Coinfección bacteriana en el paciente COVID-19 crítico: incidencia, impacto y necesidad de tratamiento antibiótico / Bacterial coinfection in the critically-ill COVID-19 patient: incidence, impact and need for antimicrobial therapy

Objetivos. Evaluar la frecuencia de coinfección bacteriana al ingreso en UCI en pacientes con neumonía por SARS-CoV-2, su microbiología e impacto en el pronóstico. El objetivo secun dario fue identificar factores de riesgo de coinfección al ingreso. Métodos. Estudio retrospectivo, se incluyeron pacientes con neumonía por SARS-CoV-2 ingresados en UCI. Definimos coinfección bacteriana por síntomas respiratorios, datos radioló gicos, resultados microbiológicos positivos y clínicamente signi ficativos en muestras obtenidas en las primeras 48 h de ingreso y/o una determinación de procalcitonina ≥ 0,5 ng/mL en las pri meras 48 h. Evaluamos variables demográficas, comorbilidades, datos de la infección por SARS-CoV-2, scores de gravedad, tra tamientos recibidos, necesidad de soporte respiratorio y resulta dos (estancia y mortalidad durante el ingreso en UCI y hospital). Resultados. Se analizaron 182 pacientes, 62 (34.1%) con coinfección bacteriana. La microbiología más frecuente fue S. pneumoniae y M. pneumoniae. El 96.1% de los pacientes re cibieron antibioterapia al ingreso, 98,9% corticoides, 27,5% tocilizumab y 7,7% remdesivir. El 85.7% necesitó ventilación mecánica invasiva. La puntuación en SOFA (OR: 1,315, IC 95% 1,116-1,548) y el retraso en el ingreso en UCI (OR: 0,899, IC 95% 0,831-0,972) se relacionaron con el riesgo de coinfección. La coinfección bacteriana aumenta el riesgo de muerte en el hospital (OR 2,283; IC 95% 1,011-5,151; p=0,047). Conclusiones. La coinfección bacteriana es frecuente en pacientes COVID ingresados en UCI y aumenta el riesgo de muerte. No es posible identificar con seguridad, en el momen to de ingreso, qué pacientes no se benefician de tratamiento antibiótico (AU)

ion upon ICU admission in SARS-CoV-2 pneumonia patients, its microbiology, and impact on prognosis.The secondary ob jective was to identify risk factors for coinfection on admis sion. Methods. Retrospective study, including patients with SARS-CoV-2 pneumonia admitted to the ICU.We defined bac terial coinfection by respiratory symptoms, radiological data, positive and clinically significant microbiological results in samples obtained in the first 48 h of admission and/or a de termination of procalcitonin ≥ 0.5 ng/mL in the first 48 h.We evaluated demographic variables, comorbidities, SARS-CoV-2 infection data, severity scores, treatments received, need for respiratory support and outcomes (ICU and hospital mortality). Results. A total of 182 patients were analyzed, 62 (34.1%) with bacterial coinfection.The most frequent microbiology was S. pneumoniae and M. pneumoniae.96.1% of the patients re ceived antibiotic therapy on admission, 98.9% corticosteroids, 27.5% tocilizumab, and 7.7% remdesivir.85.7% required inva sive mechanical ventilation.The SOFA score (OR: 1.315, 95% CI 1.116-1.548) and the delay in ICU admission (OR: 0.899, 95% CI 0.831-0.972) were related to the risk of coinfection.Bacterial coinfection increases the risk of death in hospital (OR 2.283; 95% CI 1.011.5.151; p=0.047). Conclusions. Bacterial coinfection is common in COVID patients admitted to the ICU and increases the risk of death.It is not possible to identify with certainty, at the time of admis sion, which patients do not benefit from antibiotic treatment (AU)

Surface Bragg gratings of proteins patterned on integrated waveguides for (bio)chemical analysis.

