The Association of Desert Dust with the Risk of Acute Coronary Syndrome in Subjects of a Younger Age.

Objectives: Recently, desert dust in Europe has been recognized as a cardiovascular health problem. In Spain, desert dust inflows in recent years have been associated with worsening air quality. The present study examines whether desert dust events are related to the incidence of acute coronary syndrome (ACS) in patients under 55 years of age. Methods: Data from 2416 consecutive patients admitted to a tertiary hospital due to ACS were prospectively analyzed. A case-crossover time-stratified design using Poisson conditional regression models was applied to estimate the impact of desert dust events involving particulate matter concentrations of an aerodynamic diameter <10 µm (PM10) on the incidence of ACS in patients under 55 years of age. Results: Desert dust intrusion on days 0 to 5 before ACS onset showed no significant association with the incidence of ACS in patients under 55 years of age. The incidence rate ratios of PM10 concentrations 1, 2, 3, 3, 4, and 5 days before ACS onset (for changes of 10 µg/m3) were 1.02 (95% CI 0.97-1.1; p = 0.41), 1.01 (95% CI 0.96-1.07; p = 0.66), 0.99 (95% CI 0.94-1.05; p = 0.78), 0.96 (95% CI 0.9-1.02; p = 0.18), and 0.97 (95% CI 0.91-1.04; p = 0.41). Conclusions: Our findings suggest that desert dust is unlikely to be related to the incidence of ACS in patients under 55 years of age.

ZnO-Loaded Graphene for NO2 Gas Sensing.

This paper investigates the effect of decorating graphene with zinc oxide (ZnO) nanoparticles (NPs) for the detection of NO2. In this regard, two graphene sensors with different ZnO loadings of 5 wt.% and 20 wt.% were prepared, and their responses towards NO2 at room temperature and different conditions were compared. The experimental results demonstrate that the graphene loaded with 5 wt.% ZnO NPs (G95/5) shows better performance at detecting low concentrations of the target gas than the one loaded with 20 wt.% ZnO NPs (G80/20). Moreover, measurements under dry and humid conditions of the G95/5 sensor revealed that the material is very sensitive to ambient moisture, showing an almost eight-fold increase in NO2 sensitivity when the background changes from dry to 70% relative humidity. Regarding sensor selectivity, it presents a significant selectivity towards NO2 compared to other gas compounds.

Nursing Recommendations in the Management of Systemic Lupus Erythematosus: A Delphi Consensus.

Introduction: Nurses' role in the management of people with systemic lupus erythematosus (SLE) is essential. Specific guidelines for nurses have not been previously developed in Spain. This project aimed to try to develop comprehensive and validated recommendations for nurses regarding the management of people with SLE. Method: A Delphi questionnaire with 90 general and specific recommendations was designed by the scientific committee and underwent two rounds of participation. Results: Panellists reached a consensus on "agreement" for 85 recommendations during the first round and for 87 recommendations after the second and final rounds. Panellists agreed that people with SLE should be managed within a multidisciplinary team, and that this team should include specialized nurses. Panellists stated that most of the services lack specialized nurses. Experts identified lack of specific training programs targeted to nurses as the main barrier for application of recommendations. Panellists recommended an extended role for nurses in the management of people with SLE, including diagnosis, patient education, treatment monitoring and administration, and follow-up. Conclusions: This study is the first consensus that provides nursing recommendations from experts on the management of people with SLE in Europe. Design of standardized training programs targeted to nurses would facilitate the application of the recommendations.

SPSB1-mediated inhibition of TGF-ß receptor-II impairs myogenesis in inflammation.

