Accreditation systems for midwifery training programs worldwide: A scoping review. / Sistemas de acreditación de programas de formación en partería profesional en el mundo: una revisión de alcance.

Accreditation of midwifery training programs aims to improve the quality of midwifery education and care. The study aimed to diagnose the accreditation systems of midwifery programs worldwide, identifying characteristics, standards, and differences. According to Arksey and O'Malley's framework, a scoping review was conducted by searching databases, grey literature, and accreditation system websites. A total of 2574 articles and 198 websites related to education accreditation were identified, selecting 47 that addressed midwifery programs. The results show that while a global accreditation system in midwifery from the International Confederation of Midwives exists, it has been scarcely used. There is considerable heterogeneity across accreditation systems, with higher-income countries having more robust and specific systems. In contrast, accreditation is less common in lower-income countries and often depends on international support. The diversity across accreditation systems reflects differing needs, resources, and cultural approaches. The need for standardization and global improvement of accreditation systems is highlighted. Strengthening the International Confederation of Midwives accreditation system as a global system, with standards adaptable to each country or region according to their local contexts, could be key to advancing the professionalization and recognition of midwifery worldwide.

La acreditación de programas de formación de partería profesional pretende mejorar la calidad de la educación y la atención en obstetricia. El objetivo del estudio fue realizar un diagnóstico de los sistemas de acreditación de programas de partería en el mundo, identificando características, estándares y diferencias. Se realizó una revisión de alcance según marco de Arksey y O'Malley, mediante búsqueda en bases de datos, literatura gris y páginas web de sistemas de acreditación. Se identificaron 2574 artículos y 198 páginas web relacionados con la acreditación en educación, seleccionando 47 que abordaban programas de partería. Los resultados muestran que, si bien existe un sistema global de acreditación en partería de la Confederación Internacional de Matronas, ha sido escasamente utilizado. Asimismo, existe una heterogeneidad notable en los sistemas de acreditación, con países de mayor ingreso teniendo sistemas más robustos y específicos, mientras que en países de menor ingreso, la acreditación es menos común y a menudo depende de apoyo internacional. La diversidad en los sistemas de acreditación refleja variadas necesidades, recursos y enfoques culturales, lo cual genera la necesidad de estandarización y mejora global de los sistemas de acreditación. Fortalecer el sistema de acreditación de la Confederación Internacional de Matronas como sistema global, con estándares adaptables a cada país o región según sus contextos locales, podría ser clave para avanzar en la profesionalización y reconocimiento de la partería a nivel mundial.

Additive Manufacturing of Fe-Mn-Si-Based Shape Memory Alloys: State of the Art, Challenges and Opportunities.

Additive manufacturing (AM) constitutes the new paradigm in materials processing and its use on metals and alloys opens new unforeseen possibilities, but is facing several challenges regarding the design of the microstructure, which is particularly awkward in the case of functional materials, like shape memory alloys (SMA), as they require a robust microstructure to withstand the constraints appearing during their shape change. In the present work, the attention is focused on the AM of the important Fe-Mn-Si-based SMA family, which is attracting a great technological interest in many industrial sectors. Initially, an overview on the design concepts of this SMA family is offered, with special emphasis to the problems arising during AM. Then, such concepts are considered in order to experimentally develop the AM production of the Fe-20Mn-6Si-9Cr-5Ni (wt%) SMA through laser powder bed fusion (LPBF). The complete methodology is approached, from the gas atomization of powders to the LPBF production and the final thermal treatments to functionalize the SMA. The microstructure is characterized by scanning and transmission electron microscopy after each step of the processing route. The reversibility of the ε martensitic transformation and its evolution on cycling are studied by internal friction and electron microscopy. An outstanding 14% of fully reversible thermal transformation of ε martensite is obtained. The present results show that, in spite of the still remaining challenges, AM by LPBF offers a good approach to produce this family of Fe-Mn-Si-based SMA, opening new opportunities for its applications.

Real world data on the demographic and clinicopathological profile and management of patients with early-stage HER2-positive breast cancer and residual disease treated with adjuvant trastuzumab emtansine (KARMA study).