The incorporation of biomacromolecules onto silicon waveguiding microstructures constitutes a growing trend that pushes towards compact and miniaturized biosensing systems. This paper presents the integration of one-dimensional periodic nanostructures of proteins on the surface of micrometric silicon waveguides for transducing binding events between biomacromolecules. The study demonstrates this new bioanalytical principle by experimental results and theoretical calculations, and proves that rib waveguides (1--1.6-µm width) together with protein gratings (495--515-nm period) display suitable spectral responses for this optical biosensing system. Protein assemblies of bovine serum albumin are fabricated on the surface of silicon nitride waveguides, characterized by electron microscopy, and their response is measured by optical frequency domain reflectometry along the fabrication process and the subsequent stages of the biorecognition assays. Detection and quantification limits of 0.3 and 3.7 µg·mL-1, respectively, of specific antibodies are inferred from experimental dose-response curves. Among other interesting features, the results of this study point towards new miniaturized and integrated sensors for label-free bioanalysis.

Surface Micro-Patterned Biofunctionalized Hydrogel for Direct Nucleic Acid Hybridization Detection.

The present research is focused on the development of a biofunctionalized hydrogel with a surface diffractive micropattern as a label-free biosensing platform. The biosensors described in this paper were fabricated with a holographic recording of polyethylene terephthalate (PET) surface micro-structures, which were then transferred into a hydrogel material. Acrylamide-based hydrogels were obtained with free radical polymerization, and propargyl acrylate was added as a comonomer, which allowed for covalent immobilization of thiolated oligonucleotide probes into the hydrogel network, via thiol-yne photoclick chemistry. The comonomer was shown to significantly contribute to the immobilization of the probes based on fluorescence imaging. Two different immobilization approaches were demonstrated: during or after hydrogel synthesis. The second approach showed better loading capacity of the bioreceptor groups. Diffraction efficiency measurements of hydrogel gratings at 532 nm showed a selective response reaching a limit of detection in the complementary DNA strand of 2.47 µM. The label-free biosensor as designed could significantly contribute to direct and accurate analysis in medical diagnosis as it is cheap, easy to fabricate, and works without the need for further reagents.

Patterned Biolayers of Protein Antigens for Label-Free Biosensing in Cow Milk Allergy.

This paper focuses on creating one-dimensional diffractive grooved structures of antigen proteins on glass substrates for the label-free detection of antibodies to dairy allergens. In particular, the fabrication of protein structures is carried out by combining microcontact printing with physisorption, imines coupling, and thiol-ene click chemistry. The work first sets up these patterning methods and discusses and compares the main aspects involved in them (structure, biolayer thickness, functionality, stability). Homogeneous periodic submicron structures of proteins are created and characterized by diffractive measurements, AFM, FESEM, and fluorescence scanning. Then, this patterning method is applied to proteins involved in cow milk allergy, and the resulting structures are implemented as optical transducers to sense specific immunoglobulins G. In particular, gratings of bovine serum albumin, casein, and ß-lactoglobulin are created and assessed, reaching limits of detection in the range of 30-45 ng·mL-1 of unlabeled antibodies by diffractive biosensing.

Denaturing for Nanoarchitectonics: Local and Periodic UV-Laser Photodeactivation of Protein Biolayers to Create Functional Patterns for Biosensing.

The nanostructuration of biolayers has become a paradigm for exploiting nanoscopic light-matter phenomena for biosensing, among other biomedical purposes. In this work, we present a photopatterning method to create periodic structures of biomacromolecules based on a local and periodic mild denaturation of protein biolayers mediated by UV-laser irradiation. These nanostructures are constituted by a periodic modulation of the protein activity, so they are free of topographic and compositional changes along the pattern. Herein, we introduce the approach, explore the patterning parameters, characterize the resulting structures, and assess their overall homogeneity. This UV-based patterning principle has proven to be an easy, cost-effective, and fast way to fabricate large areas of homogeneous one-dimensional protein patterns (2 min, 15 × 1.2 mm, relative standard deviation ≃ 16%). This work also investigates the implementation of these protein patterns as transducers for diffractive biosensing. Using a model immunoassay, these patterns have demonstrated negligible signal contributions from non-specific bindings and comparable experimental limits of detection in buffer media and in human serum (53 and 36 ng·mL-1 of unlabeled IgG, respectively).

