Understanding the petal effect: Wetting properties and surface structure of natural rose petals and rose petal-derived surfaces.

The petal effect is identified as a non-wetting state with high drop adhesion. The wetting behavior of petal surfaces is attributed to the papillose structure of their epidermis, which leads to a Cassie-Baxter regime combined with strong pinning sites. Under this scenario, sessile drops are pearl shaped and, unlike lotus-like surfaces, firmly attached to the surface. Petal surfaces are used as inspiration for the fabrication of functional parahydrophobic surfaces such as antibacterial or water-harvesting surfaces. In this work, two types of rose petals were replicated by using a templating technique based in Polydimethylsiloxane (PDMS) nanocasting. The topographic structure, the condensation mechanism under saturated environments and the wetting properties of the natural rose petal and their negative and positive replicas were analyzed. Finally, we performed prospective ice adhesion studies to elucidate whether petal-like surfaces may be used as deicing solutions.

Porting and Optimizing BWA-MEM2 Using the Fujitsu A64FX Processor.

Sequence alignment pipelines for human genomes are an emerging workload that will dominate in the precision medicine field. BWA-MEM2 is a tool widely used in the scientific community to perform read mapping studies. In this paper, we port BWA-MEM2 to the AArch64 architecture using the ARMv8-A specification, and we compare the resulting version against an Intel Skylake system both in performance and in energy-to-solution. The porting effort entails numerous code modifications, since BWA-MEM2 implements certain kernels using x86_64 specific intrinsics, e.g., AVX-512. To adapt this code we use the recently introduced Arm's Scalable Vector Extensions (SVE). More specifically, we use Fujitsu's A64FX processor, the first to implement SVE. The A64FX powers the Fugaku Supercomputer that led the Top500 ranking from June 2020 to November 2021. After porting BWA-MEM2 we define and implement a number of optimizations to improve performance in the A64FX target architecture. We show that while the A64FX performance is lower than that of the Skylake system, A64FX delivers 11.6% better energy-to-solution on average. All the code used for this article is available at https://gitlab.bsc.es/rlangari/bwa-a64fx.

Water-Repellent Galvanized Steel Surfaces Obtained by Sintering of Zinc Nanopowder.

Galvanized steel surfaces are widely used in industry as a solution to prevent corrosion of steel tools that operate in outdoor or corrosive and oxidative environments. These objects are coated with a zinc protective layer deposited by hot dip galvanization. Turning the surface of galvanized steel tools into superhydrophobic may lead to very useful functionalities, although it may be a difficult task, because the preservation of the thin zinc layer is a claim. We propose herein the use of a bottom-up approach based on sandblasting, followed by sintering of zinc nanoparticles on the galvanized steel substrate, which allowed us to produce a zinc-made hierarchical structure required for superhydrophobicity. These samples acquired a double-scale structure that led to superhydrophobicity when they were later hydrophobized with a thin fluoropolymer layer. We found that sandblasting might be useful but not mandatory, unlike the sintering process, which was essential to reach superhydrophobicity. We found that, under certain experimental conditions, the surfaces showed outstanding water-repellent properties. We observed that the sandblasting on galvanized steel caused more damage than the sintering process. Sintering of low-melting-point metal nanoparticles was revealed as a promising strategy to fabricate functional metallic surfaces.

High-throughput droplet-based analysis of influenza A virus genetic reassortment by single-virus RNA sequencing.

