Tooth-Bone-Borne vs Bone-Borne Rapid Maxillary Expanders on Dentoskeletal Changes.

Purpose: This study compared the insertion and thickness of the cortical bone, the parallelism of the midpalatal suture, and the skeletal transverse dimension using a microimplant-assisted rapid palatal expansion (MARPE) with those produced by bone-anchored maxillary expander (BAME) in adults. Patients and Methods: The sample comprised 18 patients (mean age, 29.9±9.4 years) selected for the MARPE group and 18 (mean age 24.8±6.8 years) selected for the BAME group. Cone-Beam computed tomography scans taken just before and after the expansion. Results: After treatment, there was a significant palatal depth decrease. In addition, maxillary and mandibular width were increased in both groups. Regarding the cortical bone insertion and cortical bone width, it is shown an increase in both groups but those changes are not significant. However, the anterior suture opening effect occurs more frequently in the BAME than in the MARPE device. There are no differences in the frequency of opening of the midpalatal suture in the cases treated with MARPE and BAME, in both cases the most frequent opening morphology is parallel, independently of midpalatal suture maturation. Conclusion: There are no differences in the use of MARPE or BAME in the parallelism of the middle palatal suture, the cortical bone insertion, and thickness according to the maturation stages of the midpalatal suture but significantly increases the transverse dimensions of the maxillary skeleton.

Impact of ChAdOx1 or DNA Prime Vaccination on Magnitude, Breadth, and Focus of MVA-Boosted Immunogen-Specific T Cell Responses.

The efficacy of anti-viral T-cell vaccines may greatly depend on their ability to generate high-magnitude responses targeting a broad range of different epitopes. Recently, we created the HIV T-cell immunogen HTI, designed to generate T-cell responses to protein fragments more frequently targeted by HIV controllers. In the present study, we aim to maximize the breadth and magnitude of the T-cell responses generated by HTI by combining different vaccine vectors expressing HTI. We evaluated the ability to induce strong and broad T-cell responses to the HTI immunogen through prime vaccination with DNA plasmid (D) or Chimpanzee Adenovirus Ox1 (ChAdOx1; C) vectors, followed by a Modified Virus Ankara (MVA; M) vaccine boost (DDD, DDDM, C, and CM). HTI-specific T-cell responses after vaccination were measured by IFN-γ-ELISpot assays in two inbred mice strains (C57BL/6 and BALB/c). CM was the schedule triggering the highest magnitude of the response in both mice strains. However, this effect was not reflected in an increase in the breadth of the response but rather in an increase in the magnitude of the response to specific immunodominant epitopes. Immunodominance profiles in the two mouse strains were different, with a clear dominance of T-cell responses to a Pol-derived peptide pool after CM vaccination in C57BL/6. Responses to CM vaccination were also maintained at higher magnitudes over time (13 weeks) compared to other vaccination regimens. Thus, while a ChAdOx1 prime combined with MVA booster vaccination generated stronger and more sustained T-cell responses compared to three DNA vaccinations, the ChAdOx1 primed responses were more narrowly targeted. In conclusion, our findings suggest that the choice of vaccine vectors and prime-boost regimens plays a crucial role in determining the strength, duration, breadth, and focus of T-cell responses, providing further guidance for selecting vaccination strategies.

Bioactive Protein and Peptide Release from a Mucoadhesive Electrospun Membrane.