INTRODUCTION: Trastuzumab emtansine (T-DM1) significantly improves invasive disease-free survival and reduces the risk of recurrence in patients with HER2-positive early breast cancer (EBC) with residual disease (RD). The KARMA study aimed to describe the characteristics and management of these patients in clinical practice in Spain. MATERIAL AND METHODS: We conducted a multicentre retrospective study in patients with HER2-positive EBC with RD following neoadjuvant treatment (NeoT) and who had received ≥1 dose of T-DM1 as adjuvant treatment. The primary endpoint was the evaluation of sociodemographic and clinicopathological characteristics of these patients. RESULTS: A total of 114 patients were included (March-July 2020). At diagnosis, most tumours were infiltrating ductal carcinoma (IDC) (93.9 %), grade 2 (56.1 %), and hormone receptor (HR)-positive (79.8 %). Over 75 % of patients had disease in operable clinical stages (T1-3 N0-1). In the neoadjuvant setting, 86.8 % of patients received trastuzumab plus pertuzumab, and 23.6 % achieved radiological complete response. Breast-conserving surgery was performed in 55.8 % of patients. Surgical specimens showed that 89.5 % of patients had IDC, 49.1 % grade 2, 84.1 % HR-positive, and 8.3 % HER2-negative disease. Most patients had RD classified as RCB-II and Miller/Payne grade 3/4. Grade 3 treatment-related adverse events (trAEs) occurred in 5.3 % of patients. No grade 4/5 AEs occurred. Over 95 % of patients were free of invasive-disease during T-DM1 adjuvant treatment. CONCLUSION: The KARMA study describes the characteristics of patients with HER2-positive EBC with RD after NeoT and the real-life management of a T-DM1 adjuvant regimen, which showed a manageable safety profile in line with the KATHERINE trial data.

Using Open Foris Collect Earth in Kyrgyzstan to support greenhouse gas inventory in the land use, land use change, and forestry sector.

The Kyrgyz Republic (Kyrgyzstan) is one of the countries most vulnerable to the adverse effects of climate change in Central Asia. The land use, land use change, and forestry (LULUCF) sector is critical in climate change mitigation in Kyrgyzstan and is integral to national greenhouse gas (GHG) inventories. However, consistent, complete, and updated activity data is required for the LULUCF sector to develop a transparent GHG inventory. Collect Earth (CE), developed by the Food and Agriculture Organization of the United Nations (FAO), is a free, user-friendly, and open-source tool for collecting activity data for the LULUCF sector. CE assists countries in developing GHG inventories by providing consistent and complete land representation. This article reports an estimate of land use and land-use change dynamics in Kyrgyzstan, based on analyzing 13,414 1-hectare (ha) sampling units through an augmented visual interpretation approach using satellite imagery at the very high spatial and temporal resolution available through the Google Earth platform. The results show that in 2019, forests covered 1.36 million ha or 6.83% of the total land with a 6.23% uncertainty. This estimate was 5 to 16% higher than previous estimates, detecting an additional 63,024 to 188,164 ha of forestland that had not been reported previously. The new estimates suggest an average increase of 10.4% in the current forestlands of Kyrgyzstan.

Microstructural and Mechanical Characterization of Colloidal Processed WC/(W5Vol%Ni) via Spark Plasma Sintering.

This study investigates the sintering behaviour and properties of WC-based composites in which WC was mixed with W5vol%Ni in concentrations of 10vol% and 20vol%. Colloidal processing in water and spark plasma sintering were employed to disperse the WC particles and facilitate sintering. The addition of W5vol%Ni improved the sintering process, as evident from a lower onset temperature of shrinkage determined through dilatometric studies. All samples exhibited the formation of tungsten monocarbide (W2C), with a more pronounced presence in the WC/20(W5vol%Ni) composite. Sintering reached its maximum rate at 1550 °C and was completed at 1600 °C, resulting in a final density exceeding 99.8%. X-ray diffraction analysis confirmed the detection of WC and W2C phases after sintering. The observed WC content was higher than expected, which may be attributed to carbon diffusion during the process. Macro-scale mechanical characterisations revealed that the WC/10(W5vol%Ni) composite exhibited a hardness of 18.9 GPa, while the WC/20(W5vol%Ni) composite demonstrated a hardness of 18.3 GPa. Increasing the W5vol%Ni binder content caused a decrease in mechanical properties due to the formation of W2C phases. This study provides valuable insights into the sintering behavior and properties of WC/W5vol%Ni composites, offering potential applications in extreme environments.