The segmented RNA genome of influenza A viruses (IAVs) enables viral evolution through genetic reassortment after multiple IAVs coinfect the same cell, leading to viruses harboring combinations of eight genomic segments from distinct parental viruses. Existing data indicate that reassortant genotypes are not equiprobable; however, the low throughput of available virology techniques does not allow quantitative analysis. Here, we have developed a high-throughput single-cell droplet microfluidic system allowing encapsulation of IAV-infected cells, each cell being infected by a single progeny virion resulting from a coinfection process. Customized barcoded primers for targeted viral RNA sequencing enabled the analysis of 18,422 viral genotypes resulting from coinfection with two circulating human H1N1pdm09 and H3N2 IAVs. Results were highly reproducible, confirmed that genetic reassortment is far from random, and allowed accurate quantification of reassortants including rare events. In total, 159 out of the 254 possible reassortant genotypes were observed but with widely varied prevalence (from 0.038 to 8.45%). In cells where eight segments were detected, all 112 possible pairwise combinations of segments were observed. The inclusion of data from single cells where less than eight segments were detected allowed analysis of pairwise cosegregation between segments with very high confidence. Direct coupling analysis accurately predicted the fraction of pairwise segments and full genotypes. Overall, our results indicate that a large proportion of reassortant genotypes can emerge upon coinfection and be detected over a wide range of frequencies, highlighting the power of our tool for systematic and exhaustive monitoring of the reassortment potential of IAVs.

L2C2: Last-level compressed-contents non-volatile cache and a procedure to forecast performance and lifetime.

Several emerging non-volatile (NV) memory technologies are rising as interesting alternatives to build the Last-Level Cache (LLC). Their advantages, compared to SRAM memory, are higher density and lower static power, but write operations wear out the bitcells to the point of eventually losing their storage capacity. In this context, this paper presents a novel LLC organization designed to extend the lifetime of the NV data array and a procedure to forecast in detail the capacity and performance of such an NV-LLC over its lifetime. From a methodological point of view, although different approaches are used in the literature to analyze the degradation of an NV-LLC, none of them allows to study in detail its temporal evolution. In this sense, this work proposes a forecasting procedure that combines detailed simulation and prediction, allowing an accurate analysis of the impact of different cache control policies and mechanisms (replacement, wear-leveling, compression, etc.) on the temporal evolution of the indices of interest, such as the effective capacity of the NV-LLC or the system IPC. We also introduce L2C2, a LLC design intended for implementation in NV memory technology that combines fault tolerance, compression, and internal write wear leveling for the first time. Compression is not used to store more blocks and increase the hit rate, but to reduce the write rate and increase the lifetime during which the cache supports near-peak performance. In addition, to support byte loss without performance drop, L2C2 inherently allows N redundant bytes to be added to each cache entry. Thus, L2C2+N, the endurance-scaled version of L2C2, allows balancing the cost of redundant capacity with the benefit of longer lifetime. For instance, as a use case, we have implemented the L2C2 cache with STT-RAM technology. It has affordable hardware overheads compared to that of a baseline NV-LLC without compression in terms of area, latency and energy consumption, and increases up to 6-37 times the time in which 50% of the effective capacity is degraded, depending on the variability in the manufacturing process. Compared to L2C2, L2C2+6 which adds 6 bytes of redundant capacity per entry, that means 9.1% of storage overhead, can increase up to 1.4-4.3 times the time in which the system gets its initial peak performance degraded.

Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

Mechanical Durability of Low Ice Adhesion Polydimethylsiloxane Surfaces.

Elastomeric surfaces and oil-infused elastic surfaces reveal low ice adhesion, in part because of their deformability. However, these soft surfaces might jeopardize their mechanical durability. In this work, we analyzed the mechanical durability of elastic polydimethylsiloxane (PDMS) surfaces with different balances between elasticity and deicing performances. The durability was studied in terms of shear/tensile ice adhesion strength before and after different wear tests. These tests consisted of abrasion/erosion cycles using standard procedures aimed to reproduce different environmental wearing agents. The main objective is to evaluate if our PDMS surfaces can become long-lasting solutions for ice removal in real conditions. We found that our elastic surfaces show excellent durability. After the wear tests, the ice adhesion strength values remained low or even unaltered. Although the oil-infused PDMS surface was the softest one, it presented considerable durability and excellent low ice adhesion, being a promising solution.

Ice adhesion of PDMS surfaces with balanced elastic and water-repellent properties.

