Expanding congenital abnormalities of the kidney and urinary tract (CAKUT) genetics: basonuclin 2 (BNC2) and lower urinary tract obstruction

his work was supported by FIS PI16/02057, PI19/00588, PI19/00815, DTS18/00032, REDinREN RD016/0009 Fondos FEDER, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071), Sociedad Española de Nefrología, FRIAT, and Comunidad de Madrid B2017/BMD-3686 CIFRA2 and Rio Hortega to MV Perez-Gome

The use of medicines in exceptional circumstances in Spain: adding perspective to early access

The use of medicines in exceptional circumstances refers to the use of non-authorized medicines or those used outside the authorized conditions, and comprises three different situations: (1) the use of medication in research or for compassionate use; (2) the use of foreign medicines (medicines unauthorized in one country but authorized in others); and (3) off-label use (prescription of drugs for conditions other than that for which they have been officially approved). In Spain, we intend to regulate the period between authorization and pricing through the use of therapeutic positioning reports containing standard criteria. In our opinion, the key to managing this period could be restrictive access based on the therapeutic positioning reports, prespecified agreements on acquisition cost, and restrictive time framework (for use or for decision making, e.g. orphan medicines)

Tidal resource modelling for sites in the vicinity of an island near a landmass

Before tidal stream energy is exploited, tidal power resource and environmental assessments must be undertaken. This thesis explores limits to power extraction for tidal sites defined by a strait between an island and landmass. Numerical simulations provided by Fluidity are used to analyse power extraction from locations in the strait and around the island for an idealised island-landmass domain and an actual coastal site. The numerical model is verified by comparing predictions with analytical solutions for inviscid flow past a circular cylinder located in the centre of a channel and in the vicinity of a wall. The model is then validated against laboratory measurements of flow patterns for impulsively-started flow past a submerged circular cylinder, and for flow past a surface-piercing circular cylinder in oscillatory laminar shallow flow. It is demonstrated that the numerical method captures satisfactorily the mechanisms of early wake formation, which indicates the model can be applied to assess tidal stream resource within the coastal geometries considered herein. Finally, the methodology to account for power extraction is satisfactorily verified for bounded and unbounded flows. Contrary to current practices, results from a parameter study for different idealised coastal sites reveal that the maximum power extracted in the strait is not well approximated by either the power extracted naturally at the seabed or the undisturbed kinetic power. Moreover, an analytical channel model underpredicts the maximum power extracted in the strait due to its inability to account for changes in the driving head resulting from power extraction and flow diversion offshore of the island. An exception is found for islands with large aspect ratios, with the larger dimension extending parallel to the landmass; i.e. the island-landmass geometry approaching that of a channel. In this case, the extracted power is satisfactorily approximated by the power naturally dissipated at the seabed and there is good agreement with the analytical model. The maximum power extracted in the strait is shown to decrease when water depths offshore are greater than in the strait, underlining the importance of fully understanding the wider bathymetry of a given site. A similar conclusion is reached when strait blockage is reduced. The power extraction in the strait is found to be sensitive to both viscosity and seabed friction, and these parameters need to be properly estimated during the setup and calibration of models in order to reduce uncertainty. Power extraction increases when turbines are sited simultaneously both in the strait and offshore. Tidal power assessment is performed for Rathlin Sound, off the coast of Northern Ireland. Again, no clear relationship is found between maximum power extracted in the strait and either the power dissipated naturally at the seabed or the undisturbed kinetic power. A similar ratio of power extracted to undisturbed kinetic power is obtained as for the equivalent idealised model. The analytical channel model underpredicts the maximum power extracted. The actual and idealised coastal site models indicate similar responses to changes in seabed friction, and similar reduction in power extraction with decreasing strait blockage

Aplicación de técnicas de pensamiento visible en el diseño de recursos y estrategias didácticas de trabajo en AICLE