Parental Involvement in Homework During Covid-19 Confinement.

BACKGROUND: The purpose of this study was to compare parents' involvement in students' homework during COVID-19 confinement and their involvement in normal circumstances. METHOD: 628 parents of elementary and high school students completed a questionnaire about their family and family involvement in their children's homework. To address the objective, data were examined using mean differences and analysis of variance. RESULTS: As predicted, the COVID-19 situation led to more time spent doing homework for students, as well as higher levels of conflict and stress within the family. In addition, parents reported having increased their homework management during confinement in terms of emotional and motivational support for their children compared to normal circumstances. Finally, the data showed more conflicts and family involvement in the families of children with special needs compared to families of children without special needs. CONCLUSIONS: The time spent in confinement posed many challenges to families' routines and the data indicated a lack of resources available for families to manage their children's tasks, as well as an increase in family stress and conflicts.

Validation of the Shortened Version of the Metacognitive Awareness Inventory in Spanish Uiversity Students.

BACKGROUND: The Metacognitive Awareness Inventory (MAI) is used all over the world to identify metacognitive components that are relevant to learning. However, there is not enough evidence confirming its factorial structure or the suitability of its Shortened Version, proposed by various authors. Also, to date, the MAI has not been validated in the Spanish context. METHOD: After adapting the MAI to Spanish, it was administered to 1076 university students from different regions of Spain. Different structures of the MAI Shortened Version, with 19 items, were compared with the structures of the original 52-item MAI. Indexes of validity and reliability were analyzed, considering the factorial structure and relationships to other validated questionnaires. RESULTS: Only the MAI Shortened Version that differentiates between knowledge and regulation of cognition achieved a good fit. These two scales showed good convergent and divergent validity, high criterion validity in relation to academic achievement, high test- retest reliability, and high internal reliability. CONCLUSIONS: results support the traditional differentiation between knowledge of cognition and regulation of cognition, but only for the Shortened Version of the MAI. This instrument allows quick evaluations and identification of these components in Spanish contexts with adequate metric properties.

Vitamin E protects from lipid peroxidation during winter stress in the seagrass Cymodocea nodosa.

MAIN CONCLUSION: Adjustments in the antenna size and α-tocopherol contents provide protection from sustained damage in leaves of a seagrass, while low vitamin E contents appear to be enough to protect rhizomes (which appear to be more cold tolerant than leaves). Despite low temperatures can adversely affect the proper growth and development of marine angiosperms, by, among other processes, increasing reactive oxygen species production and causing oxidative damage to lipid membranes, the role of vitamin E in seagrasses, such as Cymodocea nodosa has not been explored thus far. Here, we aimed to better understand the possible role of this chain-breaking (peroxyl radical-trapping) antioxidant in response to low temperatures, and most particularly in relation to the occurrence of photo-inhibition and lipid peroxidation. Low temperatures caused an important desiccation of leaves, but not of rhizomes, which were much more tolerant to cold stress than leaves. Cold stress during winter was associated with chlorophyll loss and transient photo-inhibition, as indicated by reversible reductions in the Fv/Fm ratio. Adjustments in pigment antenna size and vitamin E contents per unit of chlorophyll during winter may help protect the photosynthetic apparatus from sustained photo-inhibitory damage and lipid peroxidation events in leaves. Rhizomes also accumulated significant amounts of vitamin E, although to a much lesser extent than leaves, and kept protected from lipid peroxidation during winter, as indicated by malondialdehyde contents, a product from secondary lipid peroxidation. It is concluded that vitamin E can help protect both leaves and rhizomes from lipid peroxidation, although cold stress during winter can cause transient photo-inhibition of the photosynthetic apparatus, in C. nodosa.

