Models to predict bacteremia in the emergency department: a systematic review. / Modelos predictivos de bacteriemia en el servicio de urgencias: revisión sistemática.

OBJECTIVES: Blood cultures are ordered in emergency departments for 15% of patients with suspected infection. The diagnostic yield varies from 2% to 20%. Thirty-day mortality in patients with bacteremia is high, doubling or tripling the rate in patients with the same infection but without bacteremia. Thus, finding an effective model to predict bacteremia that is applicable in emergency departments is an important goal. Shapiro's model is the one traditionally used as a reference internationally. The aim of this systematic review was to compare the predictive power of bacteremia risk models published since 2008, when Shapiro's model first appeared. MATERIAL AND METHODS: We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, searching in the following databases for articles published between January 2008 and May 31, 2023: PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Trip Medical Database, and ClinicalTrials.gov. No language restrictions were specified. The search terms were the following Medical Subject Headings: bacteremia/bacteraemia/blood stream infection, prediction model/clinical prediction rule/risk prediction model, emergencies/emergency/emergency department, and adults. Observational cohort studies analyzing diagnostic yield were included; case-control studies, narrative reviews, and other types of articles were excluded. The Newcastle-Ottawa Scale was used to score quality and risk of bias in the included studies. The results were compared descriptively, without meta-analysis. The protocol was included in the PROSPERO register (CRD42023426327). RESULTS: Twenty studies out of a total of 917 were found to meet the inclusion criteria. The included studies together analyzed 33 182 blood cultures, which detected 5074 cases of bacteremia (15.3%). Eleven studies were of high quality, 7 of moderate quality, and 2 of low quality. The area under the receiver operating characteristic curve (AUC) of Shapiro's model varied from 0.71 to 0.83. Sensitivity was as high as 98%, and specificity ranged from 26% to 69%. Three models with high scores for quality were also supported by both internal and external validation studies: Lee's model (AUC, 0.81; sensitivity 68%; specificity, 81%), the 5MPB-Toledo model (AUC, 0.906 to 0.946), and the MPB-INFURG-SEMES model (AUC, 0.924; sensitivity, 97%; specificity, 76%. CONCLUSION: The 5MPB-Toledo and MPB-INFURG-SEMES are useful for assessing the true risk of bacteremia in patients attended in emergency departments.

OBJETIVO: La obtención de hemocultivos (HC) se realiza en el 15% de los pacientes atendidos con sospecha de infección en los servicios de urgencias (SU) con una rentabilidad diagnóstica variable (2-20%). La mortalidad a 30 días de estos pacientes con bacteriemia es elevada, doble o triple que el resto con el mismo proceso. Así, encontrar un modelo predictivo de bacteriemia eficaz y aplicable en los SU sería muy importante. Clásicamente, el modelo de Shapiro ha sido la referencia en todo el mundo. El objetivo de esta revisión sistemática (RS) es comparar la capacidad para predecir bacteriemia en los SU de los distintos modelos predictivos publicados desde el año 2008 (fecha de publicación del modelo de Shapiro). METODO: Se realiza una RS siguiendo la normativa PRISMA en las bases de datos de PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase y ClinicalTrials.gov desde enero de 2008 hasta 31 mayo 2023 sin restricción de idiomas y utilizando una combinación de términos MESH: "Bacteremia/Bacteraemia/Blood Stream Infection", "Prediction Model/Clinical Prediction Rule/Risk Prediction Model", "Emergencies/Emergency/Emergency Department" y "Adults". Se incluyeron estudios de cohortes observacionales (analíticos de rendimiento diagnóstico). Para valorar la calidad del método empleado y el riesgo de sesgos de los artículos incluidos se utilizó la Newcastle-Ottawa Scale (NOS). No se incluyeron estudios de casos y controles, revisiones narrativas y en otros tipos de artículos. No se realizaron técnicas de metanálisis, pero los resultados se compararon narrativamente. El protocolo de la RS se registró en PROSPERO (CRD42023426327). RESULTADOS: Se identificaron 917 artículos y se analizaron finalmente 20 que cumplían los criterios de inclusión. Los estudios incluidos contienen 33.182 HC procesados con 5.074 bacteriemias (15,3%). Once estudios fueron calificados de calidad alta, 7 moderada y 2 baja. El ABC-COR conseguida por el modelo de Shapiro varía de 0,71 a 0,83, con sensibilidad (Se) hasta del 98%, con especificidad (Es) (26% a 69%). Para los tres modelos que tienen validación interna y externa y una buena calidad metodológica, el modelo de Lee consigue un ABC-COR de 0,81 con Se: 68% y Es: 81%, el modelo 5MPB-Toledo consigue un ABC-COR entre 0,91 y 0,95, y el MPB-INFURG-SEMES obtiene una ABC-COR de 0,92 con una Se: 97% y Es: 76%. CONCLUSIONES: Los modelos 5MPB-Toledo y MPB-INFURG-SEMES representan herramientas útiles para la estratificación del riesgo real de bacteriemia en los pacientes atendidos en los SU.