BACKGROUND: Sepsis-induced intensive care unit-acquired weakness (ICUAW) features profound muscle atrophy and attenuated muscle regeneration related to malfunctioning satellite cells. Transforming growth factor beta (TGF-ß) is involved in both processes. We uncovered an increased expression of the TGF-ß receptor II (TßRII)-inhibitor SPRY domain-containing and SOCS-box protein 1 (SPSB1) in skeletal muscle of septic mice. We hypothesized that SPSB1-mediated inhibition of TßRII signalling impairs myogenic differentiation in response to inflammation. METHODS: We performed gene expression analyses in skeletal muscle of cecal ligation and puncture- (CLP) and sham-operated mice, as well as vastus lateralis of critically ill and control patients. Pro-inflammatory cytokines and specific pathway inhibitors were used to quantitate Spsb1 expression in myocytes. Retroviral expression plasmids were used to investigate the effects of SPSB1 on TGF-ß/TßRII signalling and myogenesis in primary and immortalized myoblasts and differentiated myotubes. For mechanistical analyses we used coimmunoprecipitation, ubiquitination, protein half-life, and protein synthesis assays. Differentiation and fusion indices were determined by immunocytochemistry, and differentiation factors were quantified by qRT-PCR and Western blot analyses. RESULTS: SPSB1 expression was increased in skeletal muscle of ICUAW patients and septic mice. Tumour necrosis factor (TNF), interleukin-1ß (IL-1ß), and IL-6 increased the Spsb1 expression in C2C12 myotubes. TNF- and IL-1ß-induced Spsb1 expression was mediated by NF-κB, whereas IL-6 increased the Spsb1 expression via the glycoprotein 130/JAK2/STAT3 pathway. All cytokines reduced myogenic differentiation. SPSB1 avidly interacted with TßRII, resulting in TßRII ubiquitination and destabilization. SPSB1 impaired TßRII-Akt-Myogenin signalling and diminished protein synthesis in myocytes. Overexpression of SPSB1 decreased the expression of early (Myog, Mymk, Mymx) and late (Myh1, 3, 7) differentiation-markers. As a result, myoblast fusion and myogenic differentiation were impaired. These effects were mediated by the SPRY- and SOCS-box domains of SPSB1. Co-expression of SPSB1 with Akt or Myogenin reversed the inhibitory effects of SPSB1 on protein synthesis and myogenic differentiation. Downregulation of Spsb1 by AAV9-mediated shRNA attenuated muscle weight loss and atrophy gene expression in skeletal muscle of septic mice. CONCLUSIONS: Inflammatory cytokines via their respective signalling pathways cause an increase in SPSB1 expression in myocytes and attenuate myogenic differentiation. SPSB1-mediated inhibition of TßRII-Akt-Myogenin signalling and protein synthesis contributes to a disturbed myocyte homeostasis and myogenic differentiation that occurs during inflammation.

DFT Study on the Enhancement of Isobaric Specific Heat of GaN and InN Nanosheets for Use as Nanofluids in Solar Energy Plants.

In this work, GaN and InN nanosheets with dodecylamine (DDA) as surfactant have been studied as nanofluids to be used in solar plants. The interactions between the sheets and the surfactants have been performed using density functional theory. The most favorable interaction site on the surface corresponds to the metallic atom of the sheet with the N atom of the surfactant. In this interaction, the pair of electrons of N from the surfactant with the metal atom of the sheet play a stabilizing role, which is corroborated by electron localization function (ELF), quantum theory of atoms in molecules (QTAIM), and density of states (DOS) analysis. The isobaric specific heat values for the most favorable interaction were obtained in the presence of water, ethylene glycol, and diphenyl oxide as solvents for the first time. The highest value corresponds to systems with diphenyl oxide, being the values obtained of 0.644 J/gK and 0.363 J/gK for GaN-DDA and InN-DDA systems, respectively. These results open the possibilities of using GaN-DDA and InN-DDA systems in solar energy applications.

Metabolic remodeling in cardiac hypertrophy and heart failure with reduced ejection fraction occurs independent of transcription factor EB in mice.

