Low-Income Participants' Preference Between Financial Incentives for Behavioral Goals vs Weight Loss Targets and Associations With Behavioral Goal Adherence.

PURPOSE: Examine associations between whether participants' were matched to their preferred financial incentive design and behavioral goal adherence in a weight management intervention. DESIGN: Secondary quantitative analysis incorporating qualitative survey data. SETTING: Primary care clinics in socioeconomically disadvantaged communities in New York City and Los Angeles. SUBJECTS: 668 participants (mean age 46.9 years, 81.0% female, 97.7% Hispanic) with obesity were enrolled in the Financial Incentives foR Weight Reduction (FIReWoRk) intervention. MEASURES: We explored qualitatively participant's reasons for hypothetically choosing a behavioral goal-directed vs a weight loss outcome-based financial incentive program. Additionally, behavioral adherence to different goals was collected at the 6-month timepoint, categorized by match to preferred financial incentive design. ANALYSIS: Logistic regression was used to examine if participants with certain demographic and higher psychosocial factors were more likely to choose goal-directed over outcome-based incentives. Additionally, logistic regression was used to test for associations between preference and behavioral adherence, using incentive type as an interaction term. RESULTS: 60.1% of participants preferred the goal-directed incentive, with the majority stating that it was more structured. Married participants were more likely to prefer goal-directed incentives (OR = 1.57, CI = 1.06-2.33, P = .025). Moderation analysis revealed that participants who preferred goal-directed and were matched to goal-directed had greater rates of behavioral adherence for program attendance and self-weighing, but not dietary tracking and physical activity tracking, compared to those who preferred outcome-based and were matched to outcome-based. CONCLUSION: Receiving one's preferred incentive design may not play a strong role in behavioral goal adherence during financially incentivized weight loss interventions.

Mechanism of actin capping protein recruitment and turnover during clathrin-mediated endocytosis.

Clathrin-mediated endocytosis depends on polymerization of a branched actin network to provide force for membrane invagination. A key regulator in branched actin network formation is actin capping protein (CP), which binds to the barbed end of actin filaments to prevent the addition or loss of actin subunits. CP was thought to stochastically bind actin filaments, but recent evidence shows CP is regulated by a group of proteins containing CP-interacting (CPI) motifs. Importantly, how CPI motif proteins function together to regulate CP is poorly understood. Here, we show Aim21 and Bsp1 work synergistically to recruit CP to the endocytic actin network in budding yeast through their CPI motifs, which also allosterically modulate capping strength. In contrast, twinfilin works downstream of CP recruitment, regulating the turnover of CP through its CPI motif and a non-allosteric mechanism. Collectively, our findings reveal how three CPI motif proteins work together to regulate CP in a stepwise fashion during endocytosis.

Etomidato en el tratamiento del síndrome de Cushing / Etomidate in the treatment of Cushing syndrome

El síndrome de Cushing es una enfermedad metabólica causada por la exposición crónica a niveles elevados de glucocorticoides. Se puede presentar como una emergencia endocrina por un aumento rápido de los niveles de cortisol en sangre, con aumento de la morbimortalidad por enfermedad cardiovascular e infecciones. El etomidato es un fármaco que permite el control rápido de los niveles de cortisol plasmáticos, por inhibición del enzima 11β-hidroxilasa. Presentamos un caso clínico de hipercortisolemia severa, acompañada de alteraciones metabólicas y neuropsiquiátricas, en el que el control de los niveles de cortisol previamente a la cirugía se consiguió con perfusión de etomidato. (AU)

Cushing syndrome is a metabolic disease caused by chronic exposure to high levels of glucocorticoids. It can present as an endocrine emergency due to a rapid increase in circulating cortisol leading to increased risk of cardiovascular disease and infection. Etomidate rapidly reduces plasma cortisol levels by inhibiting the action of 11β-hidroxilase. We report the case of a patient with severe hypercortisolaemia accompanied by metabolic and psychiatric disorders in whom administration of etomidate reduced preoperative levels of cortisol. (AU)

Etomidate in the treatment of Cushing syndrome.

