Estrés y ansiedad en estudiantes de enfermería durante la primera ola de la pandemia de COVID-19.

OBJECTIVE: To compare anxiety and acute stress levels among nursing students who joined the labour market during the first wave of the COVID-19 pandemic   and those who did not. METHODS: A cross-sectional, multicentre descriptive study across three Spanish public universities. A total of 216 nursing students participated in our study. Data collection was carried through an online questionnaire, that included variables on conditions for entering the labour market, the Zung Anxiety Self-Assessment Scale and the Stanford Acute Stress Reaction Questionnaire. We performed univariate and multivariate analyses.  Results: Overall, 42.6% (n=92) of the students entered the labour market during the first wave of the COVID-19 pandemic. The global anxiety score was x?=36.31 (SD=5.71) and the stress score was x?=82.39 (SD=30.84). Lower anxiety levels were observed among those who joined the labour market (x?=35.67; SD=5.78) as compared to those who did not (x?=36.73; SD=5.67). Overall 92.4% of the students were acutely stressed. Acute stress was higher among those who did not work (x?=84.35; SD=32.38) and significantly in women.  Conclusions: Nursing students were able to cope with stress in situations such as the COVID-19 pandemic. A healthy worker effect could not be ruled out. Stress and anxiety among nursing students should be considered by clinical practice preceptors and at the time students first enter the labour market.

OBJETIVO: Comparar los niveles de ansiedad y estrés agudo entre los/las estudiantes de enfermería que se incorporaron al trabajo durante la primera ola de la pandemia de COVID-19 y aquellos que no lo hicieron. Métodos: Estudio descriptivo transversal multicéntrico realizado en tres universidades públicas españolas. Un total de 216 estudiantes de enfermería participaron en nuestro estudio. La recopilación de datos se realizó mediante un formulario en línea. Se recopilaron variables relacionadas con las condiciones para ingresar al mercado laboral y se incluyó la Escala de Autoevaluación de Ansiedad de Zung y el Cuestionario de Reacción Aguda al Estrés de Stanford. Se llevaron a cabo análisis univariados y multivariados. RESULTADOS: El 42,6% de los estudiantes ingresaron al mercado laboral. La puntuación global de ansiedad fue x?=36,31 (DE=5,71) y la puntuación de estrés fue x?=82,39 (DE=30,84). Los niveles más bajos de ansiedad se encontraron en aquellos que se incorporaron al mercado laboral (x?=35,67; DE=5,78), en comparación con aquellos que no lo hicieron (x?=36,73; DE=5,67). El 92,4% del total de alumnos presentaron estrés agudo. El estrés agudo fue mayor en aquellos que no trabajaron (x?=84,35; DE=32,38), y significativamente en mujeres.  Conclusiones: Los estudiantes de enfermería mostraron ser capaces de hacer frente al estrés en situaciones como la pandemia de COVID-19. No se puede descartar un efecto del trabajador sano. El estrés y ansiedad de los estudiantes de enfermería deben tenerse en cuenta por los tutores de prácticas clínicas y cuando se incorporan al mercado laboral por primera vez.

Impact on the first year of life of newborns with gestational infection by SARS-COV-2. Analysis of auditory effects.

Introduction: One of the causes of congenital hearing loss are infections suffered by the mother during pregnancy. The objective of this study was to investigate the effects on hearing in newborns to SARS-CoV-2 seropositive mothers during pregnancy. We also studied the hearing impact in the first year of life of the newborns to investigate whether neonatal infection produced a risk of infantile sensorineural hearing loss. Material and methods: All children born in our center whose mother had been infected with SARS-CoV-2 positive COVID were included and were audiologically studied at two and a half months and at one year of life. All infants were evaluated by brainstem evoked response audiometry (BERA) and auditory steady-state responses (ASSR). Results: The range of the latencies for BERA founded were inside the desired ranges of normality both at two and a half months and at one year of life No significant differences by sex and ears were found in the BERA performed (p > 0,05). The mean ASSR values were found to be significantly below 30 dB in all frequencies studied both at two and a half months, and at one year of life (p < 0,05). Conclusion: There is no association between COVID-19 infection during pregnancy and neonatal hearing loss. Further studies are needed to clarify this field since it is still unclear whether pregnant women infected with SARS-CoV-2 can produce hearing alterations in their newborns according to the current evidence in the literature.

Clinical evolution and mortality of critically ill patients with SARS-CoV-2 pneumonia treated with remdesivir in an adult intensive care unit of Paraguay.