Background: A metabolic shift from fatty acid (FAO) to glucose oxidation (GO) occurs during cardiac hypertrophy (LVH) and heart failure with reduced ejection fraction (HFrEF), which is mediated by PGC-1α and PPARα. While the transcription factor EB (TFEB) regulates the expression of both PPARGC1A/PGC-1α and PPARA/PPARα, its contribution to metabolic remodeling is uncertain. Methods: Luciferase assays were performed to verify that TFEB regulates PPARGC1A expression. Cardiomyocyte-specific Tfeb knockout (cKO) and wildtype (WT) male mice were subjected to 27G transverse aortic constriction or sham surgery for 21 and 56 days, respectively, to induce LVH and HFrEF. Echocardiographic, morphological, and histological analyses were performed. Changes in markers of cardiac stress and remodeling, metabolic shift and oxidative phosphorylation were investigated by Western blot analyses, mass spectrometry, qRT-PCR, and citrate synthase and complex II activity measurements. Results: Luciferase assays revealed that TFEB increases PPARGC1A/PGC-1α expression, which was inhibited by class IIa histone deacetylases and derepressed by protein kinase D. At baseline, cKO mice exhibited a reduced cardiac function, elevated stress markers and a decrease in FAO and GO gene expression compared to WT mice. LVH resulted in increased cardiac remodeling and a decreased expression of FAO and GO genes, but a comparable decline in cardiac function in cKO compared to WT mice. In HFrEF, cKO mice showed an improved cardiac function, lower heart weights, smaller myocytes and a reduction in cardiac remodeling compared to WT mice. Proteomic analysis revealed a comparable decrease in FAO- and increase in GO-related proteins in both genotypes. A significant reduction in mitochondrial quality control genes and a decreased citrate synthase and complex II activities was observed in hearts of WT but not cKO HFrEF mice. Conclusions: TFEB affects the baseline expression of metabolic and mitochondrial quality control genes in the heart, but has only minor effects on the metabolic shift in LVH and HFrEF in mice. Deletion of TFEB plays a protective role in HFrEF but does not affect the course of LVH. Further studies are needed to elucidate if TFEB affects the metabolic flux in stressed cardiomyocytes.

On the hidden diversity and niche specialization of the microbial realm of subterranean estuaries.

Subterranean estuaries (STEs) modulate the chemical composition of continental groundwater before it reaches the coast, but their microbial community is poorly known. Here, we explored the microbial ecology of two neighbouring, yet contrasting STEs (Panxón and Ladeira STEs; Ría de Vigo, NW Iberian Peninsula). We investigated microbial composition (16S rRNA gene sequencing), abundance, heterotrophic production and their geochemical drivers. A total of 10,150 OTUs and 59 phyla were retrieved from porewater sampled during four surveys covering each STE seepage face. In both STEs, we find a very diverse microbial community composed by abundant cosmopolitans and locally restricted rare taxa. Porewater oxygen and dissolved organic matter are the main environmental predictors of microbial community composition. More importantly, the high variety of benthic microbiota links to biogeochemical processes of different elements in STEs. The oxygen-rich Panxón beach showed strong associations of the ammonium oxidizing archaea Nitrosopumilales with the heterotrophic community, thus acting as a net source of nitrogen to the coast. On the other hand, the prevailing anoxic conditions of Ladeira beach promoted the dominance of anaerobic heterotrophs related to the degradation of complex and aromatic compounds, such as Dehalococcoidia and Desulfatiglans, and the co-occurrence of methane oxidizers and methanogens.

Factors Influencing Quality of Life in Survivors of Head and Neck Cancer: A Preliminary Study.

OBJECTIVES: Time after diagnosis, survivors of head and neck cancer may perceive a decrease in their quality of life due to suffering from different sequelae. This preliminary study aims to describe which factors influence survivors of head and neck cancer quality of life. DATA SOURCES: A cross-sectional study was performed. Demographic and clinical factors, quality of life (global health status), pain (pressure pain thresholds), physical fitness (overall fitness), functional capacity, and fatigue were evaluated. A multiple regression model was undertaken to check which outcomes could impact quality of life. A total of 53 survivors of head and neck cancer participated in this study. Upper trapezius pressure pain threshold, overall fitness, and global fatigue were significant predictors of global health status, and when combined, they explained 42.10% of the variance in the global health status score. CONCLUSION: Quality of life perceived by survivors of head and neck cancer is influenced by pain, physical fitness, and fatigue reported. This association of outcomes may act as a symptom cluster for survivors of head and neck cancer. IMPLICATIONS FOR NURSING PRACTICE: The knowledge of this symptom cluster may help developing symptom assessment and management strategies and improving quality of life for survivors of head and neck cancer.