Parental Involvement in Homework During Covid-19 Confinement / Implicación Parental en los Deberes Escolares Durante el Confinamiento por Covid-19

Background: The purpose of this study was to compare parents’ involvement in students’ homework during COVID-19 confinement and their involvement in normal circumstances. Method: 628 parents of elementary and high school students completed a questionnaire about their family and family involvement in their children’s homework. To address the objective, data were examined using mean differences and analysis of variance. Results: As predicted, the COVID-19 situation led to more time spent doing homework for students, as well as higher levels of conflict and stress within the family. In addition, parents reported having increased their homework management during confinement in terms of emotional and motivational support for their children compared to normal circumstances. Finally, the data showed more conflicts and family involvement in the families of children with special needs compared to families of children without special needs. Conclusions: The time spent in confinement posed many challenges to families’ routines and the data indicated a lack of resources available for families to manage their children’s tasks, as well as an increase in family stress and conflicts.(AU)

Antecedentes: El propósito de este estudio fue comparar la implicación de los padres en los deberes de los hijos durante el período de confinamiento por Covid-19 con la implicación en circunstancias normales. Método: 628 padres de alumnos de Primaria y Secundaria respondieron a cuestiones sobre características de la familia y su implicación en los deberes escolares de los hijos. Para abordar el objetivo, los datos se estudiaron mediante diferencias de medias y análisis de varianza. Resultados: La situación de confinamiento llevó a que los estudiantes dedicaran más tiempo a hacer los deberes, así como a niveles más altos de conflictos y estrés dentro de la familia. Además, los padres informaron haber aumentado su implicación en los deberes en cuanto a apoyo emocional y motivacional dedicado a sus hijos en comparación con las circunstancias normales. Finalmente, se obtuvieron datos que muestran mayor cantidad de conflictos y estrés en familias con niños con necesidades especiales. Conclusiones: El confinamiento planteó muchos desafíos para las rutinas de las familias, observándose una falta de recursos disponibles de las familias para implicarse adecuadamente en las tareas escolares de sus hijos, así como un aumento del estrés y los conflictos familiares.(AU)

Validation of the Shortened Version of the Metacognitive Awareness Inventory in Spanish University Students / Validación de la Versión Abreviada del Inventario de Conciencia Metacognitiva en Estudiantes Universitarios Españoles

Background: The Metacognitive Awareness Inventory (MAI) is used all over the world to identify metacognitive components that are relevant to learning. However, there is not enough evidence confirming its factorial structure or the suitability of its Shortened Version, proposed by various authors. Also, to date, the MAI has not been validated in the Spanish context. Method: After adapting the MAI to Spanish, it was administered to 1076 university students from different regions of Spain. Different structures of the MAI Shortened Version, with 19 items, were compared with the structures of the original 52-item MAI. Indexes of validity and reliability were analyzed, considering the factorial structure and relationships to other validated questionnaires. Results: Only the MAI Shortened Version that differentiates between knowledge and regulation of cognition achieved a good fit. These two scales showed good convergent and divergent validity, high criterion validity in relation to academic achievement, high test- retest reliability, and high internal reliability. Conclusions: results support the traditional differentiation between knowledge of cognition and regulation of cognition, but only for the Shortened Version of the MAI. This instrument allows quick evaluations and identification of these components in Spanish contexts with adequate metric properties.(AU)