BACKGROUND: The health crisis due to Covid-19 led to the search for therapeutics that could improve the evolution of the disease. Remdesivir, an antiviral that interferes with viral replication, was one of the first to be used for the treatment of this pathology. OBJECTIVE: To determine clinical course and mortality of patients with severe SARS-CoV-2 pneumonia treated with remdesivir, in comparison of those who didn't receive the medication. PATIENTS AND METHODS: Retrospective cohort study, with medical records review of COVID-19 patients, between August 2020 and August 2021. The subjects were divided into two groups, those who received remdesivir before or after admission to intensive care and those who didn't. The primary outcome variable was mortality in intensive care. RESULTS: Of 214 subjects included, 109 (50,9%) received remdesivir. The median of days for the drug administration was 8 (2-20), IQR: 3. The bivariate analysis prove that the use of remdesivir was related with lower risk of develop Acute Respiratory Distress Syndrome (ARDS) (p = 0,019; OR: 0,521) and lower requirement of mechanical ventilation (p = 0,006; OR:0,450). Additionally, patients treated with remdesivir develop less kidney injury (p = 0,009; OR: 0,441). There was a total of 82 deaths, 29 (26,6%) in the remdesivir group and 53 (50,5%) in the control group [p < 0,001; OR: 0,356 (0,201-0,630)]. All the risk factors associated with mortality in the bivariate analysis were entered into the multivariate analysis by logistic regression, the use of remdesivir remained associated as an independent protective factor to mortality (p = 0.034; OR: 0.429). CONCLUSION: Critically ill patients with SARS-CoV-2 pneumonia treated with remdesivir had a lower risk of death and need for mechanical ventilation and develop less ARDS as compared to the control group. No differences were found in the presentation of adverse effects.

Stress and anxiety in nursing students during the first wave of the COVID-19 pandemic / Estrés y ansiedad en estudiantes de enfermería durante la primera ola de la pandemia de COVID-19

Objetivo: Comparar los niveles de ansiedad y estrés agudo entre los/las estudiantes de enfermería que se incorporaron al trabajo durante la primera ola de la pandemia de COVID-19 y aquellos que no lo hicieron. Métodos: Estudio descriptivo transversal multicéntrico realizado en tres universidades públicas españolas. Un total de 216 estudiantes de enfermería participaron en nuestro estudio. La recopilación de datos se realizó mediante un formulario en línea. Se recopilaron variables relacionadas con las condiciones para ingresar al mercado laboral y se incluyó la Escala de Autoevaluación de Ansiedad de Zung y el Cuestionario de Reacción Aguda al Estrés de Stanford. Se llevaron a cabo análisis univariados y multivariados. Resultados: El 42,6% de los estudiantes ingresaron al mercado laboral. La puntuación global de ansiedad fue x?=36,31 (DE=5,71) y la puntuación de estrés fue x?=82,39 (DE=30,84). Los niveles más bajos de ansiedad se encontraron en aquellos que se incorporaron al mercado laboral (x?=35,67; DE=5,78), en comparación con aquellos que no lo hicieron (x?=36,73; DE=5,67). El 92,4% del total de alumnos presentaron estrés agudo. El estrés agudo fue mayor en aquellos que no trabajaron (x?=84,35; DE=32,38), y significativamente en mujeres. Conclusiones: Los estudiantes de enfermería mostraron ser capaces de hacer frente al estrés en situaciones como la pandemia de COVID-19. No se puede descartar un efecto del trabajador sano. El estrés y ansiedad de los estudiantes de enfermería deben tenerse en cuenta por los tutores de prácticas clínicas y cuando se incorporan al mercado laboral por primera vez (AU)

Objective: To compare anxiety and acute stress levels among nursing students who joined the labour market during the first wave of the COVID-19 pandemic and those who did not.Methods: A cross-sectional, multicentre descriptive study across three Spanish public universities. A total of 216 nursing students participated in our study. Data collection was carried through an online questionnaire, that included variables on conditions for entering the labour market, the Zung Anxiety Self-Assessment Scale and the Stanford Acute Stress Reaction Questionnaire. We performed univariate and multivariate analyses. Results: Overall, 42.6% (n=92) of the students entered the labour market during the first wave of the COVID-19 pandemic. The global anxiety score was x̄=36.31 (SD=5.71) and the stress score was x̄=82.39 (SD=30.84). Lower anxiety levels were observed among those who joined the labour market (x̄=35.67; SD=5.78) as compared to those who did not (x̄=36.73; SD=5.67). Overall 92.4% of the students were acutely stressed. Acute stress was higher among those who did not work (x̄=84.35; SD=32.38) and significantly in women. Conclusions: Nursing students were able to cope with stress in situations such as the COVID-19 pandemic. A healthy worker effect could not be ruled out. Stress and anxiety among nursing students should be considered by clinical practice preceptors and at the time students first enter the labour market (AU)

Cross-cultural adaptation of the FRAIL scale for critically ill patients in Spain.