Calcium foliar fertilization and its effect on quality and shelf life in andean blackberry fruits (Rubus glaucus Benth.)

Calcium is the third most crucial nutrient for andean blackberry; however, its absorption is limited in acid soils, and its low mobility in the plant decreases its effects on fruits. Therefore, the effect of foliar fertilizers with calcium on andean blackberry fruits was estimated. In three locations, experiments were established with five calcium sources (Ca chelate, CaB nitrate, Ca oxide, CaB and CaBZn gluconate) and a control without calcium, applied in three phenological stages and recording: weight, diameters, firmness, color, juice, pulp, pH, soluble solids, acidity, dehydration, and damage. Soil and tissue analysis was performed to identify the relationship between the plant's nutritional conditions and its fertilization response. For the statistical analysis were used mixed models, tests of means, and principal components. Foliar fertilization with chelate, nitrate, and calcium oxide in andean blackberry crops with thorns, in production, with pruning management, and in the phenological stages of flower bud, fruit set, and red fruit, is a viable alternative to improve firmness, weight, and diameter of the fruits. In contrast, the chemical and color parameters in andean blackberry fruits depend on the edaphoclimatic conditions of each zone. This fertilization should be considered as a complement in soils without acidity problems and with balanced cationic saturations.

El calcio es el tercer nutriente más importante para la mora; sin embargo, su absorción se ve limitada en suelos ácidos y su baja movilidad en planta disminuye su efecto en frutos. Por tanto, se estimó el efecto de fertilizantes foliares con calcio en frutos de mora. En tres localidades, se establecieron experimentos con cinco recursos de Ca (quelato de Ca, nitrato de CaB, óxido de Ca, KCaB y gluconato de CaBZn) y un control sin calcio, aplicados en tres etapas fenológicas y registrándose: peso, diámetros, firmeza, color, jugo, pulpa, pH, sólidos solubles, acidez, deshidratación y daños. Se realizó análisis de suelo y tejido, para identificar la relación entre las condiciones nutricionales de la planta y su respuesta a la fertilización. Para el análisis estadístico, se utilizaron modelos mixtos, pruebas de medias y componentes principales. La fertilización foliar con quelato, nitrato y óxido de calcio en cultivos de mora andina con espinas, en producción, con manejo de podas y en las etapas fenológicas de botón floral, cuajado y fruto rojo, es una alternativa viable para mejorar la firmeza, peso y diámetro de los frutos. En contraste, los parámetros químicos y de color en frutos de mora andina dependen de las condiciones edafoclimáticas propias de cada zona. Esta fertilización, se debe considerar como complemento en suelos sin problemas de acidez y con saturaciones catiónicas equilibradas.

Poly(amidoamine) Dendrimer as an Interfacial Dipole Modification in Crystalline Silicon Solar Cells.

Poly(amidoamine) (PAMAM) dendrimers are used to modify the interface of metal-semiconductor junctions. The large number of protonated amines contributes to the formation of a dipole layer, which finally serves to form electron-selective contacts in silicon heterojunction solar cells. By modification of the work function of the contacts, the addition of the PAMAM dendrimer interlayer quenches Fermi level pinning, thus creating an ohmic contact between the metal and the semiconductor. This is supported by the observation of a low contact resistivity of 4.5 mΩ cm2, the shift in work function, and the n-type behavior of PAMAM dendrimer films on the surface of crystalline silicon. A silicon heterojunction solar cell containing the PAMAM dendrimer interlayer is presented, which achieved a power conversion efficiency of 14.5%, an increase of 8.3% over the reference device without the dipole interlayer.

