[Impact of a cardiac rehabilitation program on adherence to the mediterranean diet and physical activity in acute coronary syndrome]. / Impacto de un programa de rehabilitación cardiaca en la adherencia a la dieta mediterránea y la actividad física en el síndrome coronario agudo.

Objective: To evaluate the efficacy of a cardiac rehabilitation program (CRP) in improving adherence to non-pharmacological secondary prevention in patients with acute coronary syndrome (ACS). Method: Retrospective study of patients with ACS referred to CRP in a tertiary hospital from 2018 to 2021. Pre-post differences in adherence to physical activity, Mediterranean diet, smoking, and motivation to change were analyzed. Age, sex, and baseline motivation were analyzed in predicting change in adherence. Results: 418 patients were included. At the end of the CRP, the adherence to the mediterranean diet increased (p < 0.05; d = 0.83), frequency of physical activity increased by 2.16 (p < 0.05), and motivation to change remained constant (p = 0.94). Both women and men improved their adherence to the mediterranean diet. Both sexes performed more physical activity at the end of the CRP (1.89 times more in men and 4 times more in women; p < 0.05). An association was found between initial motivation and greater changes in adherence to the mediterranean diet (p < 0.05). An inversely proportional difference was observed between age and adherence to the mediterranean diet (p < 0.05). Conclusions: The CRP, in our hospital environment, has an effect of improving adherence to the mediterranean diet and physical exercise in patients with ACS. The change in adherence to the diet increases as the motivation to change the baseline increases, and age is inversely related to the change in adherence.

Objetivo: Evaluar la eficacia de un programa de rehabilitación cardiaca (PRC) sobre la mejora de la adherencia a las medidas de prevención secundaria no farmacológicas en pacientes con síndrome coronario agudo (SCA). Método: Estudio retrospectivo con pacientes con SCA derivados a PRC en un hospital terciario de 2018 a 2021. Se analizaron diferencias pre-post de adherencia a actividad física, dieta mediterránea, tabaquismo y motivación al cambio. Se analizaron la edad, el sexo y la motivación basal en la predicción del cambio de adherencia. Resultados: Se incluyeron 418 pacientes. Al final del PRC aumentó la adherencia a la dieta mediterránea (p < 0.05; d = 0.83), la frecuencia de actividad física aumentó 2,16 (p < 0.05) y la motivación al cambio se mantuvo constante (p = 0.94). Tanto las mujeres como los hombres mejoraron la adherencia a la dieta mediterránea. Ambos sexos realizaron más ejercicio físico al final del PRC (1.89 veces más los hombres y 4 las mujeres; p < 0.05). Se encontró una asociación entre motivación inicial y mayores cambios en la adherencia a la dieta mediterránea (p < 0.05). Se observó una diferencia inversamente proporcional entre la edad y la adherencia a la dieta mediterránea (p < 0.05). Conclusiones: El PRC, en nuestro medio hospitalario, mejora la adherencia a la dieta mediterránea y al ejercicio físico en los pacientes con SCA. La adherencia a la dieta mediterránea aumenta a medida que lo hace la motivación al cambio basal, mientras que la edad está inversamente relacionada con el cambio de adherencia.

Scalable protein production by Komagataella phaffii enabled by ARS plasmids and carbon source-based selection.