AIM: To translate and culturally adapt the FRAIL scale into Spanish and perform a preliminary test of diagnostic accuracy in patients admitted to intensive care units. DESIGN: Cross-sectional diagnostic study. METHODS: Five intensive care units (ICU) in Spain were participated. Stage 1: Three native Spanish-speaking bilingual translators familiar with the field of critical care translated the scale from English into Spanish. Stage 2: Three native English-speaking bilingual translators familiar with critical care medicine. Stage 3: Authors of the original scale compared the English original and back-translated versions of the scale. Stage 4: Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the comprehension and relevance of each of the items of the Spanish version in 30 patients of 3 different age ranges (<50, 50-65 and >65 years). RESULTS: The FRAIL scale was translated and adapted cross-culturally for patients admitted to intensive care units in Spain. The process consisted of four stages: translation, back translation, comparison and pilot test. There was good correspondence between the original scale and the Spanish version in 100% of the items. The participating patients assessed the relevance (content validity) and comprehensibility (face validity) of each of the items of the first Spanish version. The relevance of some of the items scored low when the scale was used in patients younger than 65 years. CONCLUSIONS: We have cross-culturally adapted the FRAIL scale, originally in English, to Spanish for its use in the critical care medical setting in Spanish-speaking countries. IMPLICATIONS FOR PROFESSIONALS: Physicians and nurses can apply the new scale to all patients admitted to the intensive care units. Nursing care can be adapted according to frailty, trying to reduce the side effects of admission to these units for the most fragile patients. REPORTING METHOD: The manuscript's authors have adhered to the EQUATOR guidelines, using the COSMIN reporting guideline for studies on the measurement properties of patient-reported outcome measures. PATIENT OR PUBLIC CONTRIBUTION: In a pilot clinical study, we applied the first version of the FRAIL-Spain scale to intensive care unit (ICU) patients. Five nurses with more than 5 years of ICU experience and five critical care physicians assessed the relevance (content validity) and comprehensibility (face validity) of the five items of the first Spanish version. Relevance was assessed using a 4-point Likert scale ranging from 1 (no relevance) to 4 (high relevance), and comprehensibility was assessed as poor, acceptable or good. Each health professional applied the scale to three patients (total number of patients = 30) of three different age ranges (<50, 50-65 and >65 years) and recorded the time of application of the scale to each patient. Although the frailty scales were initially created by geriatricians to be applied to the elders, there is little experience with their application in critically ill patients of any age. Therefore, more information is needed to determine the relevance of using this scale in critical care patients. In this pilot study, we considered that nurses and critical care physicians should evaluate frailty using this adapted scale in adult patients admitted to the Intensive Care Units.

Augmentative biological control for squash bug (Hemiptera: Coreidae) using the egg parasitoid, Hadronotus pennsylvanicus (Hymenoptera: Scelionidae).

The squash bug, Anasa tristis (De Geer) (Hemiptera: Coreidae), is a serious pest of cucurbit crops across the United States. Conventional growers commonly use broad-spectrum insecticides to manage squash bugs, however organic growers lack these effective chemical tools and must rely on alternative management strategies. Biological control of A. tristis is largely understudied, specifically the potential of natural enemy, Hadronotus pennsylvanicus (Ashmead) (Hymenoptera: Scelionidae), as an augmentative biological control agent. For this reason, we performed early-season field releases of H. pennsylvanicus on organic farms in southeastern Virginia to test if this would improve A. tristis egg parasitism. We chose organic vegetable farms growing summer squash (Cucurbita pepo L.) as release sites and nearby Virginia Tech Agricultural Research Extension Centers (AREC) as no-release sites. Parasitoids were reared in the lab and deployed as parasitized egg masses (~2-3 females wasps/plant) in June 2020 and 2021. Before parasitoid deployment, host eggs collected from release and no-release sites displayed low levels of H. pennsylvanicus parasitism in 2020 (<21%) and 2021 (<8%). In both years, the percentage of A. tristis eggs parasitized within 2 weeks post deployment was significantly greater at release sites (~60%) than at no-release sites (~14%). High rates of H. pennsylvanicus parasitism (>72%) were further observed at release sites 4, 6, 8, and 10 weeks following parasitoid deployment. Our study demonstrates that releases of lab-reared H. pennsylvanicus can increase A. tristis egg parasitism rates and subsequently decrease successful nymph hatch rates in early summer squash plantings.