Cushing syndrome is a metabolic disease caused by chronic exposure to high levels of glucocorticoids. It can present as an endocrine emergency due to a rapid increase in circulating cortisol leading to increased risk of cardiovascular disease and infection. Etomidate rapidly reduces plasma cortisol levels by inhibiting the action of 11ß-hidroxilase. We report the case of a patient with severe hypercortisolaemia accompanied by metabolic and psychiatric disorders in whom administration of etomidate reduced preoperative levels of cortisol.

Frequency-Dependent Squeezed Vacuum Source for the Advanced Virgo Gravitational-Wave Detector.

In this Letter, we present the design and performance of the frequency-dependent squeezed vacuum source that will be used for the broadband quantum noise reduction of the Advanced Virgo Plus gravitational-wave detector in the upcoming observation run. The frequency-dependent squeezed field is generated by a phase rotation of a frequency-independent squeezed state through a 285 m long, high-finesse, near-detuned optical resonator. With about 8.5 dB of generated squeezing, up to 5.6 dB of quantum noise suppression has been measured at high frequency while close to the filter cavity resonance frequency, the intracavity losses limit this value to about 2 dB. Frequency-dependent squeezing is produced with a rotation frequency stability of about 6 Hz rms, which is maintained over the long term. The achieved results fulfill the frequency dependent squeezed vacuum source requirements for Advanced Virgo Plus. With the current squeezing source, considering also the estimated squeezing degradation induced by the interferometer, we expect a reduction of the quantum shot noise and radiation pressure noise of up to 4.5 dB and 2 dB, respectively.

How competition between overlapping generations can influence optimal egg-laying strategies in annual social insects.

Annual social insects are an integral functional group of organisms, particularly in temperate environments. An emblematic part of their annual cycle is the social phase, during which the colony-founding queen rears workers that later assist her in rearing sexual progeny (gynes and drones). In many annual social insects, such as species of bees, wasps, and other groups, developing larvae are provisioned gradually as they develop (progressive provisioning) leading to multiple larval generations being reared simultaneously. We present a model for how the queen in such cases should optimize her egg-laying rate throughout the social phase depending on number-size trade-offs, colony age-structure, and energy balance. Complementing previous theory on optimal allocation between workers vs. sexuals in annual social insects and on temporal egg-laying patterns in solitary insects, we elucidate how resource competition among overlapping larval generations can influence optimal egg-laying strategies. With model parameters informed by knowledge of a common bumblebee species, the optimal egg-laying schedule consists of two temporally separated early broods followed by a more continuous rearing phase, matching empirical observations. However, eggs should initially be laid continuously at a gradually increasing rate when resources are scarce or mortality risks high and in cases where larvae are fully supplied with resources at the egg-laying stage (mass-provisioning). These factors, alongside sexual:worker body size ratios, further determine the overall trend in egg-laying rates over the colony cycle. Our analysis provides an inroad to study and mechanistically understand variation in colony development strategies within and across species of annual social insects.

Modified Mach-Zehnder interferometer for spatial coherence measurement.

Spatial coherence of light sources is usually obtained by using the classical Young's interferometer. Although the original experiment was improved upon in successive works, some drawbacks still remain. For example, several pairs of points must be used to obtain the complex coherence degree (normalized first-order correlation function) of the source. In this work, a modified Mach-Zehnder interferometer which includes a pair of lenses and is able to measure the spatial coherence degree is presented. With this modified Mach-Zehnder interferometer, it is possible to measure the full 4D spatial coherence function by displacing the incoming beam laterally. To test it, we have measured only a 2D projection (zero shear) of the 4D spatial coherence, which is enough to characterize some types of sources. The setup has no movable parts, making it robust and portable. To test it, the two-dimensional spatial coherence of a high-speed laser with two cavities was measured for different pulse energy values. We observe from the experimental measurements that the complex degree of coherence changes with the selected output energy. Both laser cavities seem to have similar complex coherence degrees for the maximum energy, although it is not symmetrical. Thus, this analysis will allow us to determine the best configuration of the double-cavity laser for interferometric applications. Furthermore, the proposed approach can be applied to any other light sources.