Antecedentes: El Inventario de Conciencia Metacognitiva (MAI) se utiliza internacionalmente para identificar componentes metacognitivos relevantes para el aprendizaje. Sin embargo, hay escasa evidencia sobre su estructura factorial y la validez de su Versión Reducida, propuesta por diversos autores. Asimismo, hasta el momento, no ha sido validado en el contexto español. Método: Tras adaptar los ítems del MAI al español, se administró a 1076 estudiantes universitarios de diferentes regiones de España. Se compararon varias estructuras de la Versión Reducida del MAI, con 19 ítems, y del MAI original, con 52 ítems. Se analizaron la validez y fiabilidad, considerando las estructuras factoriales y las relaciones con otros cuestionarios ya validados. Resultados: Sólo la Versión Reducida del MAI que diferencia conocimiento y regulación de la cognición alcanzó un ajuste aceptable. Estas dos escalas mostraron buena validez convergente y divergente, alta validez de criterio en relación al rendimiento académico, alta fiabilidad test-retest y alta consistencia interna. Conclusiones: los resultados apoyan la diferenciación tradicional entre conocimiento de la cognición y regulación de la cognición, pero solo con la adaptación al español de la Versión Reducida del MAI. Este instrumento permite evaluaciones cortas y la identificación de estos componentes con propiedades métricas adecuadas en contextos españoles.(AU)

Label-free detection of C-Reactive protein using bioresponsive hydrogel-based surface relief diffraction gratings.

Responsive hydrogel-based surface relief gratings have demonstrated great performances as transducers in optical sensing. However, novel and smart designs of hydrogels are needed for the appropriate detection of analytes and biomolecules since the existing materials are very limited to specific molecules. In this work, a biosensing system based on surface relief gratings made of bioresponsive hydrogels has been developed. In particular, the hydrogel contains phosphocholine moieties to specifically recognize C-Reactive protein (CRP). The CRP-Sensing hydrogel capacity to selectively detect CRP was fully demonstrated. Using Direct Laser Interference Patterning, micro-gratings were created on CRP-Sensing hydrogel substrates and applied for the label-free sensing of CRP using a simple laser-based homemade optical setup. Limits of detection (LOD) and quantification (LOQ) in human serum dilutions of 1.07 and 8.92 mg L-1, respectively, were reached. These results demonstrate that the biosensing system allows the selective label-free detection of CRP within concentration ranges around those related to risks of cardiovascular diseases and sepsis. Besides, amplification strategies have been carried out improving the sensitivity, widening the linear range, and reaching better LOD and LOQ (0.30 mg L-1 and 4.36 mg L-1). Finally, all the approaches were tested for the quantification of CRP in certified human serum with recoveries of around 100%.

[Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art].

Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art. BACKGROUND: The empirical evidence accumulated on the efficacy, effectiveness, and efficiency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and problems in childhood and adolescence. METHOD: A review was carried out of the psychological treatments for different psychological disorders and problems in social-emotional or behavioral adjustment in the child-adolescent population according to the Spanish National Health System (Clinical Practice Guidelines) levels of evidence and degrees of recommendation. RESULTS: The findings suggest that psychological treatments have empirical support for addressing a wide range of psychological problems in these developmental stages. The degree of empirical support ranges from low to high depending on the phenomenon analyzed. The review suggests unequal progress in the different fields of intervention. CONCLUSIONS: From this update, psychologists will be able to make informed decisions when implementing those empirically supported treatments to address the problems that occur in childhood and adolescence.

What Predicts Life Satisfaction in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD)? A Study from Parent and Child/Adolescent Perspectives.

The aim of this study was to analyze life satisfaction in a sample of 70 children and adolescents (M = 12.21, SD = 2.85) with Attention-Deficit/Hyperactivity Disorder (ADHD), according to parents' and children's/adolescents' reports. In addition, we examined the influence of a series of child/adolescent variables (ADHD presentation, and Conduct Disorder (CD) symptoms, age, gender, and pharmacological support status) on their levels of life satisfaction. Results indicated moderate correlations between children's/adolescents' and parents' perceptions of life satisfaction (r = .40; p < .01), with school being the area with the lowest levels of satisfaction. Also, 44.3% of the sample of parents reported that ADHD drastically interferes negatively in this context. Examining the effects of child/adolescent variables, only the variables age and CD symptoms generated statistically significant differences, showing that as children/adolescents grow up and/or present associate symptoms of CD, perceptions of life satisfaction tend to be more negative. These variables explained 34.5% of the variance of a composite score of life satisfaction, demonstrating a negative effect over the dependent variable. These results might have important implications for diagnosis and intervention in ADHD, as they highlight the relevance of considering life satisfaction as an important aspect to consider in both processes. Further studies must look more deeply into the mechanisms that explain these findings.