Precisión diagnóstica de la procalcitonina para la bacteriemia en el servicio de urgencias: una revisión sistemática / Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Introducción. La obtención de hemocultivos (HC) se realiza en el 15% de los pacientes atendidos con sospecha de infección en los Servicios de Urgencias Hospitalarios (SUH) con unarentabilidad diagnóstica variable (2-20%). La mortalidad a 30 días de los pacientes con bacteriemia es dos o tres veces mayor que el resto con el mismo proceso. La procalcitonina (PCT) es un biomarcador que se ha utilizado como herramienta de ayuda en la predicción de bacteriemia en los SUH. El objetivo principal de esta revisión sistemática es investigar la precisión diagnóstica de la PCT para predecir bacteriemia verdadera en los pacientes adultos atendidos con sospecha clínica de infección enel SUH, así como identificar un valor específico de PCT como el más relevante desde el punto de vista diagnóstico de decisión clínica que pueda recomendarse para la toma de decisiones. Método. Se realiza una revisión sistemática siguiendo la normativa PRISMA en las bases de datos de PubMed, Web of Sciencie, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase y ClinicalTrials.gov desde enero de 2010 hasta 31 mayo 2023 sin restricción de idiomas y utilizando una combinación de términos MESH: “Bacteremia/Bacteraemia/Blood Stream Infection”, “Procalcitonin”, “Emergencies/Emergency/ Emergency Department” y “Adults”. Se incluyeron estudios de cohortes observacionales y parcialmente una revisión sistemática. No se realizaron técnicas de metaanálisis, pero los resultados se compararon narrativamente. Resultados. Se identificaron un total de 1.372 artículos de los cuales se analizaron finalmente 20 que cumplían los criterios de inclusión. Los estudios incluidos representan un total de 18.120 HC procesados con 2.877 bacteriemias (15,88%). Diez estudios fueron calificados de calidad alta, 9 moderada y 1 baja. El ABC-COR de todos los estudios se sitúa desde 0,68 (IC 95%: 0,59-0,77) hasta 0,98 (IC 95%: 0,97-0,99). . ...Conclusiones. ... . (AU)

Introduction. Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making. Method. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials. gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: “Bacteremia/ Bacteraemia/ Blood Stream Infection”, “Procalcitonin”, “Emergencies/ Emergency/ Emergency Department” and “Adults”. Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively. Results. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97- 0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. ...Conclusions. ... (AU)

Arthroscopic Assistance in Surgical Management of Distal Radius Fractures: A Systematic Review and Meta-analysis.

Background Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance. Methods Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed. Two authors independently performed the search and data extraction and assessed risk of bias (RoB) using the Cochrane RoB tool. Results A total of 1,780 relevant abstracts and citations were extracted in the preliminary search, which yielded 6 trials that met the eligibility criteria, and 3 studies were included in the quantitative synthesis. The overall pooled mean difference (MD) estimate showed no significant difference in the Disabilities of the Arm, Shoulder, and Hand scores between surgical groups with and without arthroscopic assistance (MD = 0.77 points, 95% confidence interval = -6.58 to 5.03, p = 0.79), with substantial heterogeneity (I 2 = 85%). Conclusion There was low-quality evidence that wrist arthroscopy conveyed not clinically or statistically significant difference to functional outcomes of patients with DRFs. However, our findings are limited by the numbers of studies included and lack of long-term follow-up, although they do provide a good starting point for future quality research.