La prueba cardiopulmonar de ejercicio contribuye a determinar con precisión el riesgo en pacientes con hipertensión pulmonar de bajo riesgo / Cardiopulmonary Exercise Testing Contributes to Accurate Risk Assessment in Patients with Low-risk Pulmonary Hypertension

RESUMEN Introducción : Las guías europeas de hipertensión arterial pulmonar (HAP) estratifican el riesgo valiéndose de características clínicas y estudios complementarios entre los cuales está la prueba cardiopulmonar de ejercicio (PCPE), de la cual toma en cuenta 3 parámetros: el consumo de O2 (VO2) pico, su porcentaje respecto del predicho y la pendiente ventilación minuto/ producción de dióxido de carbono (VE/VCO2). Sin embargo, ninguno de los modelos que validaron esta forma de estratificar el riesgo incluyeron la PCPE entre sus variables. Objetivos : Determinar qué proporción de pacientes con HAP del grupo I considerados de bajo riesgo y que caminan >440 metros en la prueba de caminata de 6 minutos (PC6M) tienen en la PCPE parámetros considerados de riesgo moderado o alto. Material y métodos : Se incluyeron pacientes >18 años con diagnóstico de HAP del grupo I considerados de bajo riesgo con una PC6M >400 metros a los que se les realizó una PCPE en la que se registró el VO2 pico, su porcentaje respecto del VO2 predicho y la pendiente VE/VCO2. Se determinó qué proporción de pacientes presentaban estos parámetros en un estrato de riesgo mayor a bajo riesgo (VO2 pico <15 ml/kg/min, su porcentaje respecto del predicho <65% y la pendiente VE/VCO2 >36). Resultados : Se incluyeron 18 pacientes. A pesar de ser pacientes de bajo riesgo y con buena clase funcional todos presentaron un VO2 pico menor al 85% del predicho, lo cual determina un deterioro al menos leve de la capacidad funcional. Un único paciente (6%) presentó los tres parámetros evaluados en bajo riesgo, 8 pacientes (44%) tuvieron al menos un parámetro alterado, 7 pacientes (39%) presentaron 2 parámetros alterados y en 2 pacientes (11%) todos los parámetros estuvieron alterados. Los parámetros que más frecuentemente se vieron alterados fueron el porcentaje respecto del VO2 predicho y la pendiente VE/VCO2, en el 67% de los casos. Solo 4 pacientes presentaron un VO2 pico <15 ml/k/m. Ningún paciente presentó valores de VO2 pico o porcentaje respecto del predicho en la categoría de alto riesgo. Sin embargo, 6 pacientes (33%) presentaron una pendiente VE/VCO2 considerada de alto riesgo. Conclusión : El 94% de los pacientes considerados de bajo riesgo presentaron al menos una variable en la PCPE que no corresponde a un perfil de riesgo bajo. La pendiente VE/VCO2 y el porcentaje de VO2 pico respecto del predicho fueron las variables más frecuentemente alteradas. La pendiente VE/VCO2 fue la única que mostró valores considerados de alto riesgo. La PCPE podría tener un lugar en la estratificación de precisión de pacientes de bajo riesgo. El valor de este hallazgo deberá ser evaluado en estudios prospectivos, al tiempo que genera las bases para el planteo de hipótesis respecto de la estratificación de riesgo y la intensidad del tratamiento en pacientes que aparentan estar en bajo riesgo.