HYPOTHESIS: Ice adhesion to rigid materials is reduced with low energy surfaces of high receding contact angles. However, their adhesion strength values are above the threshold value to be considered as icephobic materials. Surface deformability is a promising route to further reduce ice adhesion. EXPERIMENTS: In this work, we prepared elastomer surfaces with a wide range of elastic moduli and hydrophobicity degree and we measured their ice adhesion strength. Moreover, we also explored the deicing performance of oil-infused elastomeric surfaces. The ice adhesion was characterized by two detachment modes: tensile and shear. FINDINGS: The variety of elastomeric surfaces allowed us to simultaneously analyze the ice adhesion dependence with deformability and contact angle hysteresis. We found that the impact of these properties depends on the detachment mode, being deformability more important in shear mode and hydrophobicity more relevant in tensile mode. In addition, oil infusion further reduces ice adhesion due to the interfacial slippage. From an optimal balance between deformability and hydrophobicity, we were able to identify surfaces with super-low ice adhesion.

Ectasia coronaria y miocardiopatía hipertrófica: una entidad infrecuente / Coronary artery ectasia and hypertrophic cardiomyopathy: case report

Resumen Se presenta el caso de un paciente de 54 años que consulta por angina de esfuerzo de 2 años de evolución en quien se identifica una dilatación ectásica del árbol coronario con lesiones ateroscleróticas críticas y miocardiopatía hipertrófica septal obstructiva. Una revisión bibliográfica revela que es una asociación infrecuente de la cual solo existen reportes de casos aislados.

Abstract We present the case of a 54-year-old patient who presented with a history of 2 years with angina. Invasive studies revealed critical coronary artery stenosis coexisting with obstructive hypertrophic miopathy. This is a rare association with only isolated case reports.

Contact line relaxation of sessile drops on PDMS surfaces: A methodological perspective.

HYPOTHESIS: Characterization of contact angle hysteresis on soft surfaces is sensitive to the measurement protocol and might present adventitious time-dependencies. Contact line dynamics on solid surfaces is altered by the surface chemistry, surface roughness and/or surface elasticity. We observed a "slow" spontaneous relaxation of static water sessile drops placed on elastic surfaces. This unexpected drop motion reveals unresolved equilibrium configurations that may affect the observed values of contact angle hysteresis. Drop relaxation on deformable surfaces is partially governed by a viscoelastic dissipation located at the contact line. EXPERIMENTS: In this work, we studied the natural relaxation of water drops formed on several smooth PDMS surfaces with different elastic moduli. We monitored in time the contact angle and contact radius of each drop. For varying the initial contact angle, we used the growing-shrinking drop method. FINDINGS: We postulate that the so-called "braking effect", produced by the surface deformability, affects the contact line velocity and in consequence, the contact angle measurements. We conclude that the wetting properties of elastic surfaces should be properly examined with reliable values of contact angle measured after drop relaxation.

Can capillary lactate improve early warning scores in emergency department? An observational, prospective, multicentre study.

AIMS: To determine the prognostic usefulness of the National Early Warning Score-2 (NEWS2) and quick Sepsis-related Organ Failure Assessment (qSOFA) scores, in isolation and combined with capillary lactate (CL), using the new NEWS2-L and qSOFA-L scores to predict the 30-day mortality risk. METHODS: Prospective, multicentre and observational study in patients across four EDs. We collected sets of vital signs and CL and subsequently calculated NEWS2, qSOFA, NEWS2-L and qSOFA-L scores when patients arrived at the ED. The main outcome measure was all-cause mortality 30 days from the index event. RESULTS: A total of 941 patients were included. Thirty-six patients (3.8%) died within 30 days of the index event. A high CL level has not been linked to a higher mortality. The NEWS2 presented AUROC of 0.72 (95% CI: 0.62-0.81), qSOFA of 0.66 (95% CI: 0.56-0.77) (P < .001 in both cases) and CL 0.55 (95% CI: 0.42-0.65; P = .229) to predict 30-day mortality. The addition of CL to the scores analysed does not improve the results of the scores used in isolation. CONCLUSION: NEWS2 and qSOFA scores are a very useful tool for assessing the status of patients who come to the ED in general for all types of patients in triage categories II and III and for detecting the 30-day mortality risk. CL determined systematically in the ED does not seem to provide information on the prognosis of the patients.

Clinical Utility of Delta Lactate for Predicting Early In-Hospital Mortality in Adult Patients: A Prospective, Multicentric, Cohort Study.