Influence of trunk rotator strength on rotational medicine ball throwing performance.

BACKGROUND: The strength of the trunk musculature plays an essential role in performance. The aims of this study were to analyze the relationship between the strength of the trunk rotation muscles with rotational medicine ball throwing velocity and distance, to study differences between sex in rotational medicine ball throwing and to compare the asymmetries of trunk rotational strength and rotational medicine ball throwing. METHODS: Thirty physically active college students participated on the study. Horizontal and low cable woodchop exercises were assessed with a functional electromechanical dynamometer and throwing was measured with a radar and a measuring tape. A Pearson's correlation coefficient was calculated for the relation between trunk rotational strength and rotational medicine ball throwing. Independent samples t-test was performed to determine the differences between sex in rotational medicine ball throwing and a paired samples t-test was performed to study the asymmetries. RESULTS: Large and very large correlations were obtained between trunk rotational strength and rotational medicine ball throwing (r=0.68-0.79). Significant differences and a large effect size were found between males and females for all throwing velocity and throwing distance variables (P<0.05; ES>0.90) and asymmetries in performance of mean velocity throwing (P=0.003; ES=-0.60) and peak velocity throwing (P=0.025; ES=-0.43). No significant differences were found between dominant and non-dominant side in any of the trunk rotator strength assessment conditions (P>0.05). CONCLUSIONS: There is a large or very large correlation between the STRM and the RMBT in all its modalities. Differences in strength were found between sexes, with no significant differences between dominant and non-dominant sides.

Influence of the practice of physical exercise and healthy eating on the Vigour of university lectures.

Introduction: Vigour at work is characterized by high levels of energy and high desire to make an effort at work. This article is the result of a research carried out with university teachers in Spain whose main objective is to show what type and frequency of physical exercise and diet influence Vigour. Methods: The sample consisted of 121 subjects, 62% of whom were women and 37.2% men. A questionnaire was administered to collect information on sociodemographic data, physical exercise habits, eating habits and Vigour at work. Cross-tabulations of the dimensions of Vigour with sex, age and type of contract offered were performed. Spearman correlations and Correspondence Analysis are also carried out to provide information on the intensity and type of relationships between the Vigour dimensions. Finally, the influence of the frequency of physical exercise and diet on Total Vigour is investigated. Results: The results show that the relationships between the dimensions are very strong (sig = 0.001). In addition, the practice of moderate-high intensity physical exercise and maintaining a good adherence to the Mediterranean Diet is related to high levels of Total Vigour (F = 7.955; sig = 0.006). As for the influence of the sociodemographic variables used, significant differences were only observed in the Physical Strength dimension for sex (X2 = 6.173; p = 0.046) and age (X2 = 9.449; p = 0.051) and, with respect to the type of contract, in Emotional Energy (X2 = 19.487; p < 0.001). Discusión and conclusions: The main conclusions of our study show that practicing physical exercise of medium-high intensity four hours or more per week and a high adherence to the MD is more related to high Vigour levels than just eating well or just practicing exercise. And more studies are needed on the influence of sociodemographic variables on Vigour and its different dimensions.

Vertical Versus Horizontal Training for Improving the Change of Direction Speed in Adult Basketball Players: A Systematic Review and Meta-analysis.