El desarrollo de destrezas de pensamiento, a través de la experimentación de técnicas de “Pensamiento Visible”, es una nueva línea educativa que tiene sus raíces en la neuroeducación y que tiene sus bases en la teoría inicial de las inteligencias múltiples de H. Gardner con su posterior desarrollo. Este Trabajo de Fin de Grado tiene como propósito fundamental investigar sobre aquellas técnicas y estrategias de aprendizaje necesarias para hacer el pensamiento visible al alumnado de 5ª curso de un centro bilingüe de Educación Primaria. Así mismo, se pretende recalcar la importancia de trabajar con los distintos tipos de inteligencias para conseguir una mayor eficacia. Para ello, se pone el énfasis en la visibilidad del pensamiento del alumnado, potenciando sus habilidades mediante la inteligencia emocional y espacial-artística. Así, se plantea una propuesta para la asignatura de Science/ Ciencias Naturales impartida en lengua inglesa como lengua vehicular, en la que se toma como punto de partida la implementación de una secuencia o unidad didáctica, usando la imagen como soporte visual y como herramienta de aprendizaje. La imagen así se transforma en la gran protagonista para el desarrollo de la literacidad, siendo los recursos didácticos y su organización el eje de la secuenciaGrado en Educación Primari

Haemodialysate: Long neglected, difficult to optimize, may modify hard outcomes

In two recent CKJ reviews, experts (Basile and Lomonte and Locatelli et al.) have reviewed haemodialysate composition. A longneglected issue, observational studies have associated the composition of haemodialysate to adverse outcomes. However, the scarcity of clinical trial-derived information results in limited guideline recommendations on the issue. Indeed, guidelines have more frequently indicated what not to do rather than what to do. In this setting, expert opinion becomes invaluable. In designing haemodialysate composition, a balance should be struck between the need to correct within a time frame of around 4 hours the electrolyte and water imbalances that take 48 to 72 h to build, with the need for gradual correction of these imbalances. The issue is complicated further by the impact of individual variability in dietary habits, medications and comorbidities. In this regard, a personalized medicine approach to individualization of haemodialysate composition offers the best chance of improving patient outcomes. But how can haemodialysate individualization be achieved, and what clinical trial design will best test the impact of such approaches on patient outcomes?Grant support: ISCIII and FEDER funds PI13/00047, Sociedad Española de Nefrologia, ISCIII-RETIC REDinREN/RD012/0021, Comunidad de Madrid CIFRA S2010/BMD-2378. Salary support: Programa Intensificación Actividad Investigadora (ISCIII/Agencia Laín-Entralgo/CM) to A.O

Drug-drug interactions between tyrosine kinase inhibitors and concomitant medications: drug safety in chronic myeloid leukemia treatment.

Background: Clinical Pharmacist should be aware of hematologic toxicities from tyrosine kinase inhibitors (TKI) used to treat chronic myelogenous leukemia (CML). Drug-drug interactions (DDI) may be problematic. Objective: To analyze DDI between TKI and the concomitant medication. Setting: Retrospective observational study carried in a tertiary hospital of Spain. Method: A bibliographic search was made on the UpToDate®, Lexicomp® and Micromedex® software platforms to search for evidence on DDI between TKI and the concomitant medication. Main outcome measure: Number of interactions with respect to sex,to number of concomitant drugs, and to TKI used. Results: A total of 28 patients were analyzed. 78.6% of patients had medication associated with the TKI. There was a total of 50 significant DDI, out of a total of 128 drugs, so the risk of having interaction in the study population was 39.1%. Regarding the management of the interactions by the hematologist and the acceptance of the pharmaceutical intervention: 10 patients experienced 14 high-level interactions. Of these the doctor knew 50% and had performed intervention in all cases: modify the treatment in 28.6%, consulted with service responsible for treatment in 42.8% and spaced the intake of drugs in 28.6%. It is important to periodically review concomitant medication and to have a strategy to manage interactions. The role of the clinical pharmacist is essential in communication with the patient, assessment of treatments, detecting potential interactions and disseminating information among the multidisciplinary team. Conclusion: All patients who are prescribed oral antineoplastic drugs are provided patient education materials about TKI, which include possible interactions. Any changes in the patient’s medications prompt a review for DDI

Pharmaceutical intervention after evaluation of the risk of ictus in elderly patients institutionalized with atrial fibrillation