Miticidal Tools for Management of Southern Red Mites Infesting Southern Highbush Blueberries.

Tetranychid outbreaks have been detected since 2016 in southern highbush blueberries (SHB); however, it was not until 2019 that the southern red mite (SRM), Oligonychus ilicis (Acari: Tetranychidae) was confirmed as the pest causing severe bronzing and stunting, in multiple Florida and Georgia commercial blueberry plantings. To date, only three miticides (fenazaquin, fenpyroximate, and acequinocyl) have been registered for use in SHB and there are no clear guidelines on how to manage SRM in SHB. Similarly, there is no knowledge regarding the existence of natural enemies of SRM in SHB. This is the first report of naturally occurring predatory mites (Amblyseius sp. and Neoseiulus ilicis) associated with SRM in SHB. Predatory mites were recorded in blueberry bushes after treatment with seven miticides used to suppress SRM populations including spiromesifen, acequinocyl, sulfur, sulfur + molasses, bifenazate, fenpyroximate, and fenazaquin. The number of SRM recorded per leaf and averaged plant damage ratings (0 = no bronzing-4 = 100% bronzing) were used to evaluate miticide efficacy. Additionally, the presence or absence of predatory mites per sample was recorded. Fenpyroximate used as the standard miticide, significantly reduced mite numbers seven days after application, as well as acequinocyl and fenazaquin. Fenpyroximate and fenazaquin demonstrated the best performance for managing O. ilicis on SHB and treated bushes demonstrated significantly less bronzing compared with the control plants. These miticides were also safe to naturally occurring predatory mites. Lastly, the level of growers' awareness regarding SRM was assessed using surveys in 2020 to design adequate educational materials available to the grower community.

From students to nurses under pressure: Nursing students' entry into employment during the first COVID-19 wave.

AIMS AND OBJECTIVE: To describe the experiences of nursing students and their mental health as they entered employment during the first wave of the COVID-19 pandemic (May-June 2020). BACKGROUND: As other healthcare professionals, nursing students who worked during the first COVID-19 wave suffered from dysfunctional mental health symptoms. DESIGN: Sequential, mixed-method, multicentre study. METHODS: The study population comprised 92 students in the third and fourth year of the Nursing degree at three Spanish universities, who entered employment during the pandemic. Data were collected between May and June 2020. In the quantitative phase, data were collected using an online questionnaire containing both validated anxiety and stress scales. In the qualitative phase, semi-structured interviews were conducted with 18 participants. A descriptive analysis of the quantitative data and a reflexive thematic analysis of the qualitative data were carried out, and analyses were combined. COREQ checklist was used for reporting. RESULTS: The combined quantitative and qualitative results were organised into five thematic areas: (1) Interruption of clinical placements, (2) Entering employment on a healthcare assistant contract, (3) Preventing contagion, (4) Adapting to the situation and managing emotions, and (5) Lessons learned. CONCLUSION: The students had a positive overall experience of entering employment, as they were able to develop their nursing skills. However, they had an emotional impact in form of stress caused by excessive responsibility, academic uncertainty, lack of personal protective equipment and training in its use, and the possibility of spreading disease to their family members. RELEVANCE TO CLINICAL PRACTICE: In the current context, changes must be made in study programmes to instruct nursing students to be able to cope with extreme clinical situations, such as pandemics. The programmes should include a more extensive coverage of epidemics and pandemics and management of emotional aspects such as resilience.

A Deep Q-Network based hand gesture recognition system for control of robotic platforms.