BACKGROUND: Most recombinant Komagataella phaffii (Pichia pastoris) strains for protein production are generated by genomic integration of expression cassettes. The clonal variability in gene copy numbers, integration loci and consequently product titers limit the aptitude for high throughput applications in drug discovery, enzyme engineering or most comparative analyses of genetic elements such as promoters or secretion signals. Circular episomal plasmids with an autonomously replicating sequence (ARS), an alternative which would alleviate some of these limitations, are inherently unstable in K. phaffii. Permanent selection pressure, mostly enabled by antibiotic resistance or auxotrophy markers, is crucial for plasmid maintenance and hardly scalable for production. The establishment and use of extrachromosomal ARS plasmids with key genes of the glycerol metabolism (glycerol kinase 1, GUT1, and triosephosphate isomerase 1, TPI1) as selection markers was investigated to obtain a system with high transformation rates that can be directly used for scalable production processes in lab scale bioreactors. RESULTS: In micro-scale deep-well plate experiments, ARS plasmids employing the Ashbya gossypii TEF1 (transcription elongation factor 1) promoter to regulate transcription of the marker gene were found to deliver high transformation efficiencies and the best performances with the reporter protein (CalB, lipase B of Candida antarctica) for both, the GUT1- and TPI1-based, marker systems. The GUT1 marker-bearing strain surpassed the reference strain with integrated expression cassette by 46% upon re-evaluation in shake flask cultures regarding CalB production, while the TPI1 system was slightly less productive compared to the control. In 5 L bioreactor methanol-free fed-batch cultivations, the episomal production system employing the GUT1 marker led to 100% increased CalB activity in the culture supernatant compared to integration construct. CONCLUSIONS: For the first time, a scalable and methanol-independent expression system for recombinant protein production for K. phaffii using episomal expression vectors was demonstrated. Expression of the GUT1 selection marker gene of the new ARS plasmids was refined by employing the TEF1 promoter of A. gossypii. Additionally, the antibiotic-free marker toolbox for K. phaffii was expanded by the TPI1 marker system, which proved to be similarly suited for the use in episomal plasmids as well as integrative expression constructs for the purpose of recombinant protein production.

An Exploration of Resilience and Positive Affect among Undergraduate Nursing Students: A Longitudinal Observational Study.

BACKGROUND: The purpose of this study is to analyze the variation in resilience and emotional state scores in nursing students throughout the four years of training for the nursing degree. METHODS: This is a longitudinal observational study of a paired and prospective cohort of 176 nursing students who enrolled in the first year of a bachelor's degree in 2019. The study followed up with the students in 2022 and examined several sociodemographic factors, including sex, marital status, date of birth, living arrangements and occupation. Additionally, the study investigated changes in negative affect, positive affect, and resilience. RESULTS: A total of 176 students participated in the study. The study found that resilience increased from 68.24 ± 10.59 to 70.87 ± 9.06 (p < 0.001), positive affect increased from 28.16 ± 4.59 to 33.08 ± 8.00 (p < 0.001), and the negative affect score decreased from 25.27 ± 5.12 to 21.81 ± 7.85 (p < 0.001). The study also found that married individuals experienced an increase in negative affect (p = 0.03) compared to singles or those in open relationships. Furthermore, the change in resilience was greater in men than in women (p = 0.01). CONCLUSIONS: Throughout their four-year training, nursing students experience an increase in resilience and positive affect, as well as a decrease in negative affect.

"Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis".

BACKGROUND: Pulmonary artery catheterization (PAC) has been widely used in critically ill patients, yielding mixed results. Prior studies on cardiogenic shock (CS) predominantly included patients with acute myocardial infarction. This study aims to examine the effect of PAC use in patients with non-ischemic CS. METHODS: This retrospective cohort study employed data from the National Inpatient Sample (NIS) database, including weighted hospitalizations of adult patients with non-ischemic CS during 2017 to 2019. In-hospital outcomes were compared between groups using inverse probability of treatment weighting. RESULTS: A total of 303,970 patients with non-ischemic CS were included, of whom 17.5% received a PAC during their hospitalization. The median age was 67 years (interquartile range: 57 - 77) and 61% were male. After inverse probability of treatment weighting, patients in the PAC group had significantly lower in-hospital mortality (24.8% vs. 35.3%, p < 0.001), renal replacement therapy (10.7% vs. 12.4%, p = 0.002), in-hospital cardiac arrest (7.1% vs. 9.6%, p < 0.001), and mechanical ventilation (44.6% vs. 50.4%, p < 0.001) compared to non-PAC group. In contrast, the PAC group had higher use of intra-aortic balloon pump (15.4% vs. 3.4%, p < 0.001), percutaneous ventricular assist devices (12.6% vs. 2.6%, p < 0.001), extracorporeal membrane oxygenation (3.9% vs. 2.5%, p < 0.001), and heart transplantation (2.1% vs. 0.4%, p < 0.001). CONCLUSION: In the real-world setting, invasive hemodynamic monitoring with PAC in patients with non-ischemic CS is associated with survival benefits and a reduction in adverse events, including reduced need for renal replacement therapy, mechanical ventilation and risk of in-hospital cardiac arrest.