One of the challenges in the emergency department (ED) is the early identification of patients with a higher risk of clinical deterioration. The objective is to evaluate the prognostic capacity of ΔLA (correlation between prehospital lactate (pLA) and hospital lactate (hLA)) with respect to in-hospital two day mortality. We conducted a pragmatic, multicentric, prospective and blinded-endpoint study in adults who consecutively attended and were transported in advanced life support with high priority from the scene to the ED. The corresponding area under the receiver operating characteristics curve (AUROC) was obtained for each of the outcomes. In total, 1341 cases met the inclusion criteria. The median age was 71 years (interquartile range: 54-83 years), with 38.9% (521 cases) females. The total 2 day mortality included 106 patients (7.9%). The prognostic precision for the 2 day mortality of pLA and hLA was good, with an AUROC of 0.800 (95% CI: 0.74-0.85; p < 0.001) and 0.819 (95% CI: 0.76-0.86; p < 0.001), respectively. Of all patients, 31.5% (422 cases) had an ΔLA with a decrease of <10%, of which a total of 66 patients (15.6%) died. A lactate clearance ≥ 10% is associated with a lower risk of death in the ED, and this value could potentially be used as a guide to determine if a severely injured patient is improving in response to the established treatment.

Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department.

The objective of this study was to analyze and compare the usefulness of quick sequential organ failure assessment score (qSOFA) and sequential organ failure assessment (SOFA) scores for the detection of early (two-day) mortality in patients transported by emergency medical services (EMSs) to the emergency department (ED) (infectious and non-infectious). We performed a multicentric, prospective and blinded end-point study in adults transported with high priority by ambulance from the scene to the ED with the participation of five hospitals. For each score, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated. We included 870 patients in the final cohort. The median age was 70 years (IQR 54-81 years), and 338 (38.8%) of the participants were women. Two-day mortality was 8.3% (73 cases), and 20.9% of cases were of an infectious pathology. For two-day mortality, the qSOFA presented an AUC of 0.812 (95% CI: 0.75-0.87; p < 0.001) globally with a sensitivity of 84.9 (95% CI: 75.0-91.4) and a specificity of 69.4 (95% CI: 66.1-72.5), and a SOFA of 0.909 (95% CI: 0.86-0.95; p < 0.001) with sensitivity of 87.7 (95% CI: 78.2-93.4) and specificity of 80.7 (95% CI: 77.4-83.3). The qSOFA score can serve as a simple initial assessment to detect high-risk patients, and the SOFA score can be used as an advanced tool to confirm organ dysfunction.

Self-Deicing Electrolyte Hydrogel Surfaces with Pa-level Ice Adhesion and Durable Antifreezing/Antifrost Performance.

Despite the remarkable advances in mitigating ice formation and accretion, however, no engineered anti-icing surfaces today can durably prevent frost formation, droplet freezing, and ice accretion in an economical and ecofriendly way. Herein, sustainable and low-cost electrolyte hydrogel (EH) surfaces are developed by infusing salted water into a hydrogel matrix for avoiding icing. The EH surfaces can both prevent ice/frost formation for an extremely long time and reduce ice adhesion strength to ultralow value (Pa-level) at a tunable temperature window down to -48.4 °C. Furthermore, ice can self-remove from the tilted EH surface within 10 s at -10 °C by self-gravity. As demonstrated by both molecular dynamic simulations and experiments, these extreme performances are attributed to the diffusion of ions to the interface between EH and ice. The sustainable anti-icing properties of EH can be maintained by replenishing in real-time with available ion sources, indicating the promising applications in offshore platforms and ships.