Protein-based biologics constitute a rapidly expanding category of therapeutic agents with high target specificity. Their clinical use has dramatically increased in recent years, but administration is largely via injection. Drug delivery across the oral mucosa is a promising alternative to injections, in order to avoid the gastrointestinal tract and first-pass metabolism. Current drug delivery formulations include liquid sprays, mucoadhesive tablets and films, which lack dose control in the presence of salivary flow. To address this, electrospun membranes that adhere tightly to the oral mucosa and release drugs locally have been developed. Here, we investigated the suitability of these mucoadhesive membranes for peptide or protein release. Bradykinin (0.1%) or insulin (1, 3, and 5%) were incorporated by electrospinning from ethanol/water mixtures. Immersion of membranes in buffer resulted in the rapid release of bradykinin, with a maximal release of 70 ± 12% reached after 1 h. In contrast, insulin was liberated more slowly, with 88 ± 11, 69.0 ± 5.4, and 63.9 ± 9.0% cumulative release of the total encapsulated dose after 8 h for membranes containing 1, 3, and 5% w/w insulin, respectively. Membrane-eluted bradykinin retained pharmacological activity by inducing rapid intracellular calcium release upon binding to its cell surface receptor on oral fibroblasts, when examined by flow cytometry. To quantify further, time-lapse confocal microscopy revealed that membrane-eluted bradykinin caused a 1.58 ± 0.16 fold-change in intracellular calcium fluorescence after 10 s compared to bradykinin solution (2.13 ± 0.21), relative to placebo. In conclusion, these data show that electrospun membranes may be highly effective vehicles for site-specific administration of biotherapeutic proteins or peptides directly to the oral mucosa for either local or systemic drug delivery applications.

Clinical inertia in newly diagnosed type 2 diabetes mellitus among patients attending selected healthcare institutions in Colombia.

BACKGROUND: The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. OBJECTIVE: To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. METHODS: An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. RESULTS: A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86). CONCLUSIONS: In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

Mapping cumulative compound hydrometeorological and marine-induced risks on the NW Mediterranean coast.

Coastal risks in the Mediterranean are a result of the complex interplay between hydrometeorological and marine hazards. The region encompasses areas with varying degrees of vulnerability to these hazards, as well as spatial variations in exposure values, making it essential to adopt a comprehensive and nuanced approach to risk assessment and management. It is worth noting that hydrometeorological hazards, such as flash floods, can often have a greater impact than strictly coastal hazards, highlighting the need to consider the full range of potential risks. Therefore, coastal managers must adopt a multi-hazard approach to make sound risk management decisions. This study addresses this need using an index-based framework that assesses the integrated risk in time and space (hereafter referred to as cumulative compound risk) in coastal zones by aggregating the main hydrometeorological and marine hazards, the vulnerability of the territory to both types of hazards, and values at exposure. The framework is designed for use at large spatial scales (applied to a 1100 km coastline in this study), with the basic spatial unit being relevant for management (here set as the municipality in this study). Its application enables the assessment of spatial variations in integrated risk as well as individual hydrometeorological and marine contributions. The combined use of the indices and cluster analysis helps identify similarities and differences in the risk profile of spatial units, and thus, define homogeneous areas from a risk management perspective. In this study, the framework was applied to the Spanish Mediterranean coastline, an area representative of the climatic, geomorphological, and socioeconomic conditions of the Mediterranean coast.

Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone.

PURPOSE: This work aims to compare the interval cancer rate and interval cancer characteristics between women screened with digital breast tomosynthesis (DBT) + digital mammography (DM) and those screened with DM alone. METHODS: The interval cancer rate and interval cancer characteristics of the study population included in the Córdoba Breast Tomosynthesis Screening Trial (CBTST) were compared to a contemporary control population screened with DM. The tumour characteristics of screen-detected and interval cancers were also compared. Contingency tables were used to compare interval cancer rates. The chi-square test and Fisher's exact test were used to compare the qualitative characteristics of the cancers whereas Student's t test and the Mann-Whitney U test were used to analyse quantitative features. RESULTS: A total of 16,068 screening exams with DBT + DM were conducted within the CBTST (mean age 57.59 ± 5.9 [SD]) between January 2015 and December 2016 (study population). In parallel, 23,787 women (mean age 58.89 ± 5.9 standard deviation [SD]) were screened with DM (control population). The interval cancer rate was lower in the study population than in the control population (15 [0.93‰; 95% confidence interval (CI): 0.73, 1.14] vs 43 [1.8‰; 95% CI: 1.58, 2.04] respectively; p = 0.045). The difference in rate was more marked in women with dense breasts (0.95‰ in the study population vs 3.17‰ in the control population; p = 0.031). Interval cancers were smaller in the study population than in the control population (p = 0.031). CONCLUSIONS: The interval cancer rate was lower in women screened with DBT + DM compared to those screened with DM alone. These differences were more pronounced in women with dense breasts. CLINICAL RELEVANCE STATEMENT: Women screened using tomosynthesis and digital mammography had a lower rate of interval cancer than women screened with digital mammography, with the greatest difference in the interval cancer rate observed in women with dense breasts. KEY POINTS: • The interval cancer rate was lower in the study population (digital breast tomosynthesis [DBT] + digital mammography [DM]) than in the control population (DM). • The difference in interval cancer rates was more pronounced in women with dense breasts. • Interval cancers were smaller in the study population (DBT + DM) than in the control population (DM).