BIO bragg gratings on microfibers for label-free biosensing.

Discovering nanoscale phenomena to sense biorecognition events introduces new perspectives to exploit nanoscience and nanotechnology for bioanalytical purposes. Here we present Bio Bragg Gratings (BBGs), a novel biosensing approach that consists of diffractive structures of protein bioreceptors patterned on the surface of optical waveguides, and tailored to transduce the magnitude of biorecognition assays into the intensity of single peaks in the reflection spectrum. This work addresses the design, fabrication, and optimization of this system by both theoretical and experimental studies to explore the fundamental physicochemical parameters involved. Functional biomolecular gratings are fabricated by microcontact printing on the surface of tapered optical microfibers, and their structural features were characterized. The transduction principle is experimentally demonstrated, and its quantitative bioanalytical prospects are assessed in a representative immunoassay, based on patterned protein probes and selective IgG targets, in label-free conditions. This biosensing system involves appealing perspectives to avoid unwanted signal contributions from non-specific binding, herein investigated in human serum samples. The work also proves how the optical response of the system can be easily tuned, and it provides insights into the relevance of this feature to conceive multiplexed BBG systems capable to perform multiple label-free biorecognition assays in a single device.

Prevention of severe COVID-19 in the elderly by early high-titer plasma

BackgroundTherapies to interrupt progression of early COVID-19 remain elusive. Among them, convalescent plasma in hospitalized patients was unsuccessful, perhaps because antibody should be administered earlier. We advanced plasma infusions to the first 72 hours of symptoms to arrest COVID-19 progression. MethodsA randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against SARS-CoV2 in elderly subjects within 72 hours of mild COVID-19 symptoms. The primary endpoint was severe respiratory disease defined as a respiratory rate [≥]30 and/or an O2 sat<93% in room air. The study was interrupted at 76% of its projected sample size, because cases in the region decreased considerably and steady enrollment of study subjects became virtually impossible. Results160 patients underwent randomization. In the intention-to-treat analysis (ITT), 13/80(16.2%) patients receiving plasma vs. 25/80(31.2%) receiving placebo experienced severe respiratory disease [RR(95%CI)= 0.52(0.29,0.94); p=0.026)] with an RRR=48%. A modified ITT analysis, excluding six subjects who experienced the primary endpoint before infusion, showed a larger effect size [RR(95%CI) = 0.40(0.20, 0.81), p=0.007]. High- and low-titer donor analyses, based on a median IgG titer=1:3,200, evidenced a dose-dependent response with an RRR=73.3% for recipients of high-titer plasma (p=0.016) and a number needed to treat (NNT)=4.4. All secondary endpoints exhibited trends towards protection. No solicited adverse events were observed. ConclusionsEarly administration of high-titer convalescent plasma against SARS-CoV2 to mildly ill infected seniors reduced COVID-19 progression. This safe, inexpensive, outpatient intervention facilitates access to treatment from industrialized to LMIC, can decompress demands on hospitals, and may contribute to save lives. Funded by The Bill & Melinda Gates Foundation and The Fundacion INFANT Pandemic Fund. Registered in the Direccion de Sangre y Medicina Transfusional del Ministerio de Salud (PAEPCC19), Plataforma PRIISA (1421), and clinicaltrials.gov (NCT04479163). All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; RL, GPM, DW and FPP are investigators in a phase 3 SARS CoV2 trial from Pfizer; no other relationships or activities that could appear to have influenced the submitted work.