Pregnancy, Reproductive Factors, and Female Heart Failure Risk and Outcomes.

PURPOSE OF REVIEW: The purpose of this review is to provide an overview of recent evidence on female-specific risk factors related to reproductive status or pregnancy. RECENT FINDINGS: Pregnancy-related factors, including hypertensive disorders and gestational diabetes, increase the risk of heart failure in women, while breastfeeding and hormone therapy may offer protection. Hypertensive disorders of pregnancy, gestational diabetes, polycystic ovarian syndrome, placental abruption, younger maternal age at first live birth, younger maternal age at last live birth, number of stillbirths, number of pregnancies, onset of menstruation before 12 years of age, shorter reproductive age, ovariectomy, and prolonged absence of ovarian hormones may increase the risk of heart failure in women. Conversely, breastfeeding status and hormone therapy (for menopause or contraception) may serve as protective factors, while fertility treatments have no discernible effect on the risk of heart failure.

Multimorbidity analysis with low condition counts: a robust Bayesian approach for small but important subgroups.

BACKGROUND: Robustly examining associations between long-term conditions may be important in identifying opportunities for intervention in multimorbidity but is challenging when evidence is limited. We have developed a Bayesian inference framework that is robust to sparse data and used it to quantify morbidity associations in the oldest old, a population with limited available data. METHODS: We conducted a retrospective cross-sectional study of a representative dataset of primary care patients in Scotland as of March 2007. We included 40 long-term conditions and studied their associations in 12,009 individuals aged 90 and older, stratified by sex (3039 men, 8970 women). We analysed associations obtained with Relative Risk (RR), a standard measure in the literature, and compared them with our proposed measure, Associations Beyond Chance (ABC). To enable a broad exploration of interactions between long-term conditions, we built networks of association and assessed differences in their analysis when associations are estimated by RR or ABC. FINDINGS: Our Bayesian framework was appropriately more cautious in attributing association when evidence is lacking, particularly in uncommon conditions. This caution in reporting association was also present in reporting differences in associations between sex and affected the aggregated measures of multimorbidity and network representations. INTERPRETATION: Incorporating uncertainty into multimorbidity research is crucial to avoid misleading findings when evidence is limited, a problem that particularly affects small but important subgroups. Our proposed framework improves the reliability of estimations of associations and, more in general, of research into disease mechanisms and multimorbidity. FUNDING: National Institute for Health and Care Research.

Epidemiology and outcomes of pediatric cardiac arrest in a cardiovascular unit at a public hospital in Argentina.

BACKGROUND: Children with congenital heart disease present a higher frequency of cardiorespiratory arrest (CRA) than the general pediatric population. The epidemiology of CRA is not exactly known in our setting, nor are the mortality risk or the neurological evolution factors. OBJECTIVE: To describe the epidemiology and outcomes associated with pediatric cardiopulmonary resuscitation in a cardiovascular recovery unit. The primary endpoint was the survival to discharge and the secondary endpoints were the return to spontaneous circulation, the survival at 24 hours and the remote neurological condition. METHODS: Descriptive, prospective, longitudinal cohort study in children under 18 years of age who required cardiopulmonary resuscitation between 2016 and 2019. Demographic variables, characteristics of cardiopulmonary arrest, resuscitation and outcome were analyzed. An uni- and multivariate analysis was performed comparing survivors and deceased. RESULTS: Out of 1,842 hospitalized patients, 4.1% presented CRA. Fifty patients with complete records were analyzed. Seventy-eight percent (39) returned to spontaneous circulation with a high survival rate of 46%. Resuscitation > 6 min and the use of vasoactive drugs were predictors of mortality; 16/23 patients were followed up, 10 of them with normal development for age at 6 months, six had pervasive developmental disorder. CONCLUSIONS: 4.1% of patients presented CRA, with a rate of 3.4 CRA per 1,000 patient-days. Survival at hospital discharge (n = 50) was 46%. Resuscitation > 6 min and the use of vasoactive drugs were independent predictors of mortality. At six months, 63% had normal neurological development for age.