Validation of hemoglobin measurement in venous blood using HemoCue for the Ensanut 2022.

OBJECTIVE: To validate hemoglobin (Hb) concentration in venous blood (VB) using the HemoCue 201+ in a subsample of children and women from the Mexican National Health and Nutrition Survey 2022. MATERIALS AND METHODS: Prior to field work 50 HemoCue 201+ devices were verified using venous blood. During the field work 57 children (aged 1-11) and 62 women (aged 12-49) donated 3 mL of VB each. Hb was measured in each device of HemoCue 201+ and in a hematologic autoanalyzer for the validation. RESULTS: No significant bias was found in most of the devices. An adjustment criterion was used for 22 devices. Hb mean difference results were -0.049±0.578 g/dL in children and -0.098±0.628 g/dL in women. CONCLUSIONS: The HemoCue 201+ is a valid tool for estimating Hb concentration to produce reliable estimates of anemia prevalence when using venous blood.

Post-COVID-19 syndrome: Descriptive analysis based on a survivors' cohort in Colombia.

Background: The prevalence of post-COVID-19 Syndrome (PCS) is estimated to be between 10% and 20%. The main reported symptoms are fatigue, memory alterations, dyspnea, sleep disorders, arthralgia, anxiety, taste alterations, coughing and depression. This study aims to determine the prevalence of post-COVID-19 symptoms in a group of Colombian patients who were recruited during their outpatient appointments. Methodology: This cross-sectional study was conducted between December 2021 to May 2022. It included patients from outpatient facilities located in five main cities in Colombia who were positive for SARS-CoV-2 infection detected by reverse transcription-polymerase chain reaction (RT-PCR) testing and reported PCS in the following 12 weeks after their COVID-19 diagnosis. Results: A total of 1047 individuals >18 years old met the inclusion criteria and were included in the study. The median age was 46 years old. 68.2% of the participants were female, 41.5% of the patients reported having a pre-existent condition (hypertension, anxiety disorder, diabetes, hyperthyroidism, obesity and asthma). Only 22% had received at least one dose of COVID-19 vaccine prior to the COVID-19 episode registered. The more prevalent symptoms within our group are described as follows: fatigue (53.3%), dyspnea (40.3%), arthralgia and/or myalgia (43%), cephalea (40.5%), sleep disorders (35.7%) and coughing (31.3%). 72% of the patients presented four or more post-COVID 19 symptoms, 9% two symptoms, and 10% only one symptom. Conclusion: The findings of this study are consistent with international literature publicly available. The distribution and prevalence of post-COVID symptoms highlight the importance of further research to improve understanding and its potential consequences and implications in terms of quality of life and health care planning services.

Impact of real-life use of artificial intelligence as support for human reading in a population-based breast cancer screening program with mammography and tomosynthesis.

