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Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Seasonality in the condition and variability in somatic relationships of megrim (Lepidorhombus whiffiagonis) in the northeast Atlantic

Somatic parameters’ estimation of megrim (Lepidorhombus whiffiagonis), an economically important flatfish species and relevant one in the benthic community, is essential in fisheries biology. It helps us to deepen our understanding of the species life history traits and an adequate stock assessment and fishery management. Le Cren’s condition factor (K), weight-length relationships and weight conversion factors were studied in megrim for more than two decades time-series (1998–2019) and wide area with a relevant fishing activity and the species is distributed into two stocks: northern Bay of Biscay-nBB and Celtic Sea-CS stock, and southern Bay of BiscaysBB and Galician waters-Gw stock. Around 30,000 specimens, mostly collected from commercial landings by the research institutions IEO and AZTI, were sampled. Total fish length, total weight and commercial gutted weight were obtained, and five-year periods were defined throughout in the time-series. The influence of several factors, as seasonality, temporality, fish sex, maturity, abundance, and environmental conditions on the megrim condition were analyzed for each stock by GLM, being the season the most relevant factor. A clear seasonal pattern found for K, with the lowest values in spring, was found in both populations for the first time based on a multiyear period analysis. The pattern was more prominent in females and less marked in immature, related to the reproduction process. The lowest condition value was observed in May in nBB-CS and a month earlier in sBB-Gw (both after the spawning period). A progressive increase (favorable feeding conditions) followed to highest values in November–February, showing the relevance of K as indicator of the nutritional/reproductive status of megrim. Temporality (five-year periods) also had a much smaller effect on condition than seasonality. Megrim condition was inversely related to its abundance, and to the NAO index in the nBB-CS stock. Total weight-length, gutted weight-length and total weight-gutted weight relationships were fitted for each megrim stock and their temporal variations were analyzed. The large sample size, size range and time-series available allowed obtaining robust somatic parameters for the total weight-length relationships (a = 0.0049, b = 3.1012; a = 0.0041, b = 3.1682, respectively in nBB-CS stock and sBB-Gw stock), gutted weight-length relationships (a = 0.0046, b = 3.1033; a = 0.0042, b = 3.1510, respectively in nBB-CS and sBB-Gw stock), and weight conversion factors (1.049; 1.056, respectively in nBB-CS and sBB-Gw stock). They were considered the most appropriate to be used in the stock assessment of both stocks. A historical analysis of the temporal variability of the weight-length relationships showed different trends between stocks.European Union through the European Maritime and Fisheries Fund (EMFF)En prensa2,24

EDUREV:Open educational resource to support the generation of systematic reviews in Education

Diseño y valoración de un recurso educativo en abierto en revisiones sistemáticas de apoyo a la docencia en las materias de metodología de investigación de los másteres y formación en doctorado de los estudiantes de la Facultad de Educación.Design and evaluation of an open educational resource in systematic reviews to support the teaching in the subjects of research methodology of the masters and training in doctorate of students of the Faculty of Education.Depto. de Investigación y Psicología en EducaciónFac. de EducaciónFALSEsubmitte

EDUREV: validation of an open resource for the design of systematic reviews in Education

La herramienta, que tiene por nombre EDUREV, ha sido creada para ayudar a los estudiantes de Máster y Doctorado a elaborar sus revisiones sistemáticas, a la vez que se ha desarrollado siguiendo las condiciones propias de los materiales en abierto (accesibilidad, reusabilidad, adaptabilidad y combinación). El presente proyecto de innovación es continuación de dos proyectos consecutivos de Innova-Docencia concedidos en el curso 2020-2021 (nº 280) y en el curso 2021-2022 (nº 286). Por ello, son dos los objetivos generales del proyecto. El primero, desarrollar la fase de síntesis de estudios del recurso educativo EDUREV para que sirva de soporte a estudiantes de Máster y Doctorado de la Facultad de Educación en la realización de sus revisiones sistemáticas. El segundo, validar EDUREV como un recurso educativo en abierto para la elaboración de revisiones sistemática en Educación. Los principales beneficiarios del proyecto serán profesores y estudiantes de Máster y Doctorado de la Facultad de Educación. Los objetivos se alcanzarán a través de dos grandes fases y 15 tareas: Fase 1. Desarrollo de la fase de síntesis de estudios del recurso educativo EDUREV y Fase 2. Validación de EDUREV como recurso educativo en abierto para la elaboración de revisiones sistemáticas en Educación. El principal resultado esperado es la puesta en marcha de la herramienta en situaciones reales para la elaboración de revisiones sistemáticas en la Facultad de Educación de la Universidad Complutense de Madrid.Depto. de Investigación y Psicología en EducaciónFac. de EducaciónFALSEsubmitte

Weight-length relationships and weight conversion factors in two stocks of megrim (Lepidorhombus whiffiagonis): Celtic Seas - northern Bay of Biscay (7.b-k, 8.abd stock) and northern Iberian waters (8.c, 9.a stock)

BIOBENTON-4Biología de especies bentónicas comerciales (rape blanco, rape negro, gallo del norte, gallo, cigala y cuco) en el área del ICE