ANTECEDENTES: Los niños con cardiopatías congénitas experimentan paro cardiorrespiratorio (PCR) con mayor frecuencia que la población pediátrica general. Se desconoce la epidemiología exacta del PCR en nuestro medio, al igual que el riesgo de mortalidad y los factores que influyen en la evolución neurológica. OBJETIVO: Describir la epidemiología y los resultados asociados con la reanimación cardiopulmonar pediátrica en una unidad de recuperación cardiovascular. El criterio de valoración primario fue la supervivencia al momento del alta hospitalaria; los secundarios fueron el retorno de la circulación espontánea, la supervivencia a las 24 horas y la condición neurológica en el largo plazo. MÉTODO: Estudio de cohorte longitudinal, descriptivo, prospectivo, en menores de 18 años que requirieron reanimación cardiopulmonar entre 2016 y 2019. Se analizaron las variables demográficas y las características del paro cardiorrespiratorio y de la reanimación, así como su resultado. Se realizaron análisis de una y múltiples variables para comparar a los pacientes sobrevivientes con los fallecidos. RESULTADOS: De los 1,842 pacientes internados, el 4.1% experimentó PCR. Se analizaron 50 pacientes con expedientes completos. Se logró el retorno de la circulación espontánea en el 78% (39), con una supervivencia alta del 46%. La reanimación > 6 min y el uso de fármacos vasoactivos fueron factores predictivos de mortalidad; se realizó el seguimiento de 16/23 pacientes, 10 de ellos con desarrollo normal para la edad luego de seis meses, seis tenían trastorno generalizado del desarrollo. CONCLUSIONES: El 4.1% de los pacientes presentó un PCR, con una tasa de 3.4 PCR por 1,000 días-paciente. La supervivencia al egreso hospitalario (n = 50) fue del 46%. La reanimación > 6 min y la utilización de fármacos vasoactivos fueron factores predictivos independientes de mortalidad. Luego de seis meses, el 63% tenía desarrollo neurológico normal para la edad.

Synergic kinetic and physiological control to improve the efficiency of Komagataella phaffii recombinant protein production bioprocesses.

The yeast Komagataella phaffii (Pichia pastoris) is currently considered a versatile and highly efficient host for recombinant protein production (RPP). Interestingly, the regulated application of specific stress factors as part of bioprocess engineering strategies has proven potential for increasing the production of recombinant products. This study aims to evaluate the impact of controlled oxygen-limiting conditions on the performance of K. phaffii bioprocesses for RPP in combination with the specific growth rate (µ) in fed-batch cultivations. In this work, Candida rugosa lipase 1 (Crl1) production, regulated by the constitutive GAP promoter, growing at different nominal µ (0.030, 0.065, 0.100 and 0.120 h-1 ) under both normoxic and hypoxic conditions in carbon-limiting fed-batch cultures is analysed. Hypoxic fermentations were controlled at a target respiratory quotient (RQ) of 1.4, with excellent performance, using an innovative automated control based on the stirring rate as the manipulated variable developed during this study. The results conclude that oxygen limitation positively affects bioprocess efficiency under all growing conditions compared. The shift from respiratory to respiro-fermentative metabolism increases bioprocess productivity by up to twofold for the specific growth rates evaluated. Moreover, the specific product generation rate (qp ) increases linearly with µ, regardless of oxygen availability. Furthermore, this hypoxic boosting effect was also observed in the production of Candida antarctica lipase B (CalB) and pro-Rhizopus oryzae lipase (proRol), thus proving the synergic effect of kinetic and physiological stress control. Finally, the Crl1 production scale-up was conducted successfully, confirming the strategy's scalability and the robustness of the results obtained at the bench-scale level.