OBJECTIVES: To evaluate the impact of using an artificial intelligence (AI) system as support for human double reading in a real-life scenario of a breast cancer screening program with digital mammography (DM) or digital breast tomosynthesis (DBT). MATERIAL AND METHODS: We analyzed the performance of double reading screening with mammography and tomosynthesis after implementarion of AI as decision support. The study group consisted of a consecutive cohort of 1 year screening between March 2021 and March 2022 where double reading was performed with concurrent AI support that automatically detects and highlights lesions suspicious of breast cancer in mammography and tomosynthesis. Screening performance was measured as cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recalls. Performance in the study group was compared using a McNemar test to a control group that included a screening cohort of the same size, recorded just prior to the implementation of AI. RESULTS: A total of 11,998 women (mean age 57.59 years ± 5.8 [sd]) were included in the study group (5049 DM and 6949 DBT). Comparing global results (including DM and DBT) of double reading with vs. without AI support, we observed an increase in CDR, PPV, and RR by 3.2/‰ (5.8 vs. 9; p < 0.001), 4% (10.6 vs. 14.6; p < 0.001), and 0.7% (5.4 vs. 6.1; p < 0.001) respectively. CONCLUSION: AI used as support for human double reading in a real-life breast cancer screening program with DM and DBT increases CDR and PPV of the recalled women. CLINICAL RELEVANCE STATEMENT: Artificial intelligence as support for human double reading improves accuracy in a real-life breast cancer screening program both in digital mammography and digital breast tomosynthesis. KEY POINTS: • AI systems based on deep learning technology offer potential for improving breast cancer screening programs. • Using artificial intelligence as support for reading improves radiologists' performance in breast cancer screening programs with mammography or tomosynthesis. • Artificial intelligence used concurrently with human reading in clinical screening practice increases breast cancer detection rate and positive predictive value of the recalled women.

Vaccination with an HIV T-Cell Immunogen (HTI) Using DNA Primes Followed by a ChAdOx1-MVA Boost Is Immunogenic in Gut Microbiota-Depleted Mice despite Low IL-22 Serum Levels.

Despite the important role of gut microbiota in the maturation of the immune system, little is known about its impact on the development of T-cell responses to vaccination. Here, we immunized C57BL/6 mice with a prime-boost regimen using DNA plasmid, the Chimpanzee Adenovirus, and the modified Vaccinia Ankara virus expressing a candidate HIV T-cell immunogen and compared the T-cell responses between individuals with an intact or antibiotic-depleted microbiota. Overall, the depletion of the gut microbiota did not result in significant differences in the magnitude or breadth of the immunogen-specific IFNγ T-cell response after vaccination. However, we observed marked changes in the serum levels of four cytokines after vaccinating microbiota-depleted animals, particularly a significant reduction in IL-22 levels. Interestingly, the level of IL-22 in serum correlated with the abundance of Roseburia in the large intestine of mice in the mock and vaccinated groups with intact microbiota. This short-chain fatty acid (SCFA)-producing bacterium was significantly reduced in the vaccinated, microbiota-depleted group. Therefore, our results indicate that, although microbiota depletion reduces serum levels of IL-22, the powerful vaccine regime used could have overcome the impact of microbiota depletion on IFNγ-producing T-cell responses.

Short-term outcomes in the upper airway with tooth-bone-borne vs bone-borne rapid maxillary expanders.

BACKGROUND: This study compared the area and minimal section of the nasal cavity, nasopharynx, oropharynx, and hypopharynx in cases treated with different methods of microimplant-assisted expansion. METHODS: Based on a pilot study to calculate the sample size, 30 patients with transverse maxillary deficiency over 14 years of age were retrospectively selected. These patients had received two different types of microimplant-assisted maxillary expansion treatment (MARPE and BAME). The patient underwent Cone-Beam computed tomography (CBCT) before and after treatment (mean time 1.5 months) with MARPE or BAME and upper airway measurements (volume and minimum cross-sectional area) were taken to assess upper airways changes and compare changes between the groups. A paired sample t-test was performed to evaluate the T0-T1 change of airway measurements obtained with MARPE and BAME, and a student t-test to compare changes in airway measurements between MARPE and BAME. RESULTS: This investigation shows a statistically significant increase in total nasopharyngeal airway volume (0.59 ± 1.42 cm3; p < 0.01), total oropharyngeal airway volume (3.83 ± 7.53 cm3; p < 0.01) and minimum oropharyngeal cross-section (53.23 ± 126.46 mm2; p < 0.05) in all cases treated with micro-screw assisted expansion. The minimal cross-sectional area of the oropharynx ((79.12 ± 142.28 mm2; p < 0.05) and hypopharynx (59.87 ± 89.79 mm2; p < 0.05) showed significant changes for cases treated with BAME. As for the comparison between cases treated with MARPE and BAME, no differences in upper airway changes have been observed, except for the minimum cross-sectional area of the nasal cavity, which increases for MARPE (52.05 ± 132.91 mm2) and decreases for BAME (-34.10 ± 90.85 mm2). CONCLUSIONS: A significant increase in total area and minimal section at the level of nasopharynx and oropharynx was observed in cases treated with BAME. Regarding the comparison of MARPE and BAME treatments, no differences were found in the total airway volume and minimal section in upper airway except for the minimum cross section of the nasal cavity that increases for MARPE and decreases for BAME.