Hand gesture recognition (HGR) based on electromyography signals (EMGs) and inertial measurement unit signals (IMUs) has been investigated for human-machine applications in the last few years. The information obtained from the HGR systems has the potential to be helpful to control machines such as video games, vehicles, and even robots. Therefore, the key idea of the HGR system is to identify the moment in which a hand gesture was performed and it's class. Several human-machine state-of-the-art approaches use supervised machine learning (ML) techniques for the HGR system. However, the use of reinforcement learning (RL) approaches to build HGR systems for human-machine interfaces is still an open problem. This work presents a reinforcement learning (RL) approach to classify EMG-IMU signals obtained using a Myo Armband sensor. For this, we create an agent based on the Deep Q-learning algorithm (DQN) to learn a policy from online experiences to classify EMG-IMU signals. The HGR proposed system accuracy reaches up to [Formula: see text] and [Formula: see text] for classification and recognition respectively, with an average inference time per window observation of 20 ms. and we also demonstrate that our method outperforms other approaches in the literature. Then, we test the HGR system to control two different robotic platforms. The first is a three-degrees-of-freedom (DOF) tandem helicopter test bench, and the second is a virtual six-degree-of-freedom (DOF) UR5 robot. We employ the designed hand gesture recognition (HGR) system and the inertial measurement unit (IMU) integrated into the Myo sensor to command and control the motion of both platforms. The movement of the helicopter test bench and the UR5 robot is controlled under a PID controller scheme. Experimental results show the effectiveness of using the proposed HGR system based on DQN for controlling both platforms with a fast and accurate response.

Recognition of Hand Gestures Based on EMG Signals with Deep and Double-Deep Q-Networks.

In recent years, hand gesture recognition (HGR) technologies that use electromyography (EMG) signals have been of considerable interest in developing human-machine interfaces. Most state-of-the-art HGR approaches are based mainly on supervised machine learning (ML). However, the use of reinforcement learning (RL) techniques to classify EMGs is still a new and open research topic. Methods based on RL have some advantages such as promising classification performance and online learning from the user's experience. In this work, we propose a user-specific HGR system based on an RL-based agent that learns to characterize EMG signals from five different hand gestures using Deep Q-network (DQN) and Double-Deep Q-Network (Double-DQN) algorithms. Both methods use a feed-forward artificial neural network (ANN) for the representation of the agent policy. We also performed additional tests by adding a long-short-term memory (LSTM) layer to the ANN to analyze and compare its performance. We performed experiments using training, validation, and test sets from our public dataset, EMG-EPN-612. The final accuracy results demonstrate that the best model was DQN without LSTM, obtaining classification and recognition accuracies of up to 90.37%±10.7% and 82.52%±10.9%, respectively. The results obtained in this work demonstrate that RL methods such as DQN and Double-DQN can obtain promising results for classification and recognition problems based on EMG signals.

Peripheral CB1 receptor blockade acts as a memory enhancer through a noradrenergic mechanism.

Peripheral inputs continuously shape brain function and can influence memory acquisition, but the underlying mechanisms have not been fully understood. Cannabinoid type-1 receptor (CB1R) is a well-recognized player in memory performance, and its systemic modulation significantly influences memory function. By assessing low arousal/non-emotional recognition memory in mice, we found a relevant role of peripheral CB1R in memory persistence. Indeed, the peripherally-restricted CB1R specific antagonist AM6545 showed significant mnemonic effects that were occluded in adrenalectomized mice, and after peripheral adrenergic blockade. AM6545 also transiently impaired contextual fear memory extinction. Vagus nerve chemogenetic inhibition reduced AM6545-induced mnemonic effect. Genetic CB1R deletion in dopamine ß-hydroxylase-expressing cells enhanced recognition memory persistence. These observations support a role of peripheral CB1R modulating adrenergic tone relevant for cognition. Furthermore, AM6545 acutely improved brain connectivity and enhanced extracellular hippocampal norepinephrine. In agreement, intra-hippocampal ß-adrenergic blockade prevented AM6545 mnemonic effects. Altogether, we disclose a novel CB1R-dependent peripheral mechanism with implications relevant for lengthening the duration of non-emotional memory.

Hand Gesture Recognition Using EMG-IMU Signals and Deep Q-Networks.

Hand gesture recognition systems (HGR) based on electromyography signals (EMGs) and inertial measurement unit signals (IMUs) have been studied for different applications in recent years. Most commonly, cutting-edge HGR methods are based on supervised machine learning methods. However, the potential benefits of reinforcement learning (RL) techniques have shown that these techniques could be a viable option for classifying EMGs. Methods based on RL have several advantages such as promising classification performance and online learning from experience. In this work, we developed an HGR system made up of the following stages: pre-processing, feature extraction, classification, and post-processing. For the classification stage, we built an RL-based agent capable of learning to classify and recognize eleven hand gestures-five static and six dynamic-using a deep Q-network (DQN) algorithm based on EMG and IMU information. The proposed system uses a feed-forward artificial neural network (ANN) for the representation of the agent policy. We carried out the same experiments with two different types of sensors to compare their performance, which are the Myo armband sensor and the G-force sensor. We performed experiments using training, validation, and test set distributions, and the results were evaluated for user-specific HGR models. The final accuracy results demonstrated that the best model was able to reach up to 97.50%±1.13% and 88.15%±2.84% for the classification and recognition, respectively, with regard to static gestures, and 98.95%±0.62% and 90.47%±4.57% for the classification and recognition, respectively, with regard to dynamic gestures with the Myo armband sensor. The results obtained in this work demonstrated that RL methods such as the DQN are capable of learning a policy from online experience to classify and recognize static and dynamic gestures using EMG and IMU signals.