ABSTRACT Background : European guidelines for pulmonary arterial hypertension (PAH) stratify the risk using clinical characteristics and complementary studies, including the cardiopulmonary exercise test (CPET). This takes into account 3 parameters: peak O2 consumption (peak VO2), its percentage with respect to the predicted VO2, and the minute ventilation/carbon dioxide production (VE/VCO2) slope. However, none of the models that validated this way of stratifying risk included PCPE among their variables. Objectives : To determine what proportion of patients with group I PAH considered to be at low risk and who walk >440 meters in the 6-minute walk test (6MWT) have parameters considered to be of moderate or high risk in the PCPE. Methods : Patients >18 years of age, diagnosed with group I PAH at low risk of events, who walked >440 meters in the 6MWT and had NT-proBNP value <300 pg/dL were included. A CPET was performed in which the peak VO2, its percentage with respect to the predicted VO2, and the VE/VCO2 slope were recorded. It was determined what proportion of patients presented these parameters in a higher than low risk stratum (peak VO2 consumption ≤15 ml/min/Kg, its percentage with respect to the predicted VO2 ≤65% and the VE/VCO2 slope ≥36). Results : Eighteen patients were included. Despite being low-risk patients with a good functional class, all patients presented a peak VO2 less than 85% of predicted, which determines a deterioration of functional capacity. A single patient (6%) presented the three parameters evaluated at low risk, 8 patients (44%) had at least one altered parameter, 7 patients (39%) presented 2 altered parameters and in 2 patients (11%) all parameters were altered. The parameters that were most frequently altered were the percentage of predicted peak VO2 and the VE/VCO2 slope in 67% of the cases. Only 4 patients presented a peak VO2 <15 ml/kg/m. No patient presented peak VO2 values or percentage of predicted VO2 in the high-risk category. However, 6 patients (33%) presented a high-risk VE/VCO2 slope. Conclusion : Majority (92%) of the patients considered low risk and who walk more than 440 meters in 6 minutes presented at least one altered variable in the CPET. The VE/VCO2 slope and the percentage of predicted peak VO2 consumption were the most frequently altered variables. The VE/VCO2 slope was the only one that showed values considered high risk. CPET could have a place in the precision stratification of low-risk patients. The value of this finding should be evaluated in prospective studies.

Signatures of increasing environmental stress in bumblebee wings over the past century: Insights from museum specimens.

Determining when animal populations have experienced stress in the past is fundamental to understanding how risk factors drive contemporary and future species' responses to environmental change. For insects, quantifying stress and associating it with environmental factors has been challenging due to a paucity of time-series data and because detectable population-level responses can show varying lag effects. One solution is to leverage historic entomological specimens to detect morphological proxies of stress experienced at the time stressors emerged, allowing us to more accurately determine population responses. Here we studied specimens of four bumblebee species, an invaluable group of insect pollinators, from five museums collected across Britain over the 20th century. We calculated the degree of fluctuating asymmetry (FA; random deviations from bilateral symmetry) between the right and left forewings as a potential proxy of developmental stress. We: (a) investigated whether baseline FA levels vary between species, and how this compares between the first and second half of the century; (b) determined the extent of FA change over the century in the four bumblebee species, and whether this followed a linear or nonlinear trend; (c) tested which annual climatic conditions correlated with increased FA in bumblebees. Species differed in their baseline FA, with FA being higher in the two species that have recently expanded their ranges in Britain. Overall, FA significantly increased over the century but followed a nonlinear trend, with the increase starting c. 1925. We found relatively warm and wet years were associated with higher FA. Collectively our findings show that FA in bumblebees increased over the 20th century and under weather conditions that will likely increase in frequency with climate change. By plotting FA trends and quantifying the contribution of annual climate conditions on past populations, we provide an important step towards improving our understanding of how environmental factors could impact future populations of wild beneficial insects.

Heat tolerance of marine ectotherms in a warming Antarctica.

Global warming is affecting the Antarctic continent in complex ways. Because Antarctic organisms are specialized to living in the cold, they are vulnerable to increasing temperatures, although quantitative analyses of this issue are currently lacking. Here we compiled a total of 184 estimates of heat tolerance belonging to 39 marine species and quantified how survival is affected concomitantly by the intensity and duration of thermal stress. Species exhibit thermal limits displaced toward colder temperatures, with contrasting strategies between arthropods and fish that exhibit low tolerance to acute heat challenges, and brachiopods, echinoderms, and molluscs that tend to be more sensitive to chronic exposure. These differences might be associated with mobility. A dynamic mortality model suggests that Antarctic organisms already encounter temperatures that might be physiologically stressful and indicate that these ecological communities are indeed vulnerable to ongoing rising temperatures.