Sex differences in population versus in-hospital use of aortic valve replacement procedures in Spain.

BACKGROUND AND AIMS: It is not well known if sex differences in the use and results of aortic valve replacement (AVR) are changing. The aim of the study is to assess the time trends in the differences by sex in the utilisation of AVR procedures in hospitals and in the community. METHODS: Retrospective observational analysis using data from the Spanish National Hospitalizations Administrative Database. All hospitalisations between 2016 and 2021 with a main diagnosis of aortic stenosis (ICD-10 codes: I35.0 and I35.2) were included. Time trends in hospitalisation, AVRs and hospital outcomes were analysed. Crude utilisation and population-standardised rates were calculated. RESULTS: During the study period, 64 384 hospitalisations in 55 983 patients (55.5% men) with 36 915 (65,9%) AVR were recorded. Of these, 15 563 (42.2%) were transcatheter and 21 432 (58.0%) surgical. At hospital level, transcatheter procedures were more frequently performed in women (32.3% vs 24.2%, p < 0.001) and surgical in men (42.9% vs. 32.5%, p < 0.001) but at the population level, surgical and transcatheter aortic valve replacements were used more frequently in men (12.6 surgical and 8.0 transcatheter per 100 000 population) vs women (6.4 and 5.8, respectively; p < 0.001 for both comparisons). Transcatheter procedures shifted from 17.3% in 2016 to 38.0% in 2021, overtaking surgical procedures in 2018 for women and 2021 for men. CONCLUSIONS: TAVR has displaced SAVR as the most frequent AVR procedure in Spain by 2020. This occurred earlier in women, who despite the greater weight of their age group in the older population, receive fewer AVRs, both SAVR and TAVR.

Virtual Active Learning to Maximize Knowledge Acquisition in Nursing Students: A Comparative Study.

BACKGROUND: Nursing students need to acquire knowledge through active methods that promote critical thinking and decision making. The purpose of this study is to analyze whether there are differences in the acquisition of knowledge by nursing students between active face-to-face or virtual teaching methods. METHODS: In this comparative study, nursing students enrolled in the psychology course were divided into two groups: a face-to-face group that received active teaching methods and a virtual group. The virtual group was exposed to the Effective Learning Strategy (ELS), which included seminars based on video content through the Virtual Campus and answering questions using the H5P tool. In addition, participants engaged in reflection tasks on the content. Covariate data were collected, and knowledge tests were administered to both groups before and after the course. After three months, subjects were re-evaluated with a final exam to assess content retention. RESULTS: A total of 280 students were randomized. No differences were found in students' scores at the end of the knowledge test or in their final grades in the subject. Having study habits (b = 0.12, p = 0.03) and social support from relevant people (b = 0.09; p = 0.03) were associated with better post-intervention scores, and inversely with social support from friends (b = -0.12, p < 0.01). Final grades were inversely associated with digital safety literacy (b = -0.101, p = 0.01). No factors were associated with the scores of each group separately. CONCLUSIONS: The ELS virtual active learning model is as effective as face-to-face active learning methods for teaching psychology to first-year nursing students. This study was not registered.

A scale for assessing nursing students' emotional competence: A validation study.