Validation of screening criteria for spondyloarthritis in patients with inflammatory bowel disease in routine clinical practice.

BACKGROUND: Spondyloarthritis (SpA) is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). Diagnostic delay must be avoided. AIMS: We assessed the validity of SpA screening criteria (any of the following characteristics: chronic low back pain with onset before 45 years of age; inflammatory lower back pain or alternating buttock pain; arthritis; heel enthesitis; dacylitis; HLA-B27 positivity; sacroiliitis on imaging). METHODS: This was a multicenter cross-sectional observational study in IBD patients aged ≥18 years. After evaluating the SpA screening criteria, the gastroenterologists referred the participants to the rheumatologists, who determined whether the patient fulfilled the screening criteria and carried out the necessary tests for SpA diagnosis. RESULTS: 35 (11.7%) out of 300 patients were diagnosed with SpA. The combination with the best balance between sensitivity and specificity (91.4% and 72.1%, respectively, when applied by the rheumatologists; 80% and 78.9%, when applied by the gastroenterologists) for SpA screening, was fulfillment of any of the following: chronic low back pain with onset before age 45 years, inflammatory low back pain or alternating buttock pain, arthritis, or dactylitis. CONCLUSION: This is one of the first studies to validate SpA screening criteria in IBD patients in routine clinical practice.

The Role of the Interactions at the Tungsten Disulphide Surface in the Stability and Enhanced Thermal Properties of Nanofluids with Application in Solar Thermal Energy.

Transition metal dichalcogenides (TMCs) exhibit unique properties that make them of interest for catalysis, sensing or energy storage applications. However, few studies have been performed into nanofluids based on TMCs for heat transfer applications. In this study, nanofluids based on 2D-WS2 are prepared by liquid phase exfoliation to analyze their potential usage in concentrating solar power plants. Periodic-Density Functional Theory (DFT) calculations were performed to rationalize the success of the exfoliation process. The hydrogen bond interaction between the hydroxyl group from PEG, which acts as a surfactant, and the S atoms of the WS2 surface stabilizes the nanosheets in the fluid. Electron localization function (ELF) analysis is indicative of the stability of the S-H interaction from WS2 with the molecules of surfactant due to the tendency to interact through weak intermolecular forces of van der Waals solids. Moreover, improvements in thermal properties were also found. Isobaric specific heat increased by up to 10% and thermal conductivity improved by up to 37.3%. The high stability of the nanofluids and the thermal improvements were associated with the high surface area of WS2 nanosheets. These results suggest that these nanofluids could be a promising heat transfer fluid in concentrating solar power plants.

Novel WS2-Based Nanofluids for Concentrating Solar Power: Performance Characterization and Molecular-Level Insights.

Nano-colloidal suspensions of nanomaterials in a fluid, nanofluids, are appealing because of their interesting properties related to heat transfer processes. While nanomaterials based on transition metal chalcogenides (TMCs) have been widely studied in catalysis, sensing, and energy storage applications, there are few studies of nanofluids based on TMCs for heat transfer applications. In this study, the preparation and analysis of nanofluids based on 2D-WS2 in a typical heat transfer fluid (HTF) used in concentrating solar power (CSP) plants are reported. Nanofluids prepared using an exfoliation process exhibited well-defined nanosheets and were highly stable. The nanofluids were characterized in terms of properties related to their application in CSP. The presence of WS2 nanosheets did not modify significantly the surface tension, the viscosity, or the isobaric specific heat, but the thermal conductivity was improved by up to 30%. The Ur factor, which characterizes the thermal efficiency of the fluid in the solar collector, shows an enhancement of up to 22% in the nanofluid, demonstrating great promise for CSP applications. The Reynolds number and friction factor of the fluid were not significantly modified by the addition of the nanomaterial to the HTF, which is also positive for practical applications in CSP plants. Ab initio molecular dynamics simulations of the nanoparticle/fluid interface showed an irreversible dissociative adsorption of diphenyl oxide molecules on the WS2 edge, with very low kinetic barrier. The resulting "decoration" of the WS2 edge dramatically affects the nature of the interface interactions and is therefore expected to affect significantly the rheological and transport properties of the nanofluids.