ABSTRACT: Barrera-Domínguez, FJ, Martínez-García, D, Jerez-Mayorga, D, Chirosa-Ríos, LJ, Almagro, BJ, and Molina-López, J. Vertical versus horizontal training for improving the change of direction speed in adult basketball players: a systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2023-The ability to perform changes of direction (COD) is a complex skill that involves the application of multiple force-orientations, and its execution at maximum speed is crucial in basketball players. The present study aimed to synthesize findings from previous interventions classified according to force-orientation (vertical, horizontal, or mixed) and determine their magnitude of the effect on COD performance in basketball players. A systematic review of the literature was performed in several databases (Web of Science, Scopus, SPORTDiscus, and PubMed) following the PRISMA statement and reviewed the quality of the included papers according to the Cochrane Collaboration Guidelines Assessment. Sixteen articles with a total of 21 reports were included to analyze the role of force-orientations in COD performance. For the meta-analysis, the standardized mean differences with 95% confidence intervals (CIs) were calculated to determine the chronic changes induced by training and performed an effect size (ES) analysis with a random-effects model. The results showed that all force-orientations generated improvements in COD performance (ES = -0.47 [95% CI -0.57, -0.36], Z = 8.74 [p < 0.01]). It was a mixed force-orientation that produced the greatest changes (ES = -0.91 [95% CI -1.27, -0.55], Z = 4.96 [p < 0.01]), followed by vertical training (ES = -0.45 [95% CI -0.70, -0.20], Z = 3.51 [p < 0.01]). Horizontal training was the least studied and showed the smallest change (ES = -0.10 [95% CI -0.14, -0.07], Z = 5,71 [p < 0.01]). This meta-analysis demonstrates that mixed vertical and horizontally oriented training may be the most optimal because it offers a greater variety of multidirectional stimuli that better prepares the athlete to deal with complex COD in real-game situations.

Solar-pumped dual-rod Ce:Nd:YAG laser with 58 W continuous-wave output power and 5.1° tracking error compensation width.

The pursuit of high-power solar laser systems with high efficiency and capacity for large tracking error compensation is determinant for the applicability of this renewable technology. A side-pumped dual-rod Ce:Nd:YAG solar laser was developed and tested at the focus of a 2 m diameter parabolic concentrator. Maximum continuous-wave total solar laser power of 58 W was measured. To the best of our knowledge, this is the highest laser power from a Ce:NdYAG solar laser. Moreover, wide tracking error compensation width of 5.1° in the azimuthal direction was reached, being 4.25 times higher than the previous measurement without solar tracking assistance.

Pharmacological treatment for challenging behavior in adults with intellectual disability: Systematic review and meta-analysis.

INTRODUCTION: Few evidence on the use of antipsychotics in people with intellectual disabilities and challenging behaviors, generates the need to develop studies that contribute to collect, compare and synthesize the available information. The present systematic review and meta-analysis aims to determine the clinical efficacy of antipsychotic medication in reducing critical episodes in this population. METHODS: We searched Web of Science, Scopus, EBSCO, Embase, and PubMed for randomized controlled trials of antipsychotic medication versus placebo. Preliminarily yielded 1354 abstracts and citations; six studies with 274 subjects met the inclusion criteria of studies with experimental design, longitudinal type, with pre- and post-intervention measurements. RESULTS: There is evidence for the use of psychotropic drugs in the acute management of challenging behaviors in patients with intellectual disability (SMD=-0.85; 95% CI=-1.69 to -0.01; p=0.05). CONCLUSIONS: Our results coincide with the recommendations on the efficacy of the use of antipsychotics. Although our study provides evidence, the limited number of studies included in this research does not allow us to obtain totally conclusive results, although it can be considered as a guide for future studies.

Core training and performance: a systematic review with meta-analysis.

The purposes were to synthesize as much scientific evidence as possible to determine the effect of core training on balance, throwing/hitting velocity or distance, and jumping in healthy subjects, identify the possible differences between isolated and combined core training on performance and study training and sample variables related to performance. PRISMA guidelines were followed, and a systematic search was performed in the Scopus, Web of Science, Sports Discuss, and PubMed databases with no date restrictions until November 2022. The studies were considered for this meta-analysis following PICO; a) randomized control trials and randomized allocation studies with healthy subjects and > 12 years old b)isolated or combined core training programs with a minimum of 4 weeks in length; c) athletic performance outcomes for balance, throw/hit, and jump variables should be measured; d) sufficient data to calculate effect sizes. The Cochrane Collaboration Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation approach were used for assessing methodological quality. A total of 3223 studies were identified, 22 studies were included in the systematic review and 21 for the meta-analysis. We observed that core training improved balance outcomes (ES = 1.17; p < 0.0001), throwing/hitting velocity (ES = 0.30; p = 0.14), throwing/hitting distance (ES = 3.42; p = 0.03), vertical jumping (ES = 0.69; p = 0.0003), and horizontal jump (ES = 0.84; p = 0.01). Our findings indicate that core training improved different variables of performance such as balance, throw/hit, and vertical and horizontal jump.