BACKGROUND: The wellbeing of nursing professionals can be affected by emotionally challenging situations. Emotional intelligence (EI) is a recognised ability to manage stress, reduce work overload, and improve clinical relationships and decision making. Therefore, these emotional skills should be identified and developed throughout nursing education. OBJECTIVES: The aim of this study is to create an observer-based emotional measurement tool to assess the level of emotional skills in university students. DESIGN: This is a cross-sectional study. SETTING: Complutense University in Madrid, Spain. PARTICIPANTS: A total of 415 first- and fourth-year nursing students participated. METHODS: The Situational Emotional Response Scale (ERES) is a questionnaire for observing emotional competence in nursing practice. It underwent content validation using the Delphi method with 6 experts, resulting in a final version of 34 items. Focus group sessions were conducted with nursing students to ensure readability and appropriateness. Participants completed the ERES after viewing two clinical interaction videos, resulting in two sets of responses. Half of the responses were used for exploratory factor analysis (EFA) and half for confirmatory factor analysis (CFA). RESULTS: A total of 415 nursing students participated in the study. Four factors were extracted, explaining 55.1 % of the variance. The CFA was conducted with 208 students, yielding a total of 4 factors and a variance of 55.1 %. The internal consistency of the scale was high, with Cronbach's α and McDonald's ω coefficients of 0.947 and 0.949, respectively. Test-retest reliability showed a moderate intra-class correlation coefficient of 0.604 (95 % CI: 0.503-0.688) over a 15-day interval. CONCLUSIONS: The ERES questionnaire is well grounded in the theoretical framework of emotional competence as manifested in clinical practice. The empirical evidence provided by this study suggests that the ERES is a reliable, valid, useful, and innovative instrument for measuring emotional competence in university students.

Robustness of [18F]FDG PET/CT radiomic analysis in the setting of drug-induced cardiotoxicity.

BACKGROUND AND OBJECTIVES: Standardization of radiomic data acquisition protocols is still at a very early stage, revealing a strong need to work towards the definition of uniform image processing methodologies The aim of this study is to identify sources of variability in radiomic data derived from image discretization and resampling methodologies prior to image feature extraction. Furthermore, to identify robust potential image-based biomarkers for the early detection of cardiotoxicity. METHODS: Image post-acquisition processing, interpolation, and volume of interest (VOI) segmentation were performed. Four experiments were conducted to assess the reliability in terms of the intraclass correlation coefficient (ICC) of the radiomic features and the effects of the variation of voxel size and gray level discretization. Statistical analysis was performed separating the patients according to cardiotoxicity diagnosis. Differences of texture features were studied with Mann-Whitney U test. P-values <0.05 after multiple testing correction were considered statistically significant. Additionally, a non-supervised k-Means clustering algorithm was evaluated. RESULTS: The effect of the variation in the voxel size demonstrated a non-dependency relationship with the values of the radiomic features, regardless of the chosen discretization method. The median ICC values were 0.306 and 0.872 for absolute agreement and consistency, respectively, when varying the discretization bin number. The median ICC values were 0.678 and 0.878 for absolute agreement and consistency, respectively, when varying the discretization bin size. A total of 16 first order, 6 Gray Level Co-occurrence Matrix (GLCM), 4 Gray Level Dependence Matrix (GLDM) and 4 Gray Level Run Length Matrix (GLRLM) features demonstrated statistically significant differences between the diagnosis groups for interim scans (P<0.05) for the fixed bin size (FBS) discretization methodology. However, no statistically significant differences between diagnostic groups were found for the fixed bin number (FBN) discretization methodology. Two clusters based on the radiomic features were identified. CONCLUSIONS: Gray level discretization has a major impact on the repeatability of the radiomic features. The selection of the optimal processing methodology has led to the identification of texture-based patterns for the differentiation of early cardiac damage profiles.

Eficacia de un programa de rehabilitación cardiaca en polideportivo municipal comparado con el programa hospitalario: ensayo controlado aleatorizado eCARCEX / Efficacy of a cardiac rehabilitation program in a municipal sports center compared to the hospital program: randomized controlled trial eCARCEX