Objectives: To evaluate the risk of having a stroke and the risk of bleeding in institutionalized patients with atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia associated with increased morbidity and mortality. It is necessary to develop pharmacotherapy plans to minimize the risk. Design: A prospective study. Setting: Institutionalized patients. Participants: Inclusion criteria were: patients diagnosed with atrial fibrillation, with or without treatment for the prevention of stroke. Main outcome measures: The evaluation of the CHA2DS2-VASc criteria was performed. The risk of hemorrhage was assessed using the HAS-BLED scale, based on the risk factors associated with the probability of bleeding. Results: We included 53 patients (86.4 ` 6.4 years, 30.2% men). Of these, 37 (69.8%) were correctly anticoagulated. Of the remaining, 5 patients (31.2%) did not have any type of anticoagulant or antiaggregant treatment and 11 (68.7%) were treated with antiaggregant alone. The pharmaceutical intervention was performed in patients who did not meet stroke criteria. Of the untreated patients: two died before the intervention, two were recommended to be referred to cardiology and in one there was no intervention because of very advanced age. In the antiaggregant patients, it was decided not to modify the treatment. The reasons were: high risk of bleeding, very advanced age, advanced dementia or terminal illness, moderate risk of stroke, and clotting factor deficiency. Conclusions: The risk of stroke in elderly patients with atrial fibrillation is high, so it is important to control the risk factors

Second-generation antipsychotics clinical pharmacy plan developed from hospital pharmacy to primary health care

The growing role of hospital pharmacists in the ambulatory care setting challenges new changes. Drug distribution to Primary/Ambulatory Healthcare needs to reformulate a clinical pharmacy practice plan when presented with a patient having schizophrenia, according to criteria of rational drug use, equity and accessibility of the patient for sustained concentrations for several weeks indicated only for chronic therapy in patients who have trouble adhering to oral therapy that might achieve a markedly decline of positive, negative and cognitive symptoms. Therefore, these important features of long-acting injectable antipsychotics (LAIs, previously known as depot antipsychotics) need to be addressed on real-world practice. The purpose of the study is to develop drug distribution logistics for second-generation antipsychotics from Spanish Hospital Pharmacy to all Primary Health Care Sector (target population: Urban, Rural, and Homecare Support) from 2015 to 2016

Agriculture at the Phoenician site of La Fonteta (Alicante, Spain)

The Phoenician settlement of La Fonteta (Alicante, Spain) was founded in the late 8th cent BC at the mouth of the Río Segura. It has provided one of the most complete archaeobotanical records of all Phoenician Mediterranean sites which points to an agricultural system based on cultivating cereals, pulses and a wide variety of fruits such as grape, fig and pomegranate. These crops then spread to the surrounding indigenous settlements. Apart from integrating new crops, these local and regional indigenous sites progressively began to take part in a Mediterranean-wide network characterised particularly by trade in agricultural produce. The agricultural system of La Fonteta was not new to the Iberian Peninsula, as there is evidence that it arrived earlier at Phoenician colonies along its Mediterranean coastline. One of the most relevant aspects of the archaeobotanical record from La Fonteta is that it represents crafts there, as a large part of the remains correspond to plants which were burnt as fuel in its numerous metal working furnaces.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This study derives from the project FRUITCOM (Un nuevo modelo agrícola: frutales, hierro y comercio durante el I milenio A.E. - CIDEGENT/2019/003) funded by the Generalitat Valenciana carried out in the framework of two projects: HAR2017-87495-P of the Ministerio de Ciencia, Innovación y Universidades entitled Fenicios e indígenas en el Sureste de la península ibérica, Bronce Final y Hierro Antiguo entre el Vinalopó y el Segura and AICO/2021/189 of the Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital de la Generalitat Valenciana entitled Construyendo territorios entre el Bronce Final y el Ibérico Antiguo en los extremos de la Comunitat Valenciana (ConstrucTERR). The data are rooted in the project Consolidación y Puesta en Valor de Las Dunas de Guardamar (Fonteta-La Rábita) (Guardamar del Segura-Alicante) funded by the Generalitat Valenciana (2018–2021) through the Department of Education, Culture and Sport

Proyecto experimental de FP Dual en sistemas de telecomunicaciones e informáticos

Este trabajo pretende ser un breve resumen de lo que ha supuesto para mi la realización de el máster