Negotiating Boundaries: The Nurse Family Member Caring for Her Own Relative in Palliative Care

This research illuminates the challenges of living well within one's own family as a nurse caring for her own relative who is dying of a cancer-related illness. Developing a deeper awareness of the consequences of this caring work has been the central focus for inquiry in this research. Nursing requires epistemologies that encompass new ways of understanding how we live within our own families and communities and practice as nurses. The theoretical framework that guides this research interprets the French Philosopher Michel Foucault's (1926-1984) critical history of thought as an ethical project for nursing. It uses conceptual tools developed in his later writing and interviews to draw attention to how discursive knowledge and practices constitute subjectivity in relations of truth, power and the self's relation to the self. The first aspect of the analysis, landscapes of care examines the techniques of discourse as relations of power and knowledge that constitute nurse family members as subjects who have relationships with their own families and other health professionals. The second aspect analyses care of the self and others as self work undertaken to form the self as a particular kind of subject and achieve mastery over one's thoughts and actions. Nurses are called to care because they are present within their families with knowledge and expertise that makes a difference to how a dying relative experiences palliative care. Caring discourse positions nurses with responsibilities to their own; responsibilities that require sensitivity in knowing how to negotiate the relational spaces that constitute relationships with other family members and health professionals. Family discourse calls nurse family members to care as daughters, daughters-in-law, wives or mothers within normative understandings about the obligations that families have to care for their ill or dependent members. The discourse of expertise in knowing as a nurse positions nurse family members as interpreters of information for their families and observers who use their inside knowledge of how the health system works to watch over the ill person's clinical care. This expertise, which becomes visible as the exercise of professional authority in practising nursing, challenges the normative frameworks that classify and demarcate professional and lay roles in caring for the dying person. As an exploration of the complex and contradictory subjectivities of the nurse family member, this research illuminates the forms and limits of nursing practice knowledge. It shows how nursing is practised, and the identity of the nurse is created, through intellectual, political and relational work, undertaken on the self in relation to others, as modes of ethical engagement. Within this ethical engagement, nurse family members work to transform the self into discursive subjects, with the knowledge, skills and other capacities that are necessary to honour their commitments and responsibilities for care of another person. The experience of caring for their own relative transforms nurse family members' previously held values about how nurses ought to be with others in their professional work, creating a deeper sense of interest in and concern for the vulnerability of other people in palliative care

Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes

Background: In-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is high. Simple prognostic indices are needed to identify patients at high-risk of COVID-19 health outcomes. We aimed to determine the usefulness of the CONtrolling NUTritional status (CONUT) index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital admission. Methods: Our study design is of a retrospective observational study in a large cohort of COVID-19 patients. In addition to descriptive statistics, a Kaplan-Meier mortality analysis and a Cox regression were performed, as well as receiver operating curve (ROC). Results: From February 5, 2020 to January 21, 2021, there was a total of 2969 admissions for COVID-19 at our hospital, corresponding to 2844 patients. Overall, baseline (within 4 days of admission) CONUT index could be scored for 1627 (57.2%) patients. Patients' age was 67.3 ± 16.5 years and 44.9% were women. The CONUT severity distribution was: 194 (11.9%) normal (0-1); 769 (47.2%) light (2-4); 585 (35.9%) moderate (5-8); and 79 (4.9%) severe (9-12). Mortality of 30 days after admission was 3.1% in patients with normal risk CONUT, 9.0% light, 22.7% moderate, and 40.5% in those with severe CONUT (P < 0.05). An increased risk of death associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model (P < 0.05). An increasing baseline CONUT stage was associated with a longer duration of admission, a greater requirement for the use of non-invasive and invasive mechanical ventilation, and other clinical outcomes (all P < 0.05). The ROC of CONUT for mortality had an area under the curve (AUC) and 95% confidence interval of 0.711 (0.676-0746). Conclusion: The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patientsThe work is supported by a grant from the European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement (No 101016216

Ion-exchanged geopolymer for photocatalytic degradation of a volatile organic compound

In thepresentworkitisshownhowgeopolymerscanbeusedtocontrolindoorandoutdoorair pollution byphotolysisof2-ButanoneasaVolatileOrganicCompound(VOC).Anionexchange procedurewasfollowedtoincorporateTiO2 into ageopolymer(IEG),anddifferent2-Butanone concentrations wereusedinabatchreactorunderdryandhumidconditions.Variationon 2-Butanone concentrationwasfollowedbygaschromatography.ALangmuir Hinshelwood modelwas used todeterminethedisappearancerateofreactantattheinitialstageofthereaction.Gasca-Tirado, J.; Manzano-Ramirez, A.; Vazquez-Landaverde, PA.; Herrera-Diaz, EI.; Rodriguez-Ugarte, ME.; Rubio-Avalos, JC.; Amigó Borrás, V.... (2014). Ion-exchanged geopolymer for photocatalytic degradation of a volatile organic compound. Materials Letters. 134:222-224. doi:10.1016/j.matlet.2014.07.090S22222413

Estructura y diversidad del matorral submontano contiguo al área metropolitana de Monterrey, Nuevo León, México