Strength Assessment of Trunk Rotator Muscles: A Multicenter Reliability Study.

BACKGROUND: Trunk rotator strength plays an important role in sports performance and health. A reliable method to assess these muscles with functional electromechanical dynamometer has not been described. Therefore, the objectives of this paper were (I) to explore the reliability of different strength variables collected in isokinetic and isometric conditions during two trunk rotator exercises, and (II) to determine the relationship of isometric and dynamic strength variables collected in the same exercise. METHODS: A repeated measures design was performed to evaluate the reliability of the horizontal cable woodchop (HCW) and low cable woodchop (LCW) exercises. Reliability was assessed using t-tests of paired samples for the effect size, the standard error of measurement, the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). The Pearson's (r) correlation coefficient was used to explore the association between isometric and isokinetic tests. RESULTS: HCW exercise is more reliable than LCW exercise in assessing trunk rotator muscles. The strength manifestation that should be used is the average strength, and the most reliable evaluation was the HCW at 0.40 m·s-1 concentric (ICC = 0.89; CV = 10.21%) and eccentric (ICC = 0.85; CV = 9.33%) contraction and the dynamic condition that most correlated with the isometric was LWC at 0.50 m·s-1 (r = 0.83; p < 0.01). CONCLUSION: HCW is a reliable exercise to measure trunk rotator muscles.

Comparación de la violencia y agresiones sufridas por el personal de salud durante la pandemia de COVID-19 en Argentina y el resto de Latinoamérica / Comparison of violence and aggressions suffered by health personnel during the COVID-19 pandemic in Argentina and the rest of Latin America

RESUMEN Objetivos. Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. Materiales y métodos. Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. Resultados. Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). Conclusiones. Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.

ABSTRACT Objectives. To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. Materials and methods. A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. Results. A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). Conclusions. There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.

The IFN-stimulated gene IFI27 counteracts innate immune responses after viral infections by interfering with RIG-I signaling.

The recognition of viral nucleic acids by host pattern recognition receptors (PRRs) is critical for initiating innate immune responses against viral infections. These innate immune responses are mediated by the induction of interferons (IFNs), IFN-stimulated genes (ISGs) and pro-inflammatory cytokines. However, regulatory mechanisms are critical to avoid excessive or long-lasting innate immune responses that may cause detrimental hyperinflammation. Here, we identified a novel regulatory function of the ISG, IFN alpha inducible protein 27 (IFI27) in counteracting the innate immune responses triggered by cytoplasmic RNA recognition and binding. Our model systems included three unrelated viral infections caused by Influenza A virus (IAV), Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), and Sendai virus (SeV), and transfection with an analog of double-stranded (ds) RNA. Furthermore, we found that IFI27 has a positive effect on IAV and SARS-CoV-2 replication, most likely due to its ability to counteract host-induced antiviral responses, including in vivo. We also show that IFI27 interacts with nucleic acids and PRR retinoic acid-inducible gene I (RIG-I), being the interaction of IFI27 with RIG-I most likely mediated through RNA binding. Interestingly, our results indicate that interaction of IFI27 with RIG-I impairs RIG-I activation, providing a molecular mechanism for the effect of IFI27 on modulating innate immune responses. Our study identifies a molecular mechanism that may explain the effect of IFI27 in counterbalancing innate immune responses to RNA viral infections and preventing excessive innate immune responses. Therefore, this study will have important implications in drug design to control viral infections and viral-induced pathology.

Stable emission of solar laser power under non-continuous solar tracking conditions.

Solar laser technology typically requires a highly accurate solar tracking system that operates continuously, which increases energy consumption and reduces the system's lifetime. We propose a multi-rod solar laser pumping approach to enhance solar laser stability under non-continuous solar tracking conditions. Using a heliostat, solar radiation is redirected toward a first-stage parabolic concentrator. At its focus, an aspheric lens further concentrates the solar rays onto five Nd:YAG rods positioned within an elliptical-shaped pump cavity. Numerical analysis using Zemax and LASCAD software showed that the tracking error width at 10% laser power loss for the five 6.5 mm diameter and 15 mm length rods was 2.20°, which is 50% higher than that of the solar laser in previous non-continuous solar tracking experiments. 2.0% solar-to-laser conversion efficiency was also attained.

