Vocación y profesionalismo: reflexiones de los estudiantes catalizadas por el cine de Spielberg

La profesión médica tiene un marcado sentido vocacional que está estrechamente vinculado a su dimensión ética; sin embargo, existen dudas sobre el papel que los estudios de grado están ejerciendo en su desarrollo. Con la finalidad de favorecer la reflexión al respecto, se celebró un seminario con estudiantes y profesores desarrollado en 3 fases: a) libre exposición de los alumnos sobre lo que consideraban que es la vocación médica; b) presentación por parte de los profesores del marco teórico de la educación médica, seguido del visionado de varias escenas de películas dirigidas por Steven Spielberg que facilitan la reflexión sobre el significado de los componentes éticos y humanos de la medicina, y c) discusión abierta entre alumnos y profesores. Se analizan las principales conclusiones: conviene crear espacios para la reflexión sobre la dimensión vocacional de la medicina a lo largo de los estudios del grado, lo cual, de algún modo, ya se debería considerar en los procedimientos de selección y acceso; en la tarea docente es fundamental el ejemplo de los formadores, así como una tutorización individualizada que «cuide» el desarrollo vocacional; es necesario promover una formación que vaya más allá de la adquisición de conocimientos y habilidades, prestando atención a la gestión de las emociones, el acompañamiento ante los problemas éticos y la educación de las actitudes; el contacto precoz con la actividad clínica, ya desde el comienzo de los estudios se valora como un factor decisivo para motivar a los alumnos ante la inmensa carga teórica que deben afrontar. The medical profession has a marked vocational sense that is closely linked to its ethical dimension. However, there are doubts about the role that undergraduate studies are playing in their development. In order to encourage reflection on this issue, a seminar was held with students and teachers, developed in 3 phases: a) free presentation by students about what they considered to be the medical vocation; b) presentation by professors of the theoretical framework of medical education, followed by the viewing of several scenes of films directed by Steven Spielberg that facilitate reflection on the meaning of the ethical and human components of medicine, and c) open discussion between students and teachers. The main conclusions were analysed: it is worth creating spaces for reflection on the vocational dimension of medicine throughout undergraduate studies. This, in some way, should already be considered in the selection and access procedures to medical school. In the teaching task it is essential that the lecturers are seen as role models, as well as providing individualised tutoring that includes vocational development. Thus, it is necessary to promote training that goes beyond the acquisition of knowledge and skills, paying attention to the management of emotions, the approach to the ethical problems, and the education of attitudes. Early contact with clinical activity, from the beginning of studies is considered a decisive factor to motivate students before the immense theoretical burden they have to face

Olive classification according to external damage using image analysis.

The external appearance of an olive’s skin is the most decisive factor in determining its quality as a fruit. This work tries to establish a hierarchical model based on the features extracted from images of olives reflecting their external defects. Seven commercial categories of olives, established by product experts, were used: undamaged olives, mussel-scale or ‘serpeta’, hail-damaged or ‘granizo’, mill or ‘rehús’, wrinkled olive or ‘agostado’, purple olive and undefined-damage or ‘molestado’. The original images were processed using segmentation, colour parameters and morphological features of the defects and the whole fruits. The application of three consecutive discriminant analyses resulted in the correct classification of 97% and 75% of olives during calibration and validation, respectively. However the correct classification percentages vary greatly depending on the categories, ranging 80–100% during calibration and 38– 100% during validation

Corrosion behaviour of micro-plasma arc welded stainless steels in H3PO4 under flowing conditions at different temperatures

[EN] This paper studies the general corrosion behaviour of the micro-plasma arc welded AISI 316L stainless steel in phosphoric acid at different temperatures (25-60°C) and at a Reynolds number of 1456. Galvanic corrosion has been studied using zero-resistance ammeter (ZRA) measurements and polarization curves (by the mixed potential theory). Results show that the microstructure of the stainless steel is modified due to the micro-plasma arc welding procedure. Coupled current density values obtained from polarization curves increase with temperature. ZRA tests present the highest iG values at 60°C; however, the values are very close to zero for all the temperatures studied. This is in agreement with the low value of the compatibility limit and of the parameter which evaluates the importance of the galvanic phenomenon. Both techniques present the most positive potentials at the highest temperature. This study reveals that micro-plasma arc welded AISI 316L stainless steels are appropriated working in the studied H3PO4 media from a corrosion point of view for all the temperatures analysedThe authors would like to express their gratitude to the Spanish MAEC (PCI Mediterráneo C/8196/07, C/018046/08, D/023608/09) and to Asuncion Jaime for her translation assistance.Sánchez Tovar, R.; Montañés Sanjuan, MT.; García Antón, J.; Guenbour, A.; Ben Bachir, A. (2011). Corrosion behaviour of micro-plasma arc welded stainless steels in H3PO4 under flowing conditions at different temperatures. Corrosion Science. 53(4):1237-1246. https://doi.org/10.1016/j.corsci.2010.12.017S1237124653