Fundamento. El objetivo de este estudio es analizar los efectos de un programa de rehabilitación cardiaca (PRC) extrahospitalario en un centro municipal deportivo sobre la capacidad funcional y la adherencia al ejercicio físico, entre otras variables, en comparación con un modelo hospitalario. Métodos. Ensayo clínico aleatorizado con dos grupos paralelos de pacientes con síndrome coronario agudo que realizaron un PRC con ejercicio físico moderado interválico coordinado con educación en hábitos saludables en un centro deportivo municipal (GE) y en un hospital terciario (GC), entre septiembre de 2019 y junio de 2020. Se analizaron variables de adherencia, antropométricas, clínicas, psicológicas, de fuerza, de prevención secundaria (dieta, tabaco) y capacidad funcional en la prueba de ergoespirometría. Resultados. Veintidós pacientes completaron el PRC (GC=10, GE=12). Se observaron mejoras significativas pre-post en GC (colesterol, test de la silla, frecuencia cardiaca en VT1 y VT2, y vatios en VT1) y en GE (colesterol HDL, triglicéridos, test de la silla, y frecuencia cardiaca y vatios en VT1). Estas mejoras fueron mayores en el GC para la frecuencia cardiaca en VT2 (11,17 vs 2,88 lpm) y en el GE para el colesterol HDL (11,0 vs 0,63 mg/dL). Conclusiones. Este estudio no ha podido determinar la eficacia de los PRC extrahospitalarios por falta de potencia (abundantes abandonos debidos al confinamiento por COVID-19). A pesar de ello, en el GE se observó mayor aumento en colesterol HDL que en el GC, aunque la frecuencia cardiaca en VT2 fue mayor en el GC (AU)

Background. This study aimed to analyze the effects of an outpa-tient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical activity – among other variables – compared to an in-hospital program.Methods. Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a car-diac rehabilitation program that consisted of moderate physical ex-ercise intervals along with learning healthy habits in a municipal sports center (EG) and in a tertiary hospital (CG) between Septem-ber 2019 and June 2020. We collected the following data: compli-ance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirom-etry. Results. Twenty-two patients completed the cardiac rehabilitation program (EG=12, CG=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the CG, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the EG. Better achievement was found in the CG for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL).Conclusions. We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). How-ever, the EG achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the CG (AU)

Efficacy of a cardiac rehabilitation program in a municipal sports center compared to the hospital program: randomized controlled trial eCARCEX.

BACKGROUND: This study aimed to analyze the effects of an outpatient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical exercise - among other variables - compared to an in-hospital program. METHODS: Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a cardiac rehabilitation program that consisted of moderate physical exercise intervals along with learning healthy habits in a municipal sports center (experimental group) and in a tertiary hospital (control group) between September 2019 and June 2020. We collected the following data: compliance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirometry. RESULTS: Twenty-two patients completed the cardiac rehabilitation program (experimental group=12, control group=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the control group, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the experimental group. Better achievement was found in the control group for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL). CONCLUSIONS: We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). However, the experimented group achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the control group.

Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis.

Aims: Women may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations. Methods and results: Retrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017-2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P < 0.001) were referred for a first cardiology consultation. The age-related referral rates were higher in women. The most common reasons for consultation were palpitations in women (n = 676; 19.2%) and ECG abnormalities in men (n = 570; 23.2%). Delays to cardiology visits and additional tests were similar. During 24 months of follow-up, women had fewer cardiology hospitalisations (204; 5.8% vs. 229; 9.3%; P = 0.003) and lower mortality (65; 1.8% vs. 66; 2.7%; P = 0.028), but those aged <65 years had more emergency department visits (756; 48.5% vs. 560; 39.9%, P < 0.001) than men. Conclusion: There are substantial sex differences in primary care cardiology referral patterns, including causes, rates, decisions and outcomes, which are only partially explained by age differences. Further research is needed to understand the reasons for these differences.

Emotional empowerment through information research and communication to reduce fear of COVID-19 among nursing students: a randomised controlled trial.