Effects of Power Training on Functional Capacity Related to Fall Risk in Older Adults: A Systematic Review and Meta-analysis.

OBJECTIVE: Functional capacity is 1 of the main risk factors for falls among older adults. The aim of this systematic review and meta-analysis was to determine the effect of power training on functional capacity test (FCT) related to fall risk in older adults. DATA SOURCES: Systematic searches were conducted in 4 databases, including PubMed, Web of Science, Scopus, and SPORTDiscus, from inception to November 2021. STUDY SELECTION: Randomized controlled trials (RCTs) assessing the effect of power training on functional capacity compared with another type of training program or control group in older adults with the ability to exercise independently. DATA EXTRACTION: Two independent researchers evaluated eligibility and used the PEDro scale to assess risk of bias. The information extracted was related to article identification (authors, country and year of publication), participant characteristics (sample, sex, and age), strength training protocols (exercises/intensity/weeks), and the outcome of the FCT used related to fall risk. The Cochran Q statistic and I2 statistics was used to assess heterogeneity. Random-effects model were conducted to pool the effect sizes expressed as mean differences (MD). DATA SYNTHESIS: Twelve studies (478 subjects) were selected for systematic review. A meta-analysis comprised 6 studies (217 subjects) where the outcome measure was the 30-second Sit to Stand (30s-STS) test, and another comprised 4 studies (142 subjects) where the outcome measure was the timed Up and Go (TUG) test. There was an improvement in performance in favor of the experimental group in both the TUG subgroup (MD -0.31 s; 95% CI -0.63, 0.00 s; P=.05), and the 30s-STS subgroup (MD 1.71 reps; 95% CI -0.26, 3.67 reps; P=.09). CONCLUSIONS: In conclusion, power training increases functional capacity related to fall risk further than other types of exercise in older adults.

Influence of the body positions adopted for resistance training on intraocular pressure: a comparison between the supine and seated positions.

OBJECTIVES: A variety of factors are known to mediate on the intraocular pressure (IOP) response to resistance training. However, the influence of the body position adopted during resistance training on IOP remain unknown. The objective of this study was to determine the IOP response to the bench press exercise at three levels of intensity when performed in supine and seated positions. METHODS: Twenty-three physically active healthy young adults (10 men and 13 women) performed 6 sets of 10 repetitions against the 10-RM (repetition maximum) load during the bench press exercise against three levels of intensity (high intensity: 10-RM load; medium intensity: 50% of the 10-RM load; and control: no external load) and while adopting two different body positions (supine and seated). A rebound tonometer was employed to measure IOP in baseline conditions (after 60 s in the corresponding body position), after each of the 10 repetitions, and after 10 s of recovery. RESULTS: The body position adopted during the execution of the bench press exercise significantly affected the changes in IOP (p < 0.001, ηp2 = 0.83), with the seated position providing lower increases in IOP levels compared to the supine position. There was an association between IOP and exercise intensity, with greater IOP values in the more physically demanding conditions (p < 0.001, ηp2 = 0.80). CONCLUSIONS: The use of seated positions, instead of supine positions, for the execution of resistance training should be prioritized for maintaining more stable IOP levels. This set of findings incorporates novel insights into the mediating factors on the IOP response to resistance training. In future studies, the inclusion of glaucoma patients would allow to assess the generalizability of these findings.

Adolescent Behaviours and Their Relationship to the Risk of Developing Eating Disorders.