Changes in Molar Tipping and Surrounding Alveolar Bone with Different Designs of Skeletal Maxillary Expanders.

This study compared the buccolingual angulation (BLA) of the upper and lower first permanent molars before and after using the different methods of microimplant-assisted expansion in adults and its influence on bone insertion loss. METHODS: Cone-beam computed tomography scans taken before and after the expansion in 36 patients (29.9 ± 9.4 years) were used to assess dental and periodontal changes and compare changes between the groups. RESULTS: This research shows a statistically significant increase in the BLA of the upper first molars. An increase of the BLA of the lower molars is also observed in MARPE. Regarding the comparison between cases treated with MARPE (4.42° ± 10.25°; 3.67° ± 9.56°) and BAME (-0.51° ± 4.61°; 2.34° ± 4.51°), it was observed that upper molar torque increased significantly less in cases treated with BAME. In cases with CWRU < 96° at T0, a slight bone insertion gain was observed at T1, whereas if CWRU ≥ 96°, a slight bone insertion loss was observed. Regarding the labial cortical bone loss, a slight gain of CBW was observed in all cases. This labial cortical enlargement (T0-T1) is greater in cases where the CWRU < 96° at T0. CONCLUSIONS: Patients treated with MARPE show torque increase in the teeth selected to support the expansion appliance compared to cases treated with BAME. In cases where the BLA at T0 < 96°, an increase in thickness and cortical insertion is observed in the upper molars after treatment with disjunction appliances assisted with microscrews.

Aflatoxin exposure in adults in southern and eastern Mexico in 2018: A descriptive study.

OBJECTIVE: To estimate the frequency of detection and levels of aflatoxin B1-lysine adduct (AFB1-lys), an important hepatocellular carcinoma (HCC) risk factor, in eastern and southern Mexico. MATERIALS AND METHODS: We determined serum AFB1-lys using mass spectrometry in a representative sample of 952 adults (weighted n = 7,493,354) from five states (Campeche, Chiapas, Tamaulipas, Veracruz and Yucatán) in 2018. We calculated overall and subgroup-specific frequency of detection and 95% confidence intervals (95%CI) and median AFB1-lys levels and quartiles. RESULTS: The overall frequency of detection of AFB1-lys was 91.9% (95%CI 88.6, 94.3). The median AFB1-lys level was 0.172 pg/µL (Q1-Q3, 0.060-0.582). Levels differed geographically (median pg/µL, 0.361 for Veracruz and 0.061 for Yucatan) and were higher among men and older individuals. Levels were almost three times higher in rural relative to urban areas (0.317 vs. 0.123 pg/µL). We observed higher AFB1-lys exposure in lower socioeconomic status (SES) level populations. CONCLUSION: AFB1-lys frequency of detection was very high and exposure levels were highest in Veracruz, men, rural areas, and among persons of lower SES. Understanding modifiable HCC risk factors in populations with unique epidemiological patterns could inform preventative interventions.

[Environmental impact of Emergency Services in Public Health: an assessment tool.] / Impacto medioambiental de los servicios de Urgencias en la Salud Pública: una herramienta de valoración.