Personal and Instructional Variables Related to the Learning Process in Postgraduate Courses / Variables Personales e Instruccionales Relacionadas con el Proceso de Aprendizaje en los Estudios de Postgrado

BACKGROUND: The aim of the present study was to analyze the relationship between different student characteristics (gender, reason for choosing the master's degree and specialty), the instructional context (perceived quality of the instructional process), and the characteristics of the learning process (practical learning strategies and study approach) in postgraduate study. METHOD: 621 students completed the Motivated Strategies for Learning Questionnaire, the Inventory of Study Processes, the Inventory of Self-Regulatory Learning Processes and a questionnaire developed ad hoc about instructional processes. RESULTS: The data indicates notable differences between men's and women's involvement in their postgraduate study. Furthermore, the results also suggest that it is only when postgraduate courses are done for vocational reasons and students receive quality instruction that the two factors ensure students prioritize deep learning processes (e.g., significant learning, reflections on meaning, comprehensive learning) versus a surface learning approach. (e.g., memorization, lack of reflection). CONCLUSIONS: The results may be of interest for the design of postgraduate university education policy in relation to the selection processes for both students and teachers

ANTECEDENTES: en el presente estudio se pretendió analizar la relación entre diferentes características del estudiante (género, el motivo de la realización del máster y la especialidad realizada) y del contexto instruccional (percepción de la calidad del proceso instruccional recibido) y las características del proceso de estudio (estrategias de aprendizaje utilizadas y enfoque de estudio) en los estudios de postgrado. MÉTODO: 621 estudiantes contestaron al Motivated Startegies for Learning Questionnaire, al Inventario de Procesos de Estudio, al Inventario de Procesos de Autorregulación del Aprendizaje y a un cuestionario construido ad hoc sobre procesos instruccionales. RESULTADOS: los datos obtenidos muestran diferencias importantes en la implicación de hombres y mujeres en su formación de postgrado. Asimismo, también sugieren que únicamente cuando se accede a los estudios de postgrado por motivos vocacionales y, una vez dentro, se tiene lugar un proceso instruccional de calidad está garantizado que los estudiantes prioricen procesos de aprendizaje profundo (e.g., significativo, comprensivo) sobre el uso de un enfoque de estudio superficial (e.g., memorístico, sumativo). CONCLUSIONES: se concluye que los resultados obtenidos pueden tener interés para el diseño de la política educativa universitaria de postgrado, de cara al proceso de selección tanto de los estudiantes y como del profesorado

Personal and Instructional Variables Related to the Learning Process in Postgraduate Courses.

BACKGROUND: The aim of the present study was to analyze the relationship between different student characteristics (gender, reason for choosing the master's degree and specialty), the instructional context (perceived quality of the instructional process), and the characteristics of the learning process (practical learning strategies and study approach) in postgraduate study. METHOD: 621 students completed the Motivated Strategies for Learning Questionnaire, the Inventory of Study Processes, the Inventory of Self-Regulatory Learning Processes and a questionnaire developed ad hoc about instructional processes. RESULTS: The data indicates notable differences between men's and women's involvement in their postgraduate study. Furthermore, the results also suggest that it is only when postgraduate courses are done for vocational reasons and students receive quality instruction that the two factors ensure students prioritize deep learning processes (e.g., significant learning, reflections on meaning, comprehensive learning) versus a surface learning approach. (e.g., memorization, lack of reflection). CONCLUSIONS: The results may be of interest for the design of postgraduate university education policy in relation to the selection processes for both students and teachers.

Multimodal Protocol for Assessing Metacognition and Self-Regulation in Adults with Learning Difficulties.

