Association of lead and cadmium exposure with frailty in US older adults

This is the prepint version of a work that was accepted for publication in Enviromental Research A definitive version was subsequently published in Enviromental Research 137(2015) DOI: 10.1016/j.envres.2015.01.013BACKGROUND: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. METHODS: Cross-sectional study among individuals aged ≥ 60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥ 3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. RESULTS: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9-4.9) and 0.62 µg/l (0.41-0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96-2.04) and 1.75 (1.33-2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68-1.39) and 1.55 (1.03-2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43-1.14) and 1.09 (0.56-2.11), respectively. CONCLUSIONS: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose-response relationship with frailty. These findings support that lead exposure increases frailty in older adultsThis work has been supported by grants from the Instituto de Salud Carlos III, Ministry of Health of Spain (PI12/1166) and from the European Commission (FRAILOMIC Initiative FP7-HEALTH-2012-Proposal No: 305483-2)

Barracks from modern age iberian wars (1650-1750) heritage value, contemporary use and social housing

The present paper studies 18th century military garrisons built in border villages of Portuguese Alentejo during the instability period that began with the Restoration War (1640-1668) between Portugal and Spain. Besides presenting their constructive types and materiality, the research focus on the heritage value of these barracks, especially given their urban context inside small peripheral towns’ historical centres under threat of desertification. Three cases are compared in order to determine which contemporary use better favours heritage conservation of the barracks modular structures

Is Qualitative Research in Education Being Lost in Spain? Analysis and Reflections on the Problems Arising from Generating Knowledge Hegemonically

In this paper we reflect on how qualitative research in education in Spain has become invisible, by asking a series of questions. What are the effects of this? What are the keys to understand this marginalisation of qualitative research? What are the implications for researchers and students? What challenges does qualitative research face in order to overcome this lack of visibility? To discuss these issues, we present a series of structured reflections in the form of an essay based on the preliminary impressions that have emerged in the course of a broader investigation that we are conducting and that focuses on the state of qualitative research in education in Spain. Our intention is, on the one hand, to offer a vision of the Spanish panorama to the international community, and on the other hand, to transfer the ideas that have emerged during the course of the research that we are developing to serve as a reflection and resource to other qualitative researchers

Action research through lesson study: a space for learning in initial teacher training

The purpose of this paper is to explore the influence of Lesson Study on reconstructing students’ practical knowledge during initial training as prospecting teachers. This case study sets out the voice and opinions of a student taking part in a lesson study process. The aim was to further understand how the student’s opinions around teaching change both during and after her invol- vement in the different phases of Lesson Study. Information was obtained through semi-structured interviews, observations, photo and video records, document analysis and field diaries. We were also interested in understanding the student’s perception of the influence of mentoring and tutoring on her professional develop- ment while accompanying her in her reflection about teaching. The results show that Lesson Study, as a cooperative curriculum crea- tion process, provides prospecting teachers with opportunities to build their identity as professionals within a network of peers in which they interact in order to learn together. Focused on the context of initial teacher training, this article could lead to a new approach to Lesson Study as a strategy that can bring about more relevant transformations while teachers’ beliefs, values and disposi- tions are still at an early stage of construction

Augmented renal clearance. An unnoticed relevant event

Paciente críticamente enfermo; Tasa de filtrado glomerularPacient críticament malalt; Taxa de filtrat glomerularCritically ill patient; Glomerular filtrate rateAugmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimation formula and measured GFR. Observational, prospective, multicenter study. ARC was defined as a creatinine clearance greater than 130 ml/min/1.73 m2. Eighteen hospitals were recruited. GFR measurements carried out twice weekly during a 2-month follow-up period. A total of 561 patients were included. ARC was found to have a non-negligible prevalence of 30%. More even, up to 10.7% already had ARC at intensive care unit (ICU) admission. No specific pattern of GFR was found during the follow-up. Patients in the ARC group were younger 56.5 (53.5–58.5) versus 66 (63.5–68.5) years than in the non-ARC group, p < 0.001. ICU mortality was lower in the ARC group, 6.9% versus 14.5%, p = 0.003. There was no concordance between the estimation of GFR by the CKD-EPI formula and GFR calculated from the 4-h urine. ARC is found in up to 30% of ICU patients, so renal removal drugs could be under dosed by up to 30%. And ARC is already detected on admission in 10%. It is a dynamic phenomenon without an established pattern that usually occurs in younger patients that can last for several weeks. And the CKD-EPI formula does not work to estimate the real creatinine clearance of these patients

Reduction in cardiovascular risk by sodium-bicarbonated mineral water in moderately hypercholesterolemic young adults.

Effects of drinking a sodium bicarbonated mineral water on cardiovascular risk in young men and women with moderate cardiovascular risk were studied. Eighteen young volunteers, total cholesterol levels >5.2 mmol/L without any disease participated. The study consisted in two 8-week intervention periods. Subjects consumed, as a supplement of their usual diet, 1 L/d of a control low mineral water followed by 1 L/d of the bicarbonated mineral water (mmol/L: sodium, 48; bicarbonate, 35; and chloride, 17). Determinations were performed at the end of the control water period and weeks 4 and 8 of the bicarbonated water period. Body weight, BMI, blood pressure, dietary intake, total-cholesterol, LDL-cholesterol, HDL-cholesterol, Apo A-I, Apo B, triacylgycerols, glucose, insulin, adiponectin, high sensitivity-C reactive protein (hs-CRP), soluble adhesion molecules (sICAM and sVCAM), sodium and chloride urinary excretion, and urine pH were measured. Dietary intake, body weight and BMI showed no significant variations. Systolic blood pressure decreased significantly after 4 weeks of bicarbonated water consumption without significant differences between the weeks 4 and 8. Significant reductions were observed after bicarbonated water consumption of total cholesterol (by 6.3%, p=0.012), LDL-cholesterol (by 10% p=0.001), total/HDL-cholesterol (p=0.004), LDL/HDL-cholesterol (p=0.001), and Apo B (p=0.017). Serum triacylglycerols, Apo A-I, sICAM-1, sVCAM-1 and hs-CRP levels did not change. Serum glucose values tended to decrease during the bicarbonated water intervention (p=0.056) but insulin levels did not vary. This sodium bicarbonated mineral water improves lipid profile in moderately hypercholesterolemic young men and women and could therefore be applied in dietary interventions to reduce cardiovascular risk