OBJECTIVE: Climate change is directly related to increasing medical conditions such as cardiovascular, respiratory and/or infectious diseases, as well as malnutrition and mental illness caused by the reduction of available food and the growth of situations with significant emotional impact, respectively. Evidence showed that healthcare services are responsible for 4-5% of the greenhouse gas emissions worldwide. The aim of this study is the development of an assessment tool to evaluate the carbon footprint of emergency departments. METHODS: The development of the proposed assessment tool followed five stages. Firstly, the categories of GHGs to be included in the assessment tool were determined through a literature review. This was followed by establishment of scopes and boundaries, selection of conversion factors, collection of data from the Emergency Department at the Royal Free Hospital in London as a pilot site, and finally, the development of methodology to assess the carbon footprint. RESULTS: The assessment tool was divided in three scopes and each scope included one or more categories containing several items. Data was collected from different sources such as meters invoicing and billing, auditing, and surveys. The tool is presented in a Microsoft Excel document. CONCLUSIONS: This carbon assessment tool offers an opportunity to monitor carbon emissions in emergency departments, aiming to proliferate environmental strategies. The assessment tool seeks to provide a baseline carbon footprint assessment, identifying carbon hotspots within the department. The identification of these areas of intensive carbon emissions can help guide and focus local environmental initiatives that later can be monitored with a follow-up assessment to evaluate their effectiveness.

OBJETIVO: El cambio climático está directamente relacionado con el aumento de ciertas patologías como enfermedades cardiovasculares, respiratorias y/o infecciosas, así como con la desnutrición, provocada por la reducción de los alimentos disponibles, y el deterioro de la salud mental. La evidencia ha señalado que los servicios sanitarios son responsables del 4%-5% de las emisiones de gases efecto invernadero en todo el mundo. El objetivo de este estudio fue diseñar una herramienta de evaluación de la huella de carbono de los servicios de Urgencias. METODOS: Se diseñó la herramienta a través de cinco etapas. En primer lugar, se seleccionaron las categorías a incluir en la herramienta desde una revisión de la literatura. Posteriormente, se determinaron el alcance y límites, se seleccionaron los factores de conversión, se recopilaron datos del servicio de Urgencias del Royal Free Hospital de Londres como sitio piloto y se seleccionó el método de cálculo de la huella de carbono. RESULTADOS: La herramienta resultante se dividió en tres ámbitos, y cada ámbito en una o más categorías que contienen varios elementos. Los datos se recopilaron de diferentes fuentes, como facturación, medidores, auditorías y encuestas. La herramienta se presentó en un documento de Microsoft Excel. CONCLUSIONES: Esta herramienta de evaluación de carbono ofrece una oportunidad para monitorear las emisiones de carbono en los servicios de Urgencias. Pretende proporcionar una valoración de la huella de carbono de referencia, identificando puntos críticos de emisión dentro del servicio, que puede dar lugar a iniciativas ambientales locales.

Formación universitaria en actividad física: explorando competencias y evaluación desde las guías docentes / University training in physical activity: exploring competences and assessment

Este estudio persigue analizar, explorar y comparar guías docentes de dos titulaciones universitarias españolas de Grado referidas a la formación en actividad física desde el modelo basado en competencias. Se realizó un análisis documental delas competencias y un análisis de los sistemas de evaluación, desde un prisma formativo,de54 guías docentes de asignaturas de tipología común en ambas titulaciones, consiguiéndose, tras ello, variables medibles. Se aplicóun análisis MANOVA Biplot que permitió representar gráficamente las variables que caracterizaron a las asignaturas. Los resultados mostraron diferencias sustanciales entre las titulaciones y entre perfiles de asignaturas en el Grado en Ciencias de la Actividad Física y el Deporte, que no acontecieron en el Grado en Magisterio de Educación Primaria mención Educación Física. El estudio muestra un modelo de análisis útil para la evaluación de la calidad de las guías docentes que podría ser extrapolado y ajustado a otras titulaciones. (AU)

This study seeks to analize, explore and compare teaching guides of two Spanish degrees related to training in physical activity from the competency- bassed model. A documentary analysis of the competencies and an analysis of the assessment systems, according to formative point of view, in 54 subject teaching guides in common typology of both degrees, obtaining at the end mesurables variables. A MANOVA Biplot analysis is applied to graphically represent the variables that characterize each subject profile. Its application shows substantial differences between degrees and, also, between the three subject profiles in the Degree in Physical Activity and Sports Sciences, which do not happend in the Degree in Teacher Initial Training (Physical Education at Primary School). Eventually, the study shows a useful analysis model for evaluating the quality of teaching guides that could be extrapolated and met to other degrees. (AU)