BACKGROUND: Despite an existing body of literature on anxiety reduction using multi-component methods, little is known about the effect of active student participation in research and communication of scientific information on anxiety and fear reduction. The aim of this study is to evaluate the impact of quality scientific information research and the production of informative videos on the preventive aspects of COVID-19 on fear and anxiety reduction. METHODS: A randomised controlled trial was conducted with 220 undergraduate nursing students in the first year of the nursing degree. The participating students were randomised into two groups. The experimental group carried out an intervention based on a database search for information on preventing COVID-19 and production of a video giving scientific reasons why prevention measures should be followed. In the control group, students created posters and videos about theoretical aspects of one module of the nursing degree. Both groups were surveyed before and after the intervention, measuring their state of resilience, preventive behaviours, level of anxiety, and fear of COVID-19. RESULTS: The intervention group showed a greater decrease in fear levels after the intervention than those in the control group. There were no differences between the groups in terms of resilience, preventive behaviours, or anxiety. In the experimental group, there was a significant decrease in anxiety levels and fear levels after the intervention compared to the baseline levels. CONCLUSIONS: An intervention based on active participation in searches for high-quality scientific information and production of information videos on COVID-19 prevention reduced fear and anxiety caused by COVID-19 among nursing students. TRIAL REGISTRATION: We have retrospectively registered the trial in Open Science Framework and the identification number is https://doi.org/10.17605/OSF.IO/6QU5S .

Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction.

INTRODUCTION AND OBJECTIVES: The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS: Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS: Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS: In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.

Serially improved GTOs for molecular applications (SIGMA): Basis sets from H to Ne.

A new approach for generating Gaussian basis sets is reported and tested for atoms from H to Ne. The basis sets thus calculated, named SIGMA basis sets, range from DZ to QZ sizes and have the same composition per shell as Dunning basis sets but with different treatment of the contractions. The standard SIGMA basis sets and their augmented versions have proven to be very suitable for providing good results in atomic and molecular calculations. The performance of the new basis sets is analyzed in terms of total, correlation, and atomization energies, equilibrium distances, and vibrational frequencies in several molecules, and the results are compared at several computational levels with those obtained with the corresponding Dunning and other basis sets.

Full-Term Delivery and Complete Lung Recovery following VV ECMO Support Midpregnancy in a Patient with COVID-19 ARDS.

Pregnant women are especially vulnerable to coronavirus disease 2019 (COVID-19). We present a twin pregnancy case with acute respiratory distress syndrome following COVID-19 infection at 19 weeks. The patient's ARDS was successfully managed with veno-venous extracorporeal membrane oxygenation (VV ECMO). She recovered completely and delivered healthy twins.

Sex differences in temporal trends in main and secondary pulmonary embolism diagnosis and case fatality rates: 2003-2019.

AIMS: There is controversy regarding the incidence and outcomes of pulmonary embolism (PE) according to sex. Our aim was to address sex differences in temporal trends in main and secondary hospital PE diagnoses, management and case fatality rates (CFR). METHODS AND RESULTS: Retrospective analysis of Spain´s National Healthcare System hospital database, years 2003-2019, for patients ≥18 years with main or secondary PE diagnosis. Trends by sex in hospital diagnosis, use of procedures, and CFRs were analysed by joinpoint and Poisson regression models. Of 339 469 PE diagnoses, 52% were in women. Sixty-five percent were main diagnosis, 35.2% secondary. Total annual diagnoses and frequentation rates increased similarly in men and women: average annual percent change (AAPC): 2.0% (95% CI, 1.3-2.6; P < 0.005). Secondary PEs were more common in men (37.8% vs. 32.9%, P < 0.001). Men showed greater comorbidity than women (Charlson index 2.22 ± 0.01 vs. 1.74 ± 0.01, P < 0.001), particularly cancer in the secondary diagnosis group (40.9% vs. 31.6%, P < 0.001). CFRs for PE as main diagnosis were comparable and decreased in parallel in men (from 13.8% in 2003 to 7.3% in 2019) and women (from 13.1% in 2003 to 6.9% in 2019). However, for PE as secondary diagnosis, CFRs remained higher (P < 0.001) in men (from 42.5% in 2003 to 26.2% in 2019) than women (from 34.4% in 2003 to 22.8% in 2019). CONCLUSION: PE hospital diagnosis increased significantly between 2003 and 2019 in men and women for both main and secondary diagnosis. Although in-hospital CFR decreased one third still remains very high, especially in men with secondary PE diagnosis.