Self-Preservation in the Workplace: The Importance of Well-Being for Social Work Practitioners and Field Supervisors.

The risks in the human services workplace to social workers' emotional, psychological, and physical well-being is well known. Self-care is seen as a way to minimize workplace risks, including burnout, compassion fatigue, secondary traumatic stress, and vicarious traumatization. This article examines the reported self-care practices of social work practitioners and their agencies, and the barriers that get in the way. Forty-two participants worked in agency settings and supervised students. All reported engaging in some type of self-care practice, and almost all reported some type of support from their workplace; however, 38 reported barriers to self-care. Even with self-care practices in place personally and in the workplace, obstacles remain. Social work educators need to be cognizant of these factors to ensure that field supervisors are well supported in their own self-care practices and are equipped to assist students in developing these positive practices early in their careers to help sustain workers in the social work profession.

Effectiveness and cost-effectiveness of a multicomponent intervention to implement a clinical practice guideline for systemic lupus erythematosus: protocol for a cluster-randomized controlled trial.

BACKGROUND: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with significant potential morbidity and mortality. Substantial gaps have been documented between the development and dissemination of clinical practice guidelines (CPG) and their implementation in practice. The aim of this study is to assess the effectiveness and cost-effectiveness of a multi-component knowledge transfer intervention to implement a CPG for the management of SLE (CPG-SLE). METHODS: The study is an open, multicentre, controlled trial with random allocation by clusters to intervention or control. Clusters are four public university hospitals of the Canary Islands Health Service where rheumatologists are invited to participate. Patients diagnosed with SLE at least one year prior to recruitment are selected. Rheumatologists in intervention group receive a short educational group programme to both update their knowledge about SLE management according to CPG-SLE recommendations and to acquire knowledge and training on use of the patient-centred approach, a decision support tool embedded in the electronic clinical record and a quarterly feedback report containing information on management of SLE patients. Primary endpoint is change in self-perceived disease activity. Secondary endpoints are adherence of professionals to CPG-SLE recommendations, health-related quality of life, patient perception of their participation in decision making, attitudes of professionals towards shared decision making, knowledge of professionals about SLE and use of healthcare resources. Calculated sample size is 412 patients. Data will be collected from questionnaires and clinical records. Length of follow-up will be 18 months. Multilevel mixed models with repeated time measurements will be used to analyze changes in outcomes over time. Cost-effectiveness, from both social and healthcare services perspectives, will be analyzed by measuring effectiveness in terms of quality-adjusted life years gained. Deterministic and probabilistic sensitivity analyses are planned. DISCUSSION: Impact of CPGs in clinical practice could be improved by applying proven value interventions to implement them. The results of this ongoing trial are expected to generate important scientifically valid and reproducible information not only on clinical effectiveness but also on cost-effectiveness of a multi-component intervention for implementation of a CPG based on communication technologies for chronic patients in the hospital setting. TRIAL REGISTRATION: ClinicalTrial.gov NCT03537638 . Registered on 25 May 2018.

Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness.

PURPOSE: To study the psychometric properties, including reliability, validity and responsiveness, of the Spanish EQ-5D-5L questionnaire for patients with hip or knee osteoarthritis (OA). METHODS: We included 758 patients with hip or knee OA who completed the EQ-5D-5L and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, of whom 644 also did 6 months later. The EQ-5D-5L contains five questions from which a utility index is derived. The WOMAC covers three dimensions: pain, stiffness and physical function. Floor and ceiling effects were calculated. Reliability was assessed using Cronbach's alpha. Convergent validity was tested using the Spearman correlation coefficient between EQ-5D-5L and WOMAC. We examined known-groups validity by comparing the EQ-5D-5L between subgroups defined by WOMAC scores using ANOVA or the Kruskal-Wallis test. Effect sizes were calculated to assess responsiveness, and minimal clinically important difference (MCID) was estimated. RESULTS: The EQ-5D-5L showed minimal floor and ceiling effects (< 3%). Cronbach's alpha was 0.86. The EQ-5D-5L index was strongly correlated with WOMAC pain and function scores (- 0.688 and - 0.782). Patients with higher WOMAC scores had significantly (p < 0.0001) lower EQ-5D-5L index. The 20.19% had hip or knee replacement during the follow-up. Effect sizes were small among non-surgical patients, but > 0.80 among "improved" surgical patients, being the MCID for improvement 0.32 points. CONCLUSIONS: The results support the reliability, validity and responsiveness of the EQ-5D-5L, overcoming the limitations of the EQ-5D-3L in these patients. Therefore, the EQ-5D-5L could be very useful as an outcome measure, at least in patients with hip or knee OA.