Spin-Forbidden Addition of Molecular Oxygen to Stable Enol Intermediates-Decarboxylation of 2-Methyl-1-tetralone-2-carboxylic Acid.

The deprotonation of an organic substrate is a common preactivation step for the enzymatic cofactorless addition of O2 to this substrate, as it promotes charge-transfer between the two partners, inducing intersystem crossing between the triplet and singlet states involved in the process. Nevertheless, the spin-forbidden addition of O2 to uncharged ligands has also been observed in the laboratory, and the detailed mechanism of how the system circumvents the spin-forbiddenness of the reaction is still unknown. One of these examples is the cofactorless peroxidation of 2-methyl-3,4-dihydro-1-naphthol, which will be studied computationally using single and multi-reference electronic structure calculations. Our results show that the preferred mechanism is that in which O2 picks a proton from the substrate in the triplet state, and subsequently hops to the singlet state in which the product is stable. For this reaction, the formation of the radical pair is associated with a higher barrier than that associated with the intersystem crossing, even though the absence of the negative charge leads to relatively small values of the spin-orbit coupling.

Impact of Graphene Monolayer on the Performance of Non-Conventional Silicon Heterojunction Solar Cells with MoOx Hole-Selective Contact.

In this work, a new design of transparent conductive electrode based on a graphene monolayer is evaluated. This hybrid electrode is incorporated into non-standard, high-efficiency crystalline silicon solar cells, where the conventional emitter is replaced by a MoOx selective contact. The device characterization reveals a clear electrical improvement when the graphene monolayer is placed as part of the electrode. The current-voltage characteristic of the solar cell with graphene shows an improved FF and Voc provided by the front electrode modification. Improved conductance values up to 5.5 mS are achieved for the graphene-based electrode, in comparison with 3 mS for bare ITO. In addition, the device efficiency improves by around 1.6% when graphene is incorporated on top. These results so far open the possibility of noticeably improving the contact technology of non-conventional photovoltaic technologies and further enhancing their performance.

Encapsulation of MSCs and GDNF in an Injectable Nanoreinforced Supramolecular Hydrogel for Brain Tissue Engineering.

The co-administration of glial cell line-derived neurotrophic factor (GDNF) and mesenchymal stem cells (MSCs) in hydrogels (HGs) has emerged as a powerful strategy to enhance the efficient integration of transplanted cells in Parkinson's disease (PD). This strategy could be improved by controlling the cellular microenvironment and biomolecule release and better mimicking the complex properties of the brain tissue. Here, we develop and characterize a drug delivery system for brain repair where MSCs and GDNF are included in a nanoparticle-modified supramolecular guest-host HA HG. In this system, the nanoparticles act as both carriers for the GDNF and active physical crosslinkers of the HG. The multifunctional HG is mechanically compatible with brain tissue and easily injectable. It also protects GDNF from degradation and achieves its controlled release over time. The cytocompatibility studies show that the developed biomaterial provides a friendly environment for MSCs and presents good compatibility with PC12 cells. Finally, using RNA-sequencing (RNA-seq), we investigated how the three-dimensional (3D) environment, provided by the nanostructured HG, impacted the encapsulated cells. The transcriptome analysis supports the beneficial effect of including MSCs in the nanoreinforced HG. An enhancement in the anti-inflammatory effect of MSCs was observed, as well as a differentiation of the MSCs toward a neuron-like cell type. In summary, the suitable strength, excellent self-healing properties, good biocompatibility, and ability to boost MSC regenerative potential make this nanoreinforced HG a good candidate for drug and cell administration to the brain.

Early warning signal for a tipping point suggested by a millennial Atlantic Multidecadal Variability reconstruction.