Amyloid ß-Peptide Causes the Permanent Activation of CaMKIIα through Its Oxidation.

Alzheimer's disease (AD) is characterised by the presence of extracellular amyloid plaques in the brain. They are composed of aggregated amyloid beta-peptide (Aß) misfolded into beta-sheets which are the cause of the AD memory impairment and dementia. Memory depends on the hippocampal formation and maintenance of synapses by long-term potentiation (LTP), whose main steps are the activation of NMDA receptors, the phosphorylation of CaMKIIα and the nuclear translocation of the transcription factor CREB. It is known that Aß oligomers (oAß) induce synaptic loss and impair the formation of new synapses. Here, we have studied the effects of oAß on CaMKIIα. We found that oAß produce reactive oxygen species (ROS), that induce CaMKIIα oxidation in human neuroblastoma cells as we assayed by western blot and immunofluorescence. Moreover, this oxidized isoform is significantly present in brain samples from AD patients. We found that the oxidized CaMKIIα is active independently of the binding to calcium/calmodulin, and that CaMKIIα phosphorylation is mutually exclusive with CaMKIIα oxidation as revealed by immunoprecipitation and western blot. An in silico modelling of the enzyme was also performed to demonstrate that oxidation induces an activated state of CaMKIIα. In brains from AD transgenic models of mice and in primary cultures of murine hippocampal neurons, we demonstrated that the oxidation of CaMKIIα induces the phosphorylation of CREB and its translocation to the nucleus to promote the transcription of ARC and BDNF. Our data suggests that CaMKIIα oxidation would be a pro-survival mechanism that is triggered when a noxious stimulus challenges neurons as do oAß.

Inflammatory biomarkers and pendelluft magnitude in ards patients transitioning from controlled to partial support ventilation.

The transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The magnitude of tidal volume (VT) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔPes), transpulmonary driving pressure (ΔPL), VT, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (- 15, - 20 and - 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T0) and after 4-h (T4) of partial support ventilation. Pendelluft, ΔPes, ΔPL and VT were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔPes, ΔPL, and VT were - 8.4 [- 6.7; - 10.2] cmH2O, 15.2 [12.3-16.5] cmH2O and 8.1 [7.3-8.9] m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T0/T4 ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.

Effect of a Multifunctional Biosurfactant Extract Obtained from Corn Steep Liquor on Orange and Apple Juices.

Biosurfactant extracts are multifunctional ingredients composed of natural polymers that can be used in the food industry as stabilizing and antimicrobial agents, although their inclusion in food matrices has been scarcely explored. In this work, a biosurfactant extract, with antimicrobial properties, obtained from a fermented stream of the corn wet-milling industry was introduced into an apple and orange juice matrix to evaluate the changes produced in the sugar consumption, pH, and biomass formation at different temperatures (4-36 °C) and storage time (1-7 days). It was observed that the addition of biosurfactant extract reduced the hydrolysis rate of polymeric sugars, decreasing the concentration of soluble sugars from 85.4 g/L to 49.0 g/L in apple juice after 7 days at 20 °C in the absence and presence of biosurfactant extract, respectively. In general, soluble sugars increased in juices for 5-6 days and after those sugars decreased at different rates depending on the temperature of storage. Differences in sugar solubilization and degradation were more significant in apple juice than in orange juice at 20 °C and 7 days of storage, achieving for orange juice values of 101 and 102 g/L in the absence and presence of biosurfactant extract, respectively. Biomass growth was almost unaffected by the biosurfactant extract concentration and the optimal conditions for biomass production were detected at intermediated temperatures after 6-7 days of storage for both apple and orange juices, obtaining maximum concentrations of 1.68 g/L and 1.54 g/L for apple juice and orange juice, respectively, in the absence of biosurfactant extract. The pH during storage was kept in the range of 3.35-3.48 for apple juice and of 3.40-3.77 for orange juice.