Adolescente con autolesiones no suicidas en un entorno de adversidad psicosocial / Adolescent with non-suicidal self-harm in a psychosocial adversity environment

Las conductas lesivas no suicidas suponen un problema sanitario de creciente importancia, con una prevalencia en muestras comunitarias de adolescentes del 15-20 %. Las autolesiones pueden tener un significado diverso; se clasifican en intrapersonales o interpersonales; son un factor de riesgo y evolutivo, con inicio en la adolescencia temprana. Se presenta el caso de una adolescente de 12 años con factores de riesgo psicosociales, que acudió a la consulta por cortes autoinfligidos en los brazos y las piernas, realizados con una cuchilla de afeitar, detectados en el colegio. Se intervino potenciando la autoestima y en regulación de emociones con intervención multidisciplinar (sistema educativo, servicios sociales, psiquiatría infantojuvenil y pediatría), con una evolución positiva. Es vital su detección y abordaje con el paciente y su familia para evitar riesgos futuros, especialmente, de patología psíquica. La intervención se realiza desde la Atención Primaria, pero precisa la colaboración de otros profesionales.

Non-suicidal harmful behaviors pose a health problem of increasing importance, with a prevalence in community samples of adolescents of 15-20 %. Self-harm can have adverse meaning, qualifying in intrapersonal or interpersonal; they are a risk and evolutionary factor, with an age of onset in early adolescence. We present the case of a 12-year-old adolescent with psychosocial risk factors, who went to the consultation for self-cuts in arms and legs, made with a razor, detected in the school. It was enhanced her self-steem an guided in regulation of emotions with multidisciplinary intervention (educational system, social services, infantile-juvenile Psychiatry and Pediatrics), with a positive evolution. It is vital to detect and approach this issue with the patient and the family to avoid future risks, especially psychic pathology. The intervention is done from Primary Care, but it is necessary the collaboration of other professionals.

[Adolescent with non-suicidal self-harm in a psychosocial adversity environment]. / Adolescente con autolesiones no suicidas en un entorno de adversidad psicosocial.

Non-suicidal harmful behaviors pose a health problem of increasing importance, with a prevalence in community samples of adolescents of 15-20 %. Self-harm can have adverse meaning, qualifying in intrapersonal or interpersonal; they are a risk and evolutionary factor, with an age of onset in early adolescence. We present the case of a 12-year-old adolescent with psychosocial risk factors, who went to the consultation for self-cuts in arms and legs, made with a razor, detected in the school. It was enhanced her self-steem an guided in regulation of emotions with multidisciplinary intervention (educational system, social services, infantile-juvenile Psychiatry and Pediatrics), with a positive evolution. It is vital to detect and approach this issue with the patient and the family to avoid future risks, especially psychic pathology. The intervention is done from Primary Care, but it is necessary the collaboration of other professionals.

Las conductas lesivas no suicidas suponen un problema sanitario de creciente importancia, con una prevalencia en muestras comunitarias de adolescentes del 15-20 %. Las autolesiones pueden tener un significado diverso; se clasifican en intrapersonales o interpersonales; son un factor de riesgo y evolutivo, con inicio en la adolescencia temprana. Se presenta el caso de una adolescente de 12 años con factores de riesgo psicosociales, que acudió a la consulta por cortes autoinfligidos en los brazos y las piernas, realizados con una cuchilla de afeitar, detectados en el colegio. Se intervino potenciando la autoestima y en regulación de emociones con intervención multidisciplinar (sistema educativo, servicios sociales, psiquiatría infantojuvenil y pediatría), con una evolución positiva. Es vital su detección y abordaje con el paciente y su familia para evitar riesgos futuros, especialmente, de patología psíquica. La intervención se realiza desde la Atención Primaria, pero precisa la colaboración de otros profesionales.

Predictive value of the prehospital NEWS2-L ­National Early Warning Score 2 Lactate­ for detecting early death after an emergency. / Valor predictivo del preNEWS2-L (Pre-hospital National Early Warning Score 2 Lactate) para la detección de la mortalidad precoz en el ámbito prehospitalario.