Atlantic multidecadal variability is a coherent mode of natural climate variability occurring in the North Atlantic Ocean, with strong impacts on human societies and ecosystems worldwide. However, its periodicity and drivers are widely debated due to the short temporal extent of instrumental observations and competing effects of both internal and external climate factors acting on North Atlantic surface temperature variability. Here, we use a paleoclimate database and an advanced statistical framework to generate, evaluate, and compare 312 reconstructions of the Atlantic multidecadal variability over the past millennium, based on different indices and regression methods. From this process, the best reconstruction is obtained with the random forest method, and its robustness is checked using climate model outputs and independent oceanic paleoclimate data. This reconstruction shows that memory in variations of Atlantic multidecadal variability have strongly increased recently-a potential early warning signal for the approach of a North Atlantic tipping point.

Atomic layer deposition of vanadium oxide films for crystalline silicon solar cells.

Transition metal oxides (TMOs) are promising materials to develop selective contacts on high-efficiency crystalline silicon solar cells. Nevertheless, the standard deposition technique used for TMOs is thermal evaporation, which could add potential scalability problems to industrial photovoltaic fabrication processes. As an alternative, atomic layer deposition (ALD) is a thin film deposition technique already used for dielectric deposition in the semiconductor device industry that has a straightforward up scalable design. This work reports the results of vanadium oxide (V2O5) films deposited by ALD acting as a hole-selective contact for n-type crystalline silicon (c-Si) solar cell frontal transparent contact without the additional PECVD passivating layer. A reasonable specific contact resistance of 100 mΩ cm2 was measured by the transfer length method. In addition, measurements suggest the presence of an inversion layer at the c-Si/V2O5 interface with a sheet resistance of 15 kΩ sq-1. The strong band bending induced at the c-Si surface was confirmed through capacitance-voltage measurements with a built-in voltage value of 683 mV. Besides low contact resistance, vanadium oxide films provide excellent surface passivation with effective lifetime values of up to 800 µs. Finally, proof-of-concept both-side contacted solar cells exhibit efficiencies beyond 18%, shedding light on the possibilities of TMOs deposited by the atomic layer deposition technique.

The correlation between point-of-care ultrasound and digital tomosynthesis when used with suspected COVID-19 pneumonia patients in primary care.

BACKGROUND: The use of lung ultrasound (LU) with COVID-19 pneumonia patients should be validated in the field of primary care (PC). Our study aims to evaluate the correlation between LU and radiographic imaging in PC patients with suspected COVID-19 pneumonia. METHODS: This observational, prospective and multicentre study was carried out with patients from a PC health area whose tests for COVID-19 and suspected pneumonia had been positive and who then underwent LU and a digital tomosynthesis (DT). Four PC physicians obtained data regarding the patients' symptoms, examination, medical history and ultrasound data for 12 lung fields: the total amount of B lines (zero to four per field), the irregularity of the pleural line, subpleural consolidation, lung consolidation and pleural effusion. These data were subsequently correlated with the presence of pneumonia by means of DT, the need for hospital admission and a consultation in the hospital emergency department in the following 15 days. RESULTS: The study was carried out between November 2020 and January 2021 with 70 patients (40 of whom had pneumonia, confirmed by means of DT). Those with pneumonia were older, had a higher proportion of arterial hypertension and lower oxygen saturation (sO2). The number of B lines was higher in patients with pneumonia (16.53 vs. 4.3, p < 0.001). The area under the curve for LU was 0.87 (95% CI 0.78-0.96, p < 0.001), and when establishing a cut-off point of six B lines or more, the sensitivity was 0.875 (95% CI 0.77-0.98, p < 0.05), the specificity was 0.833 (95% CI 0.692-0.975, p < 0.05), the positive-likelihood ratio was 5.25 (95% CI 2.34-11.79, p < 0.05) and the negative-likelihood ratio was 0.15 (95% CI 0.07-0.34, p < 0.05). An age of ≥ 55 and a higher number of B lines were associated with admission. Patients who required admission (n = 7) met at least one of the following criteria: ≥ 55 years of age, sO2 ≤ 95%, presence of at least one subpleural consolidation or ≥ 21 B lines. CONCLUSIONS: LU has great sensitivity and specificity for the diagnosis of COVID-19 pneumonia in PC. Clinical ultrasound findings, along with age and saturation, could, therefore, improve decision-making in this field.