El calentamiento global está afectando al continente antártico de formas complejas. Dado que los organismos antárticos están especializados a vivir en el frío, son vulnerables al aumento de las temperaturas, aunque en la actualidad hay carencia de análisis cuantitativos al respecto. Aquí recopilamos un total de 184 estimaciones de tolerancia al calor pertenecientes a 39 especies marinas, y cuantificamos cómo la supervivencia de estos organismos se ve afectada concomitantemente por la intensidad y la duración de un estrés térmico. Efectivamente las especies antárticas muestran límites térmicos desplazados hacia temperaturas más frías, con estrategias contrastadas entre los artrópodos y los peces que muestran una baja tolerancia a los desafíos térmicos agudos, y los braquiópodos, equinodermos y moluscos que tienden a ser más sensibles a la exposición crónica. Estas diferencias podrían estar asociadas con la movilidad. Un modelo dinámico de mortalidad sugiere que los organismos antárticos ya se enfrentan a temperaturas que podrían ser fisiológicamente estresantes e indican que estas comunidades ecológicas son realmente vulnerables al aumento continuo de las temperaturas.

Rehabilitación cardiorrespiratoria en hipertensión pulmonar: experiencia en un centro de referencia / Cardiorespiratory rehabilitation in pulmonary hypertension: experience in a reference center

RESUMEN Introducción: La hipertensión pulmonar (HP) abarca un grupo heterogéneo de enfermedades que genera discapacidad y aumento de la morbimortalidad. La rehabilitación cardiorrespiratoria (RC) es un recurso terapéutico subutilizado en esta condición. Objetivo: Estimar los efectos de un programa de RC en una prueba de caminata de campo y en la calidad de vida de pacientes con diagnóstico de HP de los grupos I y IV. Materiales y Métodos: Los pacientes fueron evaluados antes y después de la intervención mediante la prueba de caminata de 6 minutos (PC6M) y el Saint George's Respiratory Questionnaire (SGRQ). El programa de RC consistió en 8 semanas de ejercicios supervisados con modalidad institucional. Resultados: Se incluyeron 19 pacientes con diagnóstico de HP precapilar por cateterismo cardíaco derecho, 18 mujeres (94,7%) con una media de edad de 45,5 ± 14,3 años. Trece (68,4%) presentaron HP del grupo I, y 6 (31,6%) HP del grupo IV. Se observaron cambios estadísticamente significativos en la PC6M (diferencia de medias -DM- 31 ± 27,3 metros; p <0,001), y en el SGRQ (DM 8,2 ± 10,2; p<0,01). No se reportaron eventos adversos graves durante el programa. Conclusiones: Nuestro estudio sugiere que un programa de RC supervisado en pacientes con HP podría mejorar la distancia caminada y la calidad de vida.

ABSTRACT Background: Pulmonary hypertension (PH) comprises a heterogeneous group of diseases resulting in disability and increased morbidity and mortality. Cardiopulmonary rehabilitation (CR) is a therapeutic resource not widely used in this condition. Objective: The aim of this study was to evaluate the effects of a CR program on a walking test and on the quality of life in patients with group 1 and group 4 PH Methods: Patients were evaluated before and after the intervention with the six-minute walk test (6MWT) and Saint George's Respiratory Questionnaire (SGRQ). The program consisted of 8 weeks of supervised exercises within the institution. Results: Nineteen patients with precapillary PH diagnosed by right heart catheterization were included; 18 were women (94.7%) with a mean age of 45.5±14.3 years. Thirteen (68.4%) patients had group 1 PH and 6 (31.6%) had group 4 PH. There were statistically significant changes in the 6MWT [mean difference (MD) 31±27.3 m; p<0.001], and in the SGRQ (MD 8.2±10.2; p<0.01). No adverse events were reported during the program. Conclusions: Our study suggests that a supervised CR program in patients with PH could improve the distance walked and the quality of life.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run.