OBJECTIVES: To evaluate the ability of the prehospital National Early Warning Score 2 Lactate (preNEWS2-L) to predict early mortality, defined as death within 48 hours of the index event. We also explored the predictive capacity of the score for 7- and 30-day all-cause mortality. MATERIAL AND METHODS: Prospective, observational longitudinal study in patients attended by ambulance responders and transferred to the emergency departments of reference hospitals. We collected demographic, physiologic, clinical, and analytical data and the main diagnosis. The main outcome measure was all-cause mortality. RESULTS: s. A total of 707 patients were included. Thirty-seven patients (5.2%) died within 48 hours of the index event. The area under the receiver operating characteristic curve (AUC) for the preNEWS2-L score's prediction of early death was 0.91 (95% CI, 0.83-0.96). The AUCs for death within 7 and 30 days were 0.86 (95% CI, 0.79-0.92) and 0.82 (95% CI, 0.76-0.87), respectively, showing that the score's ability to predict death decreases by almost 10% between 48 hours and 30 days. CONCLUSION: The preNEWS2-L is a useful prognostic tool that can be assessed quickly and easily in prehospital settings.

OBJETIVO: Evaluar la capacidad de la escala Pre-hospital National Early Warning Score 2 lactate (preNEWS2-L) para predecir la mortalidad precoz (antes de 48 h) desde el suceso índice. Además, como objetivo secundario, analizar el rendimiento de la nueva escala para la mortalidad a 7 y 30 días por cualquier causa. METODO: Estudio observacional, prospectivo y longitudinal de pacientes que son atendidos por unidades móviles de emergencias y trasladados a los servicios de urgencias de su hospital de referencia. Se recogieron variables demográficas, fisiológicas, clínicas, analíticas y de diagnóstico principal. La variable de resultado principal fue la mortalidad por cualquier causa. RESULTADOS: Se incluyeron 707 pacientes. La mortalidad precoz tras el suceso índice antes de las primeras 48 h fue de 37 pacientes (5,2%). La escala preNEWS2-L obtuvo un área bajo la curva (ABC) de la característica operativa del receptor (COR) de 0,91 (IC 95%: 0,83-0,96; p < 0,001), 0,86 (IC 95%: 0,79-0,92; p < 0,001) y 0,82 (IC 95%: 0,76- 0,87; p < 0,0017) para la mortalidad a 2, 7 y 30 días, respectivamente. Su capacidad de valorar la mortalidad desciende prácticamente un 10% entre el ABC-ROC a los 2 días y el ABC a los 30 días. CONCLUSIONES: La escala generada, denominada preNEWS2-L, puede ser considerada una herramienta pronóstico muy útil para ser usada en el medio prehospitalario, por facilidad de manejo, rápida obtención y capacidad de predicción.

Valor predictivo del preNEWS2-L (Pre-hospital National Early Warning Score 2 Lactate) para la detección de la mortalidad precoz en el ámbito prehospitalario / Predictive value of the prehospital NEWS2-L -National Early Warning Score 2 Lactate- for detecting early death after an emergency

Objetivos: Evaluar la capacidad de la escala Pre-hospital National Early Warning Score 2 lactate (preNEWS2-L) para predecir la mortalidad precoz (antes de 48 h) desde el suceso índice. Además, como objetivo secundario, analizar el rendimiento de la nueva escala para la mortalidad a 7 y 30 días por cualquier causa. Método: Estudio observacional, prospectivo y longitudinal de pacientes que son atendidos por unidades móviles de emergencias y trasladados a los servicios de urgencias de su hospital de referencia. Se recogieron variables demográficas, fisiológicas, clínicas, analíticas y de diagnóstico principal. La variable de resultado principal fue la mortalidad por cualquier causa. Resultados: Se incluyeron 707 pacientes. La mortalidad precoz tras el suceso índice antes de las primeras 48 h fue de 37 pacientes (5,2%). La escala preNEWS2-L obtuvo un área bajo la curva (ABC) de la característica operativa del receptor (COR) de 0,91 (IC 95%: 0,83-0,96; p < 0,001), 0,86 (IC 95%: 0,79-0,92; p < 0,001) y 0,82 (IC 95%: 0,760,87; p < 0,0017) para la mortalidad a 2, 7 y 30 días, respectivamente. Su capacidad de valorar la mortalidad desciende prácticamente un 10% entre el ABC-ROC a los 2 días y el ABC a los 30 días. Conclusiones: La escala generada, denominada preNEWS2-L, puede ser considerada una herramienta pronóstico muy útil para ser usada en el medio prehospitalario, por facilidad de manejo, rápida obtención y capacidad de predicción