Impacto medioambientalde los servicios de Urgenciasen la Salud Pública: una herramienta de valoración / Carbon footprinting the Emergency Departments in the United Kingdom: an assessment too

FUNDAMENTOS: El cambio climático está directamente relacionado con el aumento de ciertas patologías como enfermedadescardiovasculares, respiratorias y/o infecciosas, así como con la desnutrición, provocada por la reducción de los alimentos disponibles,y el deterioro de la salud mental. La evidencia ha señalado que los servicios sanitarios son responsables del 4%-5% de las emisionesde gases efecto invernadero en todo el mundo. El objetivo de este estudio fue diseñar una herramienta de evaluación de la huella decarbono de los servicios de Urgencias.MÉTODOS: Se diseñó la herramienta a través de cinco etapas. En primer lugar, se seleccionaron las categorías a incluir en laherramienta desde una revisión de la literatura. Posteriormente, se determinaron el alcance y límites, se seleccionaron los factoresde conversión, se recopilaron datos del servicio de Urgencias del Royal Free Hospital de Londres como sitio piloto y se seleccionó elmétodo de cálculo de la huella de carbono.RESULTADOS: La herramienta resultante se dividió en tres ámbitos, y cada ámbito en una o más categorías que contienen varioselementos. Los datos se recopilaron de diferentes fuentes, como facturación, medidores, auditorías y encuestas. La herramienta sepresentó en un documento de Microsoft Excel.CONCLUSIONES: Esta herramienta de evaluación de carbono ofrece una oportunidad para monitorear las emisiones de carbonoen los servicios de Urgencias. Pretende proporcionar una valoración de la huella de carbono de referencia, identificando puntoscríticos de emisión dentro del servicio, que puede dar lugar a iniciativas ambientales locales.PALABRAS CLAVE: Huella de carbono; Emisiones de gases efecto invernadero; Servicios de Urgencias; Evaluación del ciclo devida; Impacto medioambiental.(AU)

BACKGROUND: Climate change is directly related to increasing medical conditions such as cardiovascular, respiratory and/or infectious diseases, as well as malnutrition and mental illness caused by the reduction of available food and the growth of situations with significant emotional impact, respectively. Evidence showed that healthcare services are responsible for 4-5% of the greenhouse gas emissions worldwide. The aim of this study is the development of an assessment tool to evaluate the carbon footprint ofemergency departments.METHODS: The development of the proposed assessment tool followed five stages. Firstly, the categories of GHGs to be included in the assessment tool were determined through a literature review. This was followed by establishment of scopes and boundaries, selection of conversion factors, collection of data from the Emergency Department at the Royal Free Hospital in London as a pilot site, and finally, the development of methodology to assess the carbon footprint.RESULTS : The assessment tool was divided in three scopes and each scope included one or more categories containing several items. Data was collected from different sources such as meters invoicing and billing, auditing, and surveys. The tool is presented in a Microsoft Excel document.CONCLUSIONS : This carbon assessment tool offers an opportunity to monitor carbon emissions in emergency departments, aiming to proliferate environmental strategies. The assessment tool seeks to provide a baseline carbon footprint assessment, identifying carbon hotspots within the department. The identification of these areas of intensive carbon emissions can help guide and focuslocal environmental initiatives that later can be monitored with a follow-up assessment to evaluate their effectiveness.KEYWORDS: Carbon footprint; Greenhouse gases emissions; Emergency departments; Life cycle assessment; Environmental impact.(AU)

The carbon footprint of healthcare settings: A systematic review.