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2 M_{⊙} and 1.0 M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14 yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200] Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2 M_{⊙}

Attention to acute cerebrovascular disease in Guipúzcoa: description of the results of a reference hospital in a centralized care model.

INTRODUCTION: In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS: We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION: We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS: After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.

Farmacéuticos comunitarios. El camino por recorrer / Community pharmacists. The road ahead

INTRODUCCIÓN: la revista Farmacéuticos Comunitarios (RFC) se ha consolidado en los últimos años como soporte adecuado, serio y riguroso, para el traslado a la comunidad científica de los resultados de la investigación en el ámbito de la Farmacia Comunitaria. Por otra parte, muchas instituciones académicas exigen para reconocer el trabajo de sus investigadores que éste sea publicado en revistas científicas revisadas por pares e indexadas en Journal Citation Reports (JCR) Al estar RFC indexada en este índice se convierte en vehículo para la publicación de trabajos académicos. Hasta el momento muchos farmacéuticos comunitarios, ante la escasez de revistas del sector, se veían obligados a publicar sus trabajos en revistas de otras disciplinas, con la dificultad que esto supone. Mejora continua de la calidad: El idioma de la revista es el español, y de países de habla hispana proceden más del 90 % de las visitas. Pero es obvio que la lingua franca de la ciencia es el inglés. Desde hace ya años los artículos más destacados de cada número se publican en edición bilingüe español/inglés. La proporción de artículos bilingües ira aumentando progresivamente. Hasta la fecha los artículos solo están disponibles en el momento de ser publicado el número al que pertenecen. Esto es una reminiscencia de la publicación en formato papel ya que no había otra opción. Internet ha cambiado el paradigma. En la publicación online el concepto “número” tiene cada vez menos sentido y muchas revistas publican sus artículos en lo que llaman “preprint”. Se ponen a disposición de los lectores en el momento en el que su proceso de edición ha terminado, aunque posteriormente se asignan a un número concreto. Esta es la tendencia actual en la publicación científica y a ello tenderemos. Lo más importante de una revista científica son sus lectores seguido de los autores. (AU)

Farmacovigilancia de las vacunas frente a la COVID-19 en farmacias comunitarias I. Protocolo / Pharmacovigilance of COVID-19 vaccines in community pharmacies I. Protocol

INTRODUCCIÓN: la aprobación en tiempo récord de las vacunas frente a la COVID-19 hace necesario implementar acciones de farmacovigilancia, tanto de reacciones infrecuentes, como a medio o largo plazo, con el fin de completar su perfil de seguridad.OBJETIVOS: colaborar en la evaluación de la seguridad de las vacunas, mediante la detección y seguimiento de sospechas de reacciones adversas en los usuarios de las farmacias.MATERIAL Y MÉTODOS. Diseño: estudio observacional prospectivo, en farmacias comunitarias de Ourense y Pontevedra, a partir de la administración de las vacunas frente al SARS-CoV-2 en febrero de 2021.Sujetos: usuarios de la farmacia que hayan recibido la vacuna, mayores de edad, y que firmen el consentimiento informado. Variables principales: número y porcentaje de sujetos que presentan al menos una reacción adversa en relación al número de pacientes incorporados al estudio; su número, tipo y frecuencia. Repercusión en su vida diaria. Procedimiento: oferta de participación en el estudio, entrevista en la zona de atención personalizada. Recogida de datos en un cuaderno de registro cumplimentado por el farmacéutico junto con el paciente. Seguimiento decenal presencial o telefónico después de la primera y segunda dosis de vacuna recibidas y mensual a partir del segundo mes de la segunda dosis. A los pacientes vacunados con una reacción considerada leve tras su evaluación, se recomendarán medidas no farmacológicas convenientes y si es necesario, se les indicará un medicamento sin receta adecuado para la resolución o alivio del problema de salud originado por la reacción. Tamaño muestral: para una precisión del 5,0 % en la estimación de una proporción mediante un intervalo de confianza al 95 % bilateral, asumiendo que el porcentaje de sujetos con al menos una reacción adversa sería del 20,0 %, resultó necesario incluir 246 participantes. (AU)