Objectives: To evaluate the ability of the prehospital National Early Warning Score 2 Lactate (preNEWS2-L) to predict early mortality, defined as death within 48 hours of the index event. We also explored the predictive capacity of the score for 7- and 30-day all-cause mortality. Methods: Prospective, observational longitudinal study in patients attended by ambulance responders and transferred to the emergency departments of reference hospitals. We collected demographic, physiologic, clinical, and analytical data and the main diagnosis. The main outcome measure was all-cause mortality. Results: A total of 707 patients were included. Thirty-seven patients (5.2%) died within 48 hours of the index event. The area under the receiver operating characteristic curve (AUC) for the preNEWS2-L score's prediction of early death was 0.91 (95% CI, 0.83-0.96). The AUCs for death within 7 and 30 days were 0.86 (95% CI, 0.79-0.92) and 0.82 (95% CI, 0.76-0.87), respectively, showing that the score's ability to predict death decreases by almost 10% between 48 hours and 30 days. Conclusion: The preNEWS2-L is a useful prognostic tool that can be assessed quickly and easily in prehospital settings

Analysis of the early warning score to detect critical or high-risk patients in the prehospital setting.

The early warning score can help to prevent, recognize and act at the first signs of clinical and physiological deterioration. The objective of this study is to evaluate different scales for use in the prehospital setting and to select the most relevant one by applicability and capacity to predict mortality in the first 48 h. A prospective longitudinal observational study was conducted in patients over 18 years of age who were treated by the advanced life support unit and transferred to the emergency department between April and July 2018. We analyzed demographic variables as well as the physiological parameters and clinical observations necessary to complement the EWS. Subsequently, each patient was followed up, considering their final diagnosis and mortality data. A total of 349 patients were included in our study. Early mortality before the first 48 h affected 27 patients (7.7%). The scale with the best capacity to predict early mortality was the National Early Warning Score 2, with an area under the curve of 0.896 (95% CI 0.82-0.97). The score with the lowest global classification error was 10 points with sensitivity of 81.5% (95% CI 62.7-92.1) and specificity of 88.5% (95% CI 84.5-91.6). The early warning score studied (except modified early warning score) shows no statistically significant differences between them; however, the National Early Warning Score 2 is the most used score internationally, validated at the prehospital scope and with a wide scientific literature that supports its use. The Prehospital Emergency Medical Services should include this scale among their operative elements to complement the structured and objective evaluation of the critical patient.

Summertime high resolution variability of atmospheric formaldehyde and non-methane volatile organic compounds in a rural background area.

On rural background areas atmospheric formaldehyde (HCHO) is important for its abundance and chemical reactivity, directly linked to the tropospheric ozone formation processes. HCHO is also toxic and carcinogenic to humans. Atmospheric HCHO was continuously measured in summer 2016 during 81 days (N = 6722, average: 1.42 ppbv) in a rural background area in Northern Spain, Valderejo Natural Park (VNP) using a Hantzsch fluorimetric system. To better characterize the photochemical processes the database was completed with hourly measurements of 63 Non-Methane Hydrocarbons (NMHC) performed by gas chromatography and other common atmospheric pollutants and meteorological parameters. HCHO mixing ratios were highly correlated with ozone and isoprene. Cloudy and rainy days, with low temperature and radiation, led to low HCHO mixing ratios, with maxima (<2 ppbv) registered around 14 UTC. On days with increased radiation and temperature HCHO maxima occurred slightly later (<6 ppbv, ≈16:00 UTC). During clear summer days with high temperature and radiation, two HCHO peaks were registered daily, one synchronized with the radiation maximum (≈3-4 ppbv, ≈13:00 UTC) and an absolute maximum (<10 ppbv, ≈18:00 UTC), associated with the addition of HCHO coming into VNP due to inbound transport of old polluted air masses. In the ozone episode studied, the processes of accumulation and recharge of ozone and of HCHO ran in parallel, leading to similar daily patterns of variation. Finally, HCHO mixing ratios measured in VNP were compared with other measurements at rural, forested, and remote sites all over the world, obtaining similar values.