Enabling Remote Responder Bio-Signal Monitoring in a Cooperative Human-Robot Architecture for Search and Rescue.

The roles of emergency responders are challenging and often physically demanding, so it is essential that their duties are performed safely and effectively. In this article, we address real-time bio-signal sensor monitoring for responders in disaster scenarios. In particular, we propose the integration of a set of health monitoring sensors suitable for detecting stress, anxiety and physical fatigue in an Internet of Cooperative Agents architecture for search and rescue (SAR) missions (SAR-IoCA), which allows remote control and communication between human and robotic agents and the mission control center. With this purpose, we performed proof-of-concept experiments with a bio-signal sensor suite worn by firefighters in two high-fidelity SAR exercises. Moreover, we conducted a survey, distributed to end-users through the Fire Brigade consortium of the Provincial Council of Málaga, in order to analyze the firefighters' opinion about biological signals monitoring while on duty. As a result of this methodology, we propose a wearable sensor suite design with the aim of providing some easy-to-wear integrated-sensor garments, which are suitable for emergency worker activity. The article offers discussion of user acceptance, performance results and learned lessons.

Deep learning multimodal fNIRS and EEG signals for bimanual grip force decoding.

Objective.Non-invasive brain-machine interfaces (BMIs) offer an alternative, safe and accessible way to interact with the environment. To enable meaningful and stable physical interactions, BMIs need to decode forces. Although previously addressed in the unimanual case, controlling forces from both hands would enable BMI-users to perform a greater range of interactions. We here investigate the decoding of hand-specific forces.Approach.We maximise cortical information by using electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) and developing a deep-learning architecture with attention and residual layers (cnnatt) to improve their fusion. Our task required participants to generate hand-specific force profiles on which we trained and tested our deep-learning and linear decoders.Main results.The use of EEG and fNIRS improved the decoding of bimanual force and the deep-learning models outperformed the linear model. In both cases, the greatest gain in performance was due to the detection of force generation. In particular, the detection of forces was hand-specific and better for the right dominant hand andcnnattwas better at fusing EEG and fNIRS. Consequently, the study ofcnnattrevealed that forces from each hand were differently encoded at the cortical level.Cnnattalso revealed traces of the cortical activity being modulated by the level of force which was not previously found using linear models.Significance.Our results can be applied to avoid hand-cross talk during hand force decoding to improve the robustness of BMI robotic devices. In particular, we improve the fusion of EEG and fNIRS signals and offer hand-specific interpretability of the encoded forces which are valuable during motor rehabilitation assessment.

Impact of equatorial Atlantic variability on ENSO predictive skill.

El Niño-Southern Oscillation (ENSO) is a key mode of climate variability with worldwide climate impacts. Recent studies have highlighted the impact of other tropical oceans on its variability. In particular, observations have demonstrated that summer Atlantic Niños (Niñas) favor the development of Pacific Niñas (Niños) the following winter, but it is unclear how well climate models capture this teleconnection and its role in defining the seasonal predictive skill of ENSO. Here we use an ensemble of seasonal forecast systems to demonstrate that a better representation of equatorial Atlantic variability in summer and its lagged teleconnection mechanism with the Pacific relates to enhanced predictive capacity of autumn/winter ENSO. An additional sensitivity study further shows that correcting SST variability in equatorial Atlantic improves different aspects of forecast skill in the Tropical Pacific, boosting ENSO skill. This study thus emphasizes that new efforts to improve the representation of equatorial Atlantic variability, a region with long standing systematic model biases, can foster predictive skill in the region, the Tropical Pacific and beyond, through the global impacts of ENSO.

Optimization of a GDNF production method based on Semliki Forest virus vector.