Cannabinoid signaling modulation through JZL184 restores key phenotypes of a mouse model for Williams-Beuren syndrome.

Williams-Beuren syndrome (WBS) is a rare genetic multisystemic disorder characterized by mild-to-moderate intellectual disability and hypersocial phenotype, while the most life-threatening features are cardiovascular abnormalities. Nowadays, there are no pharmacological treatments to directly ameliorate the main traits of WBS. The endocannabinoid system (ECS), given its relevance for both cognitive and cardiovascular function, could be a potential druggable target in this syndrome. We analyzed the components of the ECS in the complete deletion (CD) mouse model of WBS and assessed the impact of its pharmacological modulation in key phenotypes relevant for WBS. CD mice showed the characteristic hypersociable phenotype with no preference for social novelty and poor short-term object-recognition performance. Brain cannabinoid type-1 receptor (CB1R) in CD male mice showed alterations in density and coupling with no detectable change in main endocannabinoids. Endocannabinoid signaling modulation with subchronic (10 days) JZL184, a selective inhibitor of monoacylglycerol lipase, specifically normalized the social and cognitive phenotype of CD mice. Notably, JZL184 treatment improved cardiovascular function and restored gene expression patterns in cardiac tissue. These results reveal the modulation of the ECS as a promising novel therapeutic approach to improve key phenotypic alterations in WBS.

Williams-Beuren syndrome (WBS) is a rare disorder that causes hyper-social behavior, intellectual disability, memory problems, and life-threatening overgrowth of the heart. Behavioral therapies can help improve the cognitive and social aspects of the syndrome and surgery is sometimes used to treat the effects on the heart, although often with limited success. However, there are currently no medications available to treat WBS. The endocannabinoid system ­ which consists of cannabis-like chemical messengers that bind to specific cannabinoid receptor proteins ­ has been shown to influence cognitive and social behaviors, as well as certain functions of the heart. This has led scientists to suspect that the endocannabinoid system may play a role in WBS, and drugs modifying this network of chemical messengers could help treat the rare condition. To investigate, Navarro-Romero, Galera-López et al. studied mice which had the same genetic deletion found in patients with WBS. Similar to humans, the male mice displayed hyper-social behaviors, had memory deficits and enlarged hearts. Navarro-Romero, Galera-López et al. found that these mutant mice also had differences in the function of the receptor protein cannabinoid type-1 (CB1). The genetically modified mice were then treated with an experimental drug called JZL184 that blocks the breakdown of endocannabinoids which bind to the CB1 receptor. This normalized the number and function of receptors in the brains of the WBS mice, and reduced their social and memory symptoms. The treatment also restored the animals' heart cells to a more normal size, improved the function of their heart tissue, and led to lower blood pressure. Further experiments revealed that the drug caused the mutant mice to activate many genes in their heart muscle cells to the same level as normal, healthy mice. These findings suggest that JZL184 or other drugs targeting the endocannabinoid system may help ease the symptoms associated with WBS. More studies are needed to test the drug's effectiveness in humans with this syndrome. Furthermore, the dramatic effect JZL184 has on the heart suggests that it might also help treat high blood pressure or conditions that cause the overgrowth of heart cells.

Optimal surgical timing after post-infarction ventricular septal rupture.

BACKGROUND: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dangerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis. METHODS: We designed an observational, retrospective, multicenter study, selecting all consecutive patients with post-AMI VSR between January 1, 2008 and December 31, 2018, with non-exclusion criteria. The main objective of this study was to analyze the optimal timing for surgical repair of post-AMI VSR. Secondary endpoints were to determine which factors could influence mortality in the patients of the surgical group. RESULTS: A total of 141 patients were included. We identified lower mortality rates with an odds ratio of 0.3 (0.1-0.9) in patients operated on from day 4 compared with the surgical mortality in the first 24 hours after VSR diagnosis. The use of MCS was more frequent in patients treated with surgery, particularly for intra-aortic balloon pump (IABP; 79.6% vs. 37.8%, p < 0.001), but also for veno-arterial extracorporeal membrane oxygenation (VA-ECMO; 18.2% vs. 6.4%, p = 0.134). Total mortality was 91.5% for conservative management and 52.3% with surgical repair (p < 0.001). CONCLUSIONS: In our study, we observed that the lowest mortality rates in patients with surgical repair of post-AMI VSR were observed in patients operated on from day 4 after diagnosis of VSR, compared to earlier interventions.

Job expectations and intolerance to uncertainty of nursing students: Results from a multicentre, mixed-methods study in Spain.