Eating disorders (ED) in adolescents represent a significant problem in today's society, with multiple factors influencing them, such as predisposing factors, precipitating factors and perpetuating factors. OBJECTIVE: This paper aimed to determine the relationships between some of the factors considered to be predisposing and precipitating in terms of the development of ED in adolescents and to relate them to the SCOFF index. PARTICIPANTS: The sample was made up of 264 subjects aged between 15 and 19 (48.8% females and 51.1% males). METHODS: This study was conducted in two phases. In the first study phase, a descriptive analysis of the sample was performed, encompassing the frequencies of the independent variables and dependent variable (ED). In the second phase of study, we created several linear regression models. RESULTS: A total of 11.7% of adolescents are at high risk for ED, and the variables that predict the variability of manifesting the danger of ED are the following: physical self-conception and family relationships. CONCLUSIONS: This work shows the need to approach eating disorders in a multidisciplinary way (biological and social), since this will enable the disease to be better conceptualized and prevention guidelines to be more effective.

Interferon alpha inducible protein 6 is a negative regulator of innate immune responses by modulating RIG-I activation.

Interferons (IFNs), IFN-stimulated genes (ISGs), and inflammatory cytokines mediate innate immune responses, and are essential to establish an antiviral response. Within the innate immune responses, retinoic acid-inducible gene I (RIG-I) is a key sensor of virus infections, mediating the transcriptional induction of IFNs and inflammatory proteins. Nevertheless, since excessive responses could be detrimental to the host, these responses need to be tightly regulated. In this work, we describe, for the first time, how knocking-down or knocking-out the expression of IFN alpha-inducible protein 6 (IFI6) increases IFN, ISG, and pro-inflammatory cytokine expression after the infections with Influenza A Virus (IAV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Sendai Virus (SeV), or poly(I:C) transfection. We also show how overexpression of IFI6 produces the opposite effect, in vitro and in vivo, indicating that IFI6 negatively modulates the induction of innate immune responses. Knocking-out or knocking-down the expression of IFI6 diminishes the production of infectious IAV and SARS-CoV-2, most likely because of its effect on antiviral responses. Importantly, we report a novel interaction of IFI6 with RIG-I, most likely mediated through binding to RNA, that affects RIG-I activation, providing a molecular mechanism for the effect of IFI6 on negatively regulating innate immunity. Remarkably, these new functions of IFI6 could be targeted to treat diseases associated with an exacerbated induction of innate immune responses and to combat viral infections, such as IAV and SARS-CoV-2.

The Guadalajara Declaration on sepsis: emergency physicians' constructive comments on the Surviving Sepsis Campaign's 2021 updated guidelines. / Declaración de Guadalajara: una visión constructiva desde el servicio de urgencias a partir de la Surviving Sepsis Campaign 2021.

TEXT: The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physiciansreviewed and analyzed the 2021 SSC guidelines from our specialty's point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians' experience- and evidence-based proposals. Secondarily, the review's recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis.

TEXTO: En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara ­ México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como "la Declaración de Guadalajara".

Declaración de Guadalajara: una visión constructiva desde el servicio de urgencias a partir de la Surviving Sepsis Campaign 2021 / The Guadalajara Declaration on sepsis: emergency physicians’ constructive comments on the Surviving Sepsis Campaign’s 2021 updated guidelines

En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara – México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como “la Declaración de Guadalajara”. (AU)

The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physicians reviewed and analyzed the 2021 SSC guidelines from our specialty’s point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians’ experience- and evidence-based proposals. Secondarily, the review’s recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis. (AU)

Comparison of violence and aggressions suffered by health personnel during the COVID-19 pandemic in Argentina and the rest of Latin America. / Comparación de la violencia y agresiones sufridas por el personal de salud durante la pandemia de COVID-19 en Argentina y el resto de Latinoamérica.

OBJECTIVES.: Motivation for the study. The COVID-19 pandemic has caused profound repercussions at different socio-environmental levels. Its impact on violence against healthcare team workers in Argentina has not been well documented. Main findings. The present study evidenced high rates of aggression, particularly verbal aggression. In addition, almost half of the participants reported having suffered these events on a weekly basis. All participants who experienced violence reported having experienced post-event symptoms, and up to one-third reported having considered changing their profession after these acts. Implications. It is imperative to take action to prevent acts of violence against health personnel, or to mitigate its impact on the victims. . To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. MATERIALS AND METHODS.: A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. RESULTS.: A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). CONCLUSIONS.: There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.

OBJETIVOS.: Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. MATERIALES Y MÉTODOS.: Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. RESULTADOS.: Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). CONCLUSIONES.: Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.