Healthcare systems are responsible for 4%-5% of the emissions of greenhouse gases worldwide. The Greenhouse Gas Protocol divides carbon emissions into three scopes: scope 1 or direct emissions secondary to energy use; scope 2 or indirect emissions secondary to purchased electricity; and scope 3 for the rest of indirect emissions. AIM: To describe the environmental impact of health services. DESIGN: A systematic review was conducted in the Medline, Web of Science, CINAHL, and Cochrane databases. Studies that focused their analysis on a functional healthcare unit and which included. This review was conducted from August to October 2022. RESULTS: The initial electronic search yielded a total of 4368 records. After the screening process according to the inclusion criteria, 13 studies were included in this review. The reviewed studies found that between 15% and 50% of the total emissions corresponded to scopes 1 and 2 emissions, whereas scope 3 emissions ranged between 50% and 75% of the total emissions. Disposables, equipment (medical and non-medical) and pharmaceuticals represented the higher percentage of emissions in scope 3. CONCLUSION: Most of the emissions corresponded to scope 3, which includes the indirect emission occurring as a consequence of the healthcare activity, as this scope includes a wider range of emission sources than the other scopes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Interventions should be carried out by the healthcare organizations responsible of Greenhouse Gas emissions, and also every single individual that integrates them should make changes. The use of evidence-based approaches to identify carbon hotspots and implement the most effective interventions in the healthcare setting could lead to a significant reduction of carbon emissions. IMPACT: This literature review highlights the impact that healthcare systems have on climate change and the importance of adopting and carrying out interventions to prevent its fast development. REPORTING METHOD: This review adhered to PRISMA guideline. PRISMA 2020 is a guideline designed for systematic reviews of studies that analyse the effects of heath interventions, and aim is to help authors improve the reporting of systematic review and meta-analyses. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Arterial blood gases in newborn infants: Early extraction without prior clamping versus extraction after delayed clamping.

OBJECTIVES: To compare the postpartum arterial blood gas parameters recorded early before cord clamping and after delayed cord clamping (DCC). To explore adverse effects and complications of the cord blood gas collection technique without clamping. DESIGN: Randomised controlled trial. SETTING: Birthing room of La Ribera University Hospital (Valencia, Spain). PARTICIPANTS: 122 full-term infants born between February 2020 and January 2021. Two groups were established: the experimental group (early sampling prior to clamping and sampling again after DCC) and the non-experimental group (sampling only after DCC). MEASUREMENTS AND FINDINGS: The comparison of arterial blood gas parameters was made using the Student t-test, while the Fisher's exact test was used to compare the proportion of the adverse effects recorded. The pH and base excess values in the experimental group were significantly greater when the sampling was performed without prior clamping. No statistically significant differences were observed in relation to pCO2 or the appearance of adverse effects between the two groups. No complications were recorded. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The pH and base excess values were higher when the arterial blood gas measurements were made prior to performing the umbilical cord clamping than when the sampling was performed after the DCC. Arterial blood gas sampling without prior clamping was found to be safe, since no complications or increased adverse effects were observed. The use of this technique is therefore advised in normal births of full-term infants.

Application of the ASCO value framework to evaluate the clinical and economic value of enzalutamide and apalutamide in the early stages of prostate cancer in Colombia.

Introduction: Prostate cancer has increased in recent years, increasing the costs associated with its treatment. Second-generation oral antiandrogens have emerged as an attractive therapeutic option. Objective: To compare the health value provided by enzalutamide and apalutamide, by evaluating two stages of prostate cancer: non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). Methods: To establish, through the American Society of Clinical Oncology (ASCO) value framework, a contrast between two technologies in two stages of prostate cancer. The monthly cost of the two technologies was calculated according to the current price regulation norm in Colombia. Results: Enzalutamide showed a higher net health benefit score compared to apalutamide for both nmCRPC (48.33 versus 33.46) and mHSPC (52.0 versus 40.75). The cost per net health benefit point for the nmCRPC stage was $214,723 Colombian Pesos (COP) ($54.84 USD) with enzalutamide compared to $291,925 COP ($74.56 USD) with apalutamide, and for the mHSPC stage was $199,692 COP ($51.00 USD) with enzalutamide and $239,701 COP ($61.22 USD) with apalutamide. Conclusion: After comparing enzalutamide versus apalutamide in the nmCRPC and mHSPC stages through the ASCO value framework, enzalutamide showed a more prominent net clinical benefit and a lower investment per point awarded.