Learning disabilities (LDs) encompass disorders of those who have difficulty learning and using academic skills, exhibiting performance below expectations for their chronological age in the areas of reading, writing, and/or mathematics. Each of the disorders making up the LDs involve different deficits; however, some commonalities can be found within that heterogeneity, such in terms of learning self-regulation and metacognition. Unlike in early ages and later educational levels, there are hardly any evidence-based evaluation protocols for adults with LDs. LDs influence academic performance but also have serious consequences in professional, social, and family contexts. In response to this, the current work proposes a multimodal evaluation protocol focused on metacognitive, self-regulation of learning, and emotional processes, which make up the basis of the difficulties in adults with LDs. The assessment is carried out through analysis of the on-line learning process using a variety methods, techniques, and sensors (e.g., eye tracking, facial expressions of emotion, physiological responses, concurrent verbalizations, log files, screen recordings of human-machine interactions) and off-line methods (e.g., questionnaires, interviews, and self-report measures). This theoretically-driven and empirically-based guideline aims to provide an accurate assessment of LDs in adulthood in order to design effective prevention and intervention proposals.

Cytokine production in thyroid eye disease: in vitro effects of dexamethasone and IL-6 blockade with tocilizumab.

PURPOSE: To compare IL-6, sIL-6R, and IL-17 secretion in peripheral blood mononuclear cells (PBMCs) cultured with tocilizumab (a humanized monoclonal antibody against the interleukin-6 receptor), dexamethasone, and placebo, obtained from patients with thyroid eye disease (TED) and healthy controls. METHODS: The study was a prospective proof of concept test. We cultured peripheral blood mononuclear cells from TED patients and healthy controls with tocilizumab, dexamethasone, and placebo. IL-6, sIL-6R, and IL-17 levels in supernatants obtained from PBMCs cultures were analyzed by ELISA. RESULTS: We included seventeen patients with thyroid eye disease (12 females and five males). The mean age was 49 years. Both dexamethasone and tocilizumab influenced IL-6 and IL-6Rs levels in patients' group. Supernatants obtained from PBMCs treated with dexamethasone showed 77.2% and 82.8% lower IL-6 levels compared with those cultured with placebo and tocilizumab, respectively. Furthermore, overnight culture of PBMCs with dexamethasone showed significantly lower sIL-6R secretion compared with untreated (33.71%, p = 0.04) and tocilizumab treated (58.21%, p = 0.01) PBMCs. Neither dexamethasone nor tocilizumab affected IL-17 concentrations in PBMCs cultures. CONCLUSIONS: Both dexamethasone and tocilizumab affect the IL-6/sIL-6R system. Specifically, dexamethasone reduces and tocilizumab increases the levels of these cytokines in PBMCs cultures. These results strengthen the molecular rationale for interrogating the efficacy of tocilizumab in steroid-resistant TED, as IL-6 seems to be a common target for both anti-IL-6R antibody and steroids.

Supplementation with high-content docosahexaenoic acid triglyceride in attention-deficit hyperactivity disorder: a randomized double-blind placebo-controlled trial.

Background: Attention-deficit hyperactivity disorder (ADHD) is a complex disorder in terms of etiology, clinical presentation, and treatment outcome. Pharmacological and psychological interventions are recommended as primary treatments in ADHD; however, other nonpharmacological intervention such as a dietary supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFAs) has emerged as an attractive option. Purpose: The objective of the present study was to assess whether dietary supplementation with highly concentrated ω-3 docosahexaenoic acid (DHA) triglyceride may improve symptoms in ADHD. Method: A 6-month prospective double-blind placebo-controlled randomized clinical trial was designed in 66 patients with ADHD, aged between 6 and 18 years. Participants in the experimental group received a combination of ω-3 fatty acids (DHA 1,000 mg, eicosapentaenoic acid 90 mg, and docosapentaenoic acid 150 mg). Instruments included d2-test, AULA Nesplora, EDAH scales, and abbreviated Conner's Rating Scale. Results: In the cognitive test, between-group differences were not found, but within-group differences were of a greater magnitude in the DHA group. Between-group differences in favor of the DHA arm were observed in behavioral measures, which were already detected after 3 months of treatment. Results were not changed when adjusted by ADHD medication. Conclusions: This study provides further evidence of the beneficial effect of supplementation with ω-3 DHA in the management of ADHD.