Safety and Energy Implications of Setback Control in Operating Rooms during Unoccupied Periods

Producción CientíficaLos centros de atención sanitaria son edificios que consumen mucha energía. El potencial de ahorro de energía está limitado debido a las normas de seguridad, especialmente en áreas de cuidados críticos como los quirófanos (OR). La reducción de los caudales de aire de impulsión durante los periodos desocupados, también llamada reducción o retroceso de la ventilación, se acepta como medida de eficiencia energética siempre que no comprometa la relación de presiones. Además, los retrocesos de temperatura y humedad relativa pueden introducir mayores ahorros de energía. Este trabajo tiene como objetivo estudiar el efecto que tiene un retroceso sobre la presión positiva del OR y el ahorro que se puede conseguir tanto en el suministro energético como en las emisiones de CO 2 . Para lograr este objetivo, se realizan cinco pruebas en dos quirófanos de un hospital público durante el verano, el invierno y la media temporada. Se aplica un retroceso sobre la base de un sensor de ocupación y se monitorea la diferencia de presión de los espacios quirófano adyacentes. Se miden las condiciones y los flujos de aire del aire exterior y de suministro, así como el consumo de energía del ventilador. Se observan pérdidas puntuales en la relación de presiones durante los períodos de ocupación por apertura de puertas pero no durante las operaciones de retroceso de la ventilación. El ahorro energético conseguido representó el 75% del consumo de gas natural y el 69% de la electricidad en las RUP. Las estimaciones anuales implican un ahorro económico de cerca de 20.000 euros y más de 100 toneladas de emisiones de CO 2 .ENTE REGIONAL DE LA ENERGÍA of the Regional Government of Castile and Leon (grant number EREN_2019_L2_UVA

Diversidad bacteriana en suelos de zonas contaminadas y no contaminadas de una mina de cobre = Bacterial diversity in soils from contaminated and uncontaminated areas of a copper mine

Para entender la dinámica ecológica del suelo es de primordial importancia realizar un esquema de la distribución filogenética de las distintas bacterias que viven en él. Los análisis moleculares, en especial el metagenómico, puede aportar información detallada sobre la diversidad, estructura y funcionamiento de los microorganismos presentes en un suelo, información que pueden servir como base para su manejo y recuperación. El objetivo de este estudio fue evaluar la diversidad de las comunidades bacterianas en dos zonas de un suelo minero ubicado en la comunidad de Madrid. Los muestreos se realizaron en dos zonas de la mina identificadas como zona 1 (suelo no afectado) y zona 3 (zona de escombrera). Se realizaron análisis metagenómicos de las comunidades bacterianas presentes, con muestras de ambas zonas. Del total de secuencias bacterianas evaluadas, sólo el 1% mostró coincidencias en las bases de datos del Centro Nacional para la Información Biotecnológica (NCBI). Los resultados mostraron que el número de secuencias del dominio Bacteria es mayor en la zona 1 que en la zona 3. Aunque no se encontraron diferencias significativas entre los diferentes filos de bacterias por zona, sí se observaron diferencias en cuanto al número de especies dentro de los diferentes filos y entre las zonas de muestreo

“Acute kidney injury in critically ill patients with COVID–19: The AKICOV multicenter study in Catalonia”

Acute kidney injury; COVID-19; CataloniaLesión renal aguda; COVID-19; CataluñaLesió renal aguda; COVID-19; CatalunyaThis study describes the incidence, evolution and prognosis of acute kidney injury (AKI) in critical COVID-19 during the first pandemic wave. We performed a prospective, observational, multicenter study of confirmed COVID-19 patients admitted to 19 intensive care units (ICUs) in Catalonia (Spain). Data regarding demographics, comorbidities, drug and medical treatment, physiological and laboratory results, AKI development, need for renal replacement therapy (RRT) and clinical outcomes were collected. Descriptive statistics and logistic regression analysis for AKI development and mortality were used. A total of 1,642 patients were enrolled (mean age 63 (15.95) years, 67.5% male). Mechanical ventilation (MV) was required for 80.8% and 64.4% of these patients, who were in prone position, while 67.7% received vasopressors. AKI at ICU admission was 28.4% and increased to 40.1% during ICU stay. A total of 172 (10.9%) patients required RRT, which represents 27.8% of the patients who developed AKI. AKI was more frequent in severe acute respiratory distress syndrome (ARDS) ARDS patients (68% vs 53.6%, p<0.001) and in MV patients (91.9% vs 77.7%, p<0.001), who required the prone position more frequently (74.8 vs 61%, p<0.001) and developed more infections. ICU and hospital mortality were increased in AKI patients (48.2% vs 17.7% and 51.1% vs 19%, p <0.001) respectively). AKI was an independent factor associated with mortality (IC 1.587–3.190). Mortality was higher in AKI patients who required RRT (55.8% vs 48.2%, p <0.04). Conclusions There is a high incidence of AKI in critically ill patients with COVID-19 disease and it is associated with higher mortality, increased organ failure, nosocomial infections and prolonged ICU stay