Farmacovigilancia de las vacunas frente a la COVID-19 en farmacias comunitarias II. Reacciones adversas en farmacéuticos y personal auxiliar / Pharmacovigilance of COVID-19 vaccines in community pharmacies II. Adverse reactions in pharmacists and auxiliary personnel

OBJETIVO: conocer tipo y frecuencia de las sospechas de reacciones adversas (RA) experimentadas entre los farmacéuticos comunitarios (FC) y personal auxiliar de las farmacias de Pontevedra con la primera dosis de la vacuna y su repercusión laboral y personal.MÉTODOS . Diseño: estudio observacional transversal, febrero-abril de 2021.Sujetos: farmacéuticos, técnicos y auxiliares de la provincia de Pontevedra que ejercen en contacto con los pacientes, vacunados con la primera dosis frente al SARS-CoV-2, que dieron su consentimiento explícito. Variables: número, tipo y frecuencia de RA, repercusión. Procedimiento: se habilitó un formulario en la web del Colegio de Farmacéuticos de Pontevedra. Se anunció a los FC colegiados de la provincia su existencia y la conveniencia de cumplimentarlo. Tamaño muestral: teniendo en cuenta la metodología de incorporación al estudio, mediante cumplimentación voluntaria del cuestionario, no se consideró procedente. Análisis de resultados: test de chi- cuadrado para el análisis de variables cualitativas, t de Student y Mann-Whitney para cuantitativas. La normalidad comprobada mediante Kolmogorov-Smirnov con corrección de Lilliefors. Significación estadística p<0,05.Resultados 153 participantes manifestaron síntomas compatibles con reactividad a la vacuna, 122 (93,1 %) mujeres y 31 (86,1 %) hombres. 146 (95,4 %) que recibieron Vaxzevria® (VZ), 116 (79,4 %) mujeres y 30 (20,6 %) hombres, y 7 (4,6 %) Comirnaty® Pfizer-BioNtech (CO), 6 (85,7 %) mujeres y 1 (14,3 %) hombres. Se comunicaron 823 RA, 811 (98,5 %) con VZ y 12 (1,5 %) con CO. Reacciones más frecuentes: dolor en punto de inyección, 128 (87,7 %); escalofríos, 107 (73,3 %); dolor muscular, 106 (72,6 %). El número máximo de RA manifestadas por un participante fue 12. (AU)

Farmacovigilancia de las vacunas frente a la COVID-19 en farmacias comunitarias VI. Elección de la segunda dosis / Pharmacovigilance of COVID-19 vaccines in community pharmacies VI. Choice of second dose

INTRODUCCIÓN: en Galicia se administró Vaxzevria® (VZ) como primera dosis de la vacuna frente a Covid-19 a sanitarios y trabajadores esenciales menores de 60 años. Tras la alarma social por problemas de trombosis con trombopenia detectados, la administración sanitaria gallega permitió elegir la vacuna que recibirían como segunda dosis, repitiendo con Vaxzevria® o cambiar a Comirnaty® (CO).OBJETIVOS: conocer el número de vacunados que eligen una 2ª dosis diferente, las razones por la que eligieron una u otra y las fuentes de información utilizadas para tomar la decisión.MÉTODOS: Diseño: estudio observacional transversal, en una farmacia tras la administración de la 2ª dosis de vacuna Covid-19 en mayo/junio de 2021.Sujetos: trabajadores esenciales, vacunados con Vaxzevria®, mayores de edad, que firmaron consentimiento informado. Variables: demográficas, número de vacunados que eligen una vacuna diferente como 2ª dosis, razones para ello, fuentes de información. Procedimiento: las preguntas correspondientes a este estudio estaban incluidas en el cuaderno de recogida de datos utilizado en el proyecto FARMACOVIGILANCIA DE LAS VACUNAS COVID-19. Consideraciones éticas: el estudio del que forma parte recibió informe favorable del Comité Ético de Investigación con Medicamentos de Galicia. Resultados Se entrevistó a 28 personas, 17 (60,7 %) mujeres, 11 (39,3 %) hombres; 19 (67,9 %) sanitarios. 3 (10,7 %) eligieron como 2ª dosis Comirnaty®, 2 mujeres y 1 hombre y 1 hombre no recibió la 2ª dosis por contagio tras la 1ª.Razones para repetir vacuna: recomendación de autoridades sanitarias/instituciones científicas, 13 (54,2 %); “por no cambiar”, 14 (58,3 %); evidencia científica, 8 (33,3 %). 10 (41,7 %) manifestaron más de un motivo. (AU)