Self-assembly of chiral (1R,2S)-ephedrine and (1S,2S)-pseudoephedrine into low-dimensional aluminophosphate materials driven by their amphiphilic nature.

In an attempt to promote the crystallization of chiral inorganic frameworks, we explore the ability of chiral (1R,2S)-ephedrine and its diastereoisomer (1S,2S)-pseudoephedrine to act as organic building blocks for the crystallization of hybrid organo-inorganic aluminophosphate frameworks in the presence of fluoride. These molecules were selected because of their particular molecular asymmetric structure, which enables a rich supramolecular chemistry and a potential chiral recognition phenomenon during crystallization. Up to four new low-dimensional materials have been produced, wherein the organic molecules form an organic bilayer in-between the inorganic networks. We analyze by molecular simulations the trend of these chiral molecules to form these types of framework, which is directly related to their amphiphilic nature that triggers a strong self-assembly through hydrophobic interactions between aromatic rings and hydrophilic interactions with the fluoro-aluminophosphate inorganic units. Such a self-assembly process is strongly dependent on the concentration of the organic molecules.

Revealing at the molecular level the role of the surfactant in the enhancement of the thermal properties of the gold nanofluid system used for concentrating solar power.

A molecular dynamics study based on gold nanofluids performed with and without the presence of tetraoctylammonium halide as a surfactant in a base fluid is presented. The base fluid consisting of a mixture of biphenyl and diphenyl oxide is used in concentrating solar power (CSP) plants. The radial distribution functions (RDFs) and spatial distribution functions (SDFs) were analysed with the temperature. Theoretical results indicate that the surfactant acts as a kind of net around the nanoparticle that plays an active role in enhancing the thermal properties of the gold nanofluid system. A greater lability of the base fluid-surfactant interactions than the base fluid-gold nanoparticle interactions is observed. At lower temperatures, there is an inner layer around the gold nanoparticle with two surfactant molecules close to the metal. At a higher temperature a ratio of gold nanoparticles : diphenyl oxide molecules of 1 : 4 is maintained in the inner layer for the systems with and without the presence of a surfactant. At the highest temperatures, the presence of the surfactant in a second shell impedes the approximation of the fifth diphenyl oxide molecule. Thus, the surfactant affects the macroscopic properties of the gold nanofluid system at the molecular level.

The Role of Surfactants in the Stability of NiO Nanofluids: An Experimental and DFT Study.

This study shows an analysis of the stability of nanofluids based on a eutectic mixture of diphenyl oxide and biphenyl, which is used as a heat transfer fluid (HTF) in concentrating solar energy, and NiO nanoparticles. Two surfactants are used to analyse the stability of the nanofluids: benzalkonium chloride (BAC) and 1-octadecanethiol (ODT). From an experimental perspective, the stability is analysed by means of UV/Vis spectroscopy, particle size measurements through the dynamic light-scattering technique, and ζ-potential measurements. The results show that the stability of the nanofluids improves with the use of BAC. DFT calculations are performed to understand the role played by the surfactants. The interaction of the surfactants with both the fluid and the NiO (100) surface is studied. Quantum theory of atoms in molecules (QTAIM) analysis shows that hydrogen bridge interactions favour the stability of the fluid-surfactant mixture. The more stabilising NiO-surfactant interaction involves the Ni-H interaction of the -SH and -CH3 groups of ODT and BAC. Also, nanofluids with BAC are favoured over those with ODT, which is in agreement with experimental results. The structural and electronic effects of incorporating the surfactant onto the NiO (100) surface are shown by using electron localisation function analysis, the non-covalent interaction index and projected density of states.