AIM: To identify the job expectations and intolerance to uncertainty in final-year nursing students from three Spanish universities and evaluate the differences between them. DESIGN: Multicentre, mixed-methods study. METHODOLOGY: We included nursing students from three universities in Spain (Lleida, A Coruña and Murcia). Questionnaires were used to collect data on sociodemographic variables, job expectations and intolerance to uncertainty. In addition, in-depth personal interviews were conducted to complement quantitative data. Descriptive statistics were calculated and comparison tests (ANOVA, chi-square) were performed to analyse the differences between universities and a content analysis was carried out for qualitative data. RESULTS: The sample included 305 final-year nursing students enrolled in the 2017-2018 and 2018-2019 courses, of which 21 participants were interviewed for the qualitative phase. Findings were reported based on four main themes: Expected employment conditions, perceptions of working conditions, job uncertainty and increased chances of getting a job by continuing education after finishing the nursing degree. Results showed that 92.13% of the students were concerned about their future employment. Analysis of the in-depth interviews highlighted the uncertainty of finding a job as a nurse and the anticipated precarious employment conditions (i.e. lack of stability stemming from daily or weekly temporary contracts) in case they managed to find work. Moreover, it was shown that these perceptions affect their health, leading to situations of anxiety, stress and negativity during their time as nursing students. Overall, 65.57% considered migrating outside their town/region to increase their job opportunities and 97.0% wanted to continue their education after finishing their degree, motivated by their vocation, professional aspirations and to increase their possibilities of finding work. CONCLUSION: Nursing students find themselves in a situation of great uncertainty before finishing their studies, anticipating a future with great stress and even frustration as a result of unemployment and job insecurity. They even consider the possibility of migrating when they finish their degree to increase their job opportunities. Therefore, it is necessary to improve the recruitment process of nurses in Spain through increased security and stability and thus contribute to reducing the stress and frustration of future nurses.

Internalizing Problems and Resilience in Primary School Students in Low and High Socioeconomic Vulnerability Establishments in Chile.

BACKGROUND: The processes involved in this study were 2-fold. First, we analyzed the levels of resilience and internalized problems (defined as group of emotional symptoms) in children aged 9 to 12 years. Second, we examined whether the relationship between them varies according to the low or high vulnerability of school communities. METHODS: About 1460 students from schools in northern Chile participated. A total of 52.6% were girls, and 47.4% were boys. The scales of internalizing problems of the System of Evaluation of Children and Adolescents (SENA) and the short scale of resilience (CYRM-12) were applied. Correlations in each group and differences between groups were analyzed using a MANOVA. A 2-level path analysis was also performed. RESULTS: Resilience was higher in the context of low vulnerability while depression, social anxiety, and posttraumatic stress symptomatology were greater in the context of high vulnerability. A 2-level path analysis showed that the slope of gender, anxiety, and depression symptomatology varies between schools and an interaction effect between vulnerability and anxiety symptomatology. CONCLUSION: There are differences in the relationship between internalized problems and resilience according to whether the students belong to low or high vulnerability establishments. This study contributes to a better understanding of the relationship between internalizing problems and resilience.

Genome-wide diversity analysis to infer population structure and linkage disequilibrium among Colombian coconut germplasm.

Genetic diversity and relatedness of accessions for coconut growing in Colombia was unknown until this study. Here we develop single nucleotide polymorphisms (SNPs) along the coconut genome based on Genotyping by Sequencing (GBS) with the goal of analyze the genetic diversity, population structure, and linkage disequilibrium (LD) of a diverse coconut panel consisting of 112 coconut accessions from the Atlantic and Pacific coasts of Colombia. A comprehensive catalog of approximately 40,000 SNPs with a minor allele frequency (MAF) of > 0.05 is presented. A total of 40,614 SNPs were found but only 19,414 anchored to chromosomes. Of these, 10,338 and 4606 were exclusive to the Atlantic and Pacific gene pools, respectively, and 3432 SNPs could differentiate both gene pools. A filtered subset of unlinked and anchored SNPs (1271) showed a population structure at K = 4, separating accessions from the Pacific and Atlantic coasts that can also be distinguished by palm height, as found in previous studies. The Pacific groups had a slow LD decay, low Fixation Index (Fst) and low nucleotide diversity (π), while the Atlantic group had slightly higher genetic diversity and faster LD decay. Genome-wide diversity analyses are of importance to promote germplasm conservation and breeding programs aimed at developing new cultivars better adapted to the region.