Atención a la enfermedad cerebrovascular aguda en Guipúzcoa: descripción de los resultados de un hospital de referencia en un modelo de atención centralizado / Attention to acute cerebrovascular disease in Guipúzcoa: Description of the results of a reference hospital in a centralized care model

Introducción: En los últimos 15 años se han introducido importantes mejoras en la atención de la enfermedad cerebrovascular aguda (ECVA) en Guipúzcoa, que incluyen la implementación de un modelo centralizado en el Hospital Universitario Donostia (HUD), una mejor coordinación entre profesionales, campañas para su detección precoz, nuevos tratamientos, Unidad de Ictus y una rehabilitación específica. El objetivo de este trabajo es describir los resultados de un hospital de referencia (HUD) en un modelo de atención centralizado. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes dados de alta en el periodo de agosto-diciembre del año 2015 del HUD con diagnóstico de ECVA (CIE-9-MC-430-436 excepto 43310). Revisión de las características basales, atención en fase aguda y resultados funcionales y de mortalidad al alta y al año. Resultados y discusión: Se incluyó a 536 pacientes cuya media de edad fue de 73,6 años y cuya comorbilidad era elevada. El ictus isquémico supuso el 64,8% de las altas, seguido de la ECVA hemorrágica (20%) y del accidente isquémico transitorio (14,8%). Se atendió en < 6 h a un 53% de pacientes, activándose el «código ictus» en un 37,1%. Un 52,2% ingresó en la Unidad de Ictus. Un 11,34% de los pacientes con ictus isquémico recibió terapia por vía intravenosa y un 9,5% trombectomía mecánica. Un 12,1% de los pacientes con ECVA hemorrágica fue intervenido quirúrgicamente. El 56% inició rehabilitación en el hospital y un 39,6% la mantuvo al alta. La mortalidad al alta fue de un 13,8% y al año de un 25,9% (ictus isquémico: 25,3% y ECVA hemorrágica: 47,5%), menor a la descrita previamente en Guipúzcoa. Al año, un 62,5% de los pacientes tenían un ÿndice de Barthel 95-100 y un 50% una puntuación en escala de Rankin modificada 0-2. [...] (AU)

Introduction: In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. Material and methods: We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients’ baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. Results and discussion: We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. [...] (AU)

Genomic Signatures of Recent Adaptation in a Wild Bumblebee.

Environmental changes threaten insect pollinators, creating risks for agriculture and ecosystem stability. Despite their importance, we know little about how wild insects respond to environmental pressures. To understand the genomic bases of adaptation in an ecologically important pollinator, we analyzed genomes of Bombus terrestris bumblebees collected across Great Britain. We reveal extensive genetic diversity within this population, and strong signatures of recent adaptation throughout the genome affecting key processes including neurobiology and wing development. We also discover unusual features of the genome, including a region containing 53 genes that lacks genetic diversity in many bee species, and a horizontal gene transfer from a Wolbachia bacteria. Overall, the genetic diversity we observe and how it is distributed throughout the genome and the population should support the resilience of this important pollinator species to ongoing and future selective pressures. Applying our approach to more species should help understand how they can differ in their adaptive potential, and to develop conservation strategies for those most at risk.