Human glial cell line-derived neurotrophic factor (hGDNF) is the most potent dopaminergic factor described so far, and it is therefore considered a promising drug for Parkinson's disease (PD) treatment. However, the production of therapeutic proteins with a high degree of purity and a specific glycosylation pattern is a major challenge that hinders its commercialization. Although a variety of systems can be used for protein production, only a small number of them are suitable to produce clinical-grade proteins. Specifically, the baby hamster kidney cell line (BHK-21) has shown to be an effective system for the expression of high levels of hGDNF, with appropriate post-translational modifications and protein folding. This system, which is based on the electroporation of BHK-21 cells using a Semliki Forest virus (SFV) as expression vector, induces a strong shut-off of host cell protein synthesis that simplify the purification process. However, SFV vector exhibits a temperature-dependent cytopathic effect on host cells, which could limit hGDNF expression. The aim of this study was to improve the expression and purification of hGDNF using a biphasic temperature cultivation protocol that would decrease the cytopathic effect induced by SFV. Here we show that an increase in the temperature from 33°C to 37°C during the "shut-off period", produced a significant improvement in cell survival and hGDNF expression. In consonance, this protocol led to the production of almost 3-fold more hGDNF when compared to the previously described methods. Therefore, a "recovery period" at 37°C before cells are exposed at 33°C is crucial to maintain cell viability and increase hGDNF expression. The protocol described constitutes an efficient and highly scalable method to produce highly pure hGDNF.

Radiology departments as COVID-19 entry-door might improve healthcare efficacy and efficiency, and emergency department safety.

BACKGROUND: Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision's reliability. METHODS: We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative-group 1- and positive-group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. RESULTS: The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. CONCLUSIONS: Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.

DpgC-Catalyzed Peroxidation of 3,5-Dihydroxyphenylacetyl-CoA (DPA-CoA): Insights into the Spin-Forbidden Transition and Charge Transfer Mechanisms*.

Despite being a very strong oxidizing agent, most organic molecules are not oxidized in the presence of O2 at room temperature because O2 is a diradical whereas most organic molecules are closed-shell. Oxidation then requires a change in the spin state of the system, which is forbidden according to non-relativistic quantum theory. To overcome this limitation, oxygenases usually rely on metal or redox cofactors to catalyze the incorporation of, at least, one oxygen atom into an organic substrate. However, some oxygenases do not require any cofactor, and the detailed mechanism followed by these enzymes remains elusive. To fill this gap, here the mechanism for the enzymatic cofactor-independent oxidation of 3,5-dihydroxyphenylacetyl-CoA (DPA-CoA) is studied by combining multireference calculations on a model system with QM/MM calculations. Our results reveal that intersystem crossing takes place without requiring the previous protonation of molecular oxygen. The characterization of the electronic states reveals that electron transfer is concomitant with the triplet-singlet transition. The enzyme plays a passive role in promoting the intersystem crossing, although spontaneous reorganization of the water wire connecting the active site with the bulk presets the substrate for subsequent chemical transformations. The results show that the stabilization of the singlet radical-pair between dioxygen and enolate is enough to promote spin-forbidden reaction without the need for neither metal cofactors nor basic residues in the active site.

A comprehensive analysis on nanostructured materials in a thermoelectric micro-system based on geometric shape, segmentation structure and load resistance.

In this study, we report the novel energy behavior of high-performance nanostructured materials in a segmented thermoelectric micro-generator (TEG). Several physical elements of the materials must be considered to determine their behavior in the thermoelectric energy conversion: temperature dependence of material properties, geometric structure, segmentation, and the symmetry of each or both p-type and n-type nanostructure semiconductor thermoelements. Recently, many efforts have reported effects independent on the thermoelectric performance of semiconductor materials. In this work, exhaustive research on the performance of high-performance nanostructured materials in a segmented thermoelectric micro-generator (TEG) was carried out. Our results show the efficiency and output power of the TEG using the temperature-dependent model, i.e., a variable internal resistance for a load resistance of the system. Our approach allows us to analyze symmetrical and asymmetric geometries, showing maximum and minimum peaks values in the performance of the TEG for specific [Formula: see text] values. The performance of the TEG is improved by about [Formula: see text] and [Formula: see text], for efficiency, and output power, respectively, considering a trapezoidal geometric shape in the 2p-3n segmented system, compared with the conventional rectangular shape.