In this study the structure and diversity of the piedmont scrub that abuts the western portion of the metropolitan area of Monterrey, Mexico, were examined. Vegetation composition and diversity were assessed by sampling vegetation in 41 plots of 100 m2 each. All trees and shrubs with a basal diameter (d0.10) ≥0.5 cm were counted, including succulents. In addition, the crown diameter (dcrown) for each species was recorded. Species richness was assessed by means of the Margalef index (DMg), while Shannon’s index (H’) was used to assess species diversity. A total of 45 species, 39 genera and 18 families were recorded. Fabaceae was the most important family with the highest species richness (12), followed by Cactaceae (5), Euphorbiacae, Rhamnaceae, Rutaceae and Verbenaceae (3); these families accounted for 64.44% of the entire flora recorded in the area. As for dominance (Dr), Fabaceae, Rutaceae, Asteraceae and Verbenaceae accounted for 64.08% of the Importance Value Index (IVI) in the community. The scrub presented a density of 3629 ind./ha-1 and a total crown cover of 6629 m2/ha-1. Acacia amentacea and Zanthoxylum fagara were the most important species, since they accounted for 25.87% of the IVI values in the locality. The rank/abundance curve for species fitted best to a log-normal function, which is characteristic of mature communities. The present study shows that the studied community is characterized by a high diversity and species richness in comparison to other arid and semi-arid climate vegetation in Northeast Mexico. Structural and diversity attributes documented in this study indicated that the piedmont scrub neighboring Monterrey is a well-preserved community in a mature successional stage; hence, it is urgent to develop strategies aimed at its conservation.En este estudio se evaluaron la estructura y la diversidad del matorral submontano limítrofe con la porción occidental del área metropolitana de Monterrey, México. Se determinó la composición y la diversidad de la vegetación mediante el establecimiento de 41 parcelas de 100 m2 cada una. Se censaron todos los árboles y arbustos con un diámetro basal (d0.10) ≥0.5 cm, incluyendo a las plantas suculentas; además, se midió el diámetro de copa (dcopa), para cada especie. Se calcularon los índices de Margalef (DMg) y de Shannon (H´) para determinar la riqueza y la diversidad de especies, respectivamente. Se registraron 45 especies, 39 géneros y 18 familias. La familia Fabaceae fue la que presentó más taxones (12), seguida de Cactaceae (5), Euphorbiacae, Rhamnaceae, Rutaceae y Verbenaceae (3), las cuales constituyen en conjunto 64.44% de la flora registrada para la zona de estudio. En cuanto a la dominancia (Dr); las Fabaceae, Rutaceae, Asteraceae y Verbenaceae sumaron 64.08% de los valores del Índice de Valor de Importancia (IVI) en la comunidad. Este matorral presenta una densidad de 3629 ind./ha-1 y una cobertura de copas de 6629 m2/ha-1. Acacia amentacea y Zanthoxylum fagara fueron las más importantes al acumular entre ellas 25.87% de los valores del IVI en la localidad. La curva de rango/abundancia de especies se ajustó a una función log-normal, característica de la vegetación madura. La comunidad estudiada presenta una alta diversidad y riqueza de especies en comparación con otras asociaciones vegetales de climas áridos y semiáridos del noreste de México. Los atributos de estructura y diversidad documentados en este estudio indican que el matorral submontano contiguo a la ciudad de Monterrey está bien conservado y en una fase de sucesión madura, por lo que es urgente proponer estrategias para su conservación

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub)tropics

Background: Allergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age. Methods: In a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes. Results: 628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005). Conclusions: In a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens –some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries

Geolocation with respect to persona privacy for the Allergy Diary app - a MASK study

Background: Collecting data on the localization of users is a key issue for the MASK (Mobile Airways Sentinel network: the Allergy Diary) App. Data anonymization is a method of sanitization for privacy. The European Commission's Article 29 Working Party stated that geolocation information is personal data. To assess geolocation using the MASK method and to compare two anonymization methods in the MASK database to find an optimal privacy method. Methods: Geolocation was studied for all people who used the Allergy Diary App from December 2015 to November 2017 and who reported medical outcomes. Two different anonymization methods have been evaluated: Noise addition (randomization) and k-anonymity (generalization). Results: Ninety-three thousand one hundred and sixteen days of VAS were collected from 8535 users and 54,500 (58. 5%) were geolocalized, corresponding to 5428 users. Noise addition was found to be less accurate than k-anonymity using MASK data to protect the users' life privacy. Discussion: k-anonymity is an acceptable method for the anonymization of MASK data and results can be used for other databases.Peer reviewe

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Registro Español de Trasplante Cardiaco. XXXI Informe Oficial de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología

Introducción y objetivos Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019. Métodos Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0, 7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9, 6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0, 34), y ambas mejores que la del trienio 2010-2012 (p = 0, 002 y p = 0, 01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular. Introduction and objectives: The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods: We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results: In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P = .34). Survival in both these periods was better than that from 2010 to 2012 (P = .002 and P = .01, respectively). Conclusions: Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant