment by the patients was positive in 78.8%. The migration of a screw occurred in one patient but he still asymptomatic. No other complication was identified. CONCLUSIONS: The Bristow-Latarjet technique is a reliable technique, with few complications and with an excellent rate of recurrence in treatment of chronic shoulder instability as reported in literature; it should be used as primary surgery in some cases and the preoperative ISIS score is an excellent and simple guide to select correctly the surgical technique for each patient.

ANTECEDENTES: En el tratamiento de la inestabilidad glenohumeral anterior se han descrito multitud de técnicas quirúrgicas, todas ellas con ventajas e inconvenientes. Nuestro objetivo es analizar los resultados obtenidos a medio plazo en los pacientes que hemos intervenido mediante la técnica de Bristow-Latarjet teniendo en cuenta el valor del ISIS preoperatorio. MATERIAL Y MÉTODOS: Estudio retrospectivo de 33 pacientes intervenidos entre 2005 y 2012 con edad media de 33.2 años y seguimiento medio de 75 meses. Se recogió el resultado con las escalas de Rowe y Constant, cuestionario DASH y una encuesta de valoración subjetiva del resultado por parte de cada paciente. RESULTADOS: No se presentaron recidivas. La puntuación media postoperatoria en la escala de Rowe fue de 74.6 puntos y de 70 puntos en la escala de Constant. En el cuestionario DASH el valor promedio fue 22.9 puntos. En 78.8% de los pacientes se valoró positivamente el resultado. Se produjo la migración del tornillo en un paciente, encontrándose asintomático. No se identificaron otras complicaciones. CONCLUSIONES: La técnica de Bristow-Latarjet en el tratamiento de la inestabilidad glenohumeral anterior es una técnica fiable y con una mínima tasa de recidivas, por lo que debe emplearse como cirugía de elección en determinados casos y, para ello, la valoración preoperatoria con la escala ISIS es una buena guía a la hora de indicar el tipo de cirugía.

Electronic and postal reminders for improving immunisation coverage in children: protocol for a systematic review and meta-analysis.

INTRODUCTION: Worldwide, suboptimal immunisation coverage causes the deaths of more than one million children under five from vaccine-preventable diseases every year. Reasons for suboptimal coverage are multifactorial, and a combination of interventions is needed to improve compliance with immunisation schedules. One intervention relies on reminders, where the health system prompts caregivers to attend immunisation appointments on time or re-engages caregivers who have defaulted on scheduled appointments. We undertake this systematic review to investigate the potential of reminders using emails, phone calls, social media, letters or postcards to improve immunisation coverage in children under five. METHODS AND ANALYSIS: We will search for published and unpublished randomised controlled trials and non-randomised controlled trials in PubMed, Scopus, CINAHL, CENTRAL, Science Citation Index, WHOLIS, Clinicaltrials.gov and the WHO International Clinical Trials Platform. We will conduct screening of search results, study selection, data extraction and risk-of-bias assessment in duplicate, resolving disagreements by consensus. In addition, we will pool data from clinically homogeneous studies using random-effects meta-analysis; assess heterogeneity of effects using the χ(2) test of homogeneity; and quantify any observed heterogeneity using the I(2) statistic. ETHICS AND DISSEMINATION: This protocol does not need approval by an ethics committee because we will use publicly available data, without directly involving human participants. The results will provide updated evidence on the effects of electronic and postal reminders on immunisation coverage, and we will discuss the applicability of the findings to low and middle-income countries. We plan to disseminate review findings through publication in a peer-reviewed journal and presentation at relevant conferences. In addition, we will prepare a policymaker-friendly summary using a validated format (eg, SUPPORT Summary) and disseminate this through social media and email discussion groups. REVIEW REGISTRATION NUMBER: PROSPERO registration number CRD42014012888.

[Radiocarpal dislocation after a trivial injury]. / Luxación radiocarpiana tras traumatismo banal.

Radiocarpal dislocation is an extremely uncommon injury in Traumatology, and is usually produced by high energy trauma. There are two types of dislocation, type I: pure radiocarpal dislocation and type II: fracture-dislocation. The gold standard treatment according to the literature is surgical treatment fixing the fractures and repairing the injured ligaments. We report a clinical case of radiocarpal dislocation type I in a healthy 19 year-old male after a minor trauma. The dislocation was reduced by traction, and the wrist immobilized in a plaster cast. The functional outcome 12 months after the injury was excellent.

Levomilnacipran (F2695), a norepinephrine-preferring SNRI: profile in vitro and in models of depression and anxiety.

Levomilnacipran (LVM; F2695) is the more active enantiomer of the serotonin/norepinephrine (5-HT/NE) reuptake inhibitor (SNRI) milnacipran and is currently under development for the treatment of major depressive disorder. LVM was benchmarked against two other SNRIs, duloxetine and venlafaxine, in biochemical, neurochemical and pharmacological assays. LVM exhibited high affinity for human NE (Ki = 92.2 nM) and 5-HT (11.2 nM) transporters, and potently inhibited NE (IC50 = 10.5 nM) and 5-HT (19.0 nM) reuptake (human transporter) in vitro. LVM had 2-fold greater potency for norepinephrine relative to serotonin reuptake inhibition (i.e. NE/5-HT potency ratio: 0.6) and 17 and 27 times higher selectivity for NE reuptake inhibition compared with venlafaxine and duloxetine, respectively. LVM did not exhibit affinity for 23 off-target receptors. LVM (i.p.) increased cortical extracellular levels of 5-HT, and NE (minimal effective doses: MEDs = 20 and 10 mg/kg, respectively). In anti-depressive/anti-stress models, i.p. LVM diminished immobility time in the mouse forced swim (MED = 20 mg/kg) and tail suspension (MED = 2.5 mg/kg) tests, and reduced shock-induced ultrasonic vocalizations in rats (MED = 5 mg/kg). Duloxetine and venlafaxine were less potent (MEDs ≥ 10 mg/kg). At doses active in these three therapeutically-relevant models, LVM (i.p.) did not significantly affect spontaneous locomotor activity. In summary, LVM is a potent, selective inhibitor of NE and 5-HT transporters with preferential activity at the former. It is efficacious in models of anti-depressive/anti-stress activity, with minimal potential for locomotor side effects.

Caso de musculoesquelético presentado en la Sesión General de Lectura de Casos del XXX Congreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

No disponible

Caso de neurorradiología presentado en la Sesión General de Lectura de Casos del XXX Congreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

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Caso de tórax presentado en la Sesión General de Lectura de Casos del XXX Uongreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

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Caso de abdomen presentado en la Sesión General de Lectura de Casos del XXX Congreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

No disponible