The effectiveness of the stabilization/solidification process on the leachability and toxicity of the tannery sludge chromium

[EN] A stabilization/solidification (S/S) process by using cement was applied to tannery sludge in order to find a safer way of landfilling this waste. The effects of three parameters on the process effectiveness were analysed in terms of leachate toxicity and chromium retention (%). The parameters studied were the relative amount of added water (30e50 wt.%), cement (10e60 wt.% in the solid components), and the use of three different types of cement (clinker with additions of limestone, with additions of limestone and fly ashes, and with additions of pozzolans). Statistical analysis performed by variance analysis and categorical multifactorial tests reveals that all the studied parameters significantly influence the effectiveness of the process. Results showed that chromium retention decreases as the relative amount of cement and water increases, probably due to additional chromium provided by cement and increased in the porosity of the mixtures. Leachate toxicity showed the same minimum value for mixtures with 30% or 40% cement, depending on the type of cement, showing that clinker is the main material responsible for the process effectiveness, and additives (pozzolans or fly ashes) do not improve it. The volume increase is lower as less sludge is replaced by cement and the relative amount of water decreases, and for the cement without additions of fly ashes or pozzolans. Therefore, the latter seems to be the most appropriate cement in spite of being more expensive. This is due to the fact that the minimum toxicity value is achieved with a lower amount of cement; and moreover, the volume increase in the mixtures is lower, minimizing the disposal cost to a landfill.The authors wish to express their gratitude to the tannery facility INCUSA, S.A., to the cement facility CEMEX ESPAÑA, S.A. and to Carles Martínez for his translation assistance.Montañés Sanjuan, MT.; Sánchez Tovar, R.; Roux, MSB. (2014). The effectiveness of the stabilization/solidification process on the leachability and toxicity of the tannery sludge chromium. Journal of Environmental Management. 143:71-79. doi:10.1016/j.jenvman.2014.04.026S717914

MAF amplification licenses ERα through epigenetic remodelling to drive breast cancer metastasis

MAF amplification increases the risk of breast cancer (BCa) metastasis through mechanisms that are still poorly understood yet have important clinical implications. Oestrogen-receptor-positive (ER+) BCa requires oestrogen for both growth and metastasis, albeit by ill-known mechanisms. Here we integrate proteomics, transcriptomics, epigenomics, chromatin accessibility and functional assays from human and syngeneic mouse BCa models to show that MAF directly interacts with oestrogen receptor alpha (ERα), thereby promoting a unique chromatin landscape that favours metastatic spread. We identify metastasis-promoting genes that are de novo licensed following oestrogen exposure in a MAF-dependent manner. The histone demethylase KDM1A is key to the epigenomic remodelling that facilitates the expression of the pro-metastatic MAF/oestrogen-driven gene expression program, and loss of KDM1A activity prevents this metastasis. We have thus determined that the molecular basis underlying MAF/oestrogen-mediated metastasis requires genetic, epigenetic and hormone signals from the systemic environment, which influence the ability of BCa cells to metastasize

X chromosome inactivation does not necessarily determine the severity of the phenotype in Rett syndrome patients

Rett syndrome (RTT) is a severe neurological disorder usually caused by mutations in the MECP2 gene. Since the MECP2 gene is located on the X chromosome, X chromosome inactivation (XCI) could play a role in the wide range of phenotypic variation of RTT patients; however, classical methylation-based protocols to evaluate XCI could not determine whether the preferentially inactivated X chromosome carried the mutant or the wild-type allele. Therefore, we developed an allele-specific methylation-based assay to evaluate methylation at the loci of several recurrent MECP2 mutations. We analyzed the XCI patterns in the blood of 174 RTT patients, but we did not find a clear correlation between XCI and the clinical presentation. We also compared XCI in blood and brain cortex samples of two patients and found differences between XCI patterns in these tissues. However, RTT mainly being a neurological disease complicates the establishment of a correlation between the XCI in blood and the clinical presentation of the patients. Furthermore, we analyzed MECP2 transcript levels and found differences from the expected levels according to XCI. Many factors other than XCI could affect the RTT phenotype, which in combination could influence the clinical presentation of RTT patients to a greater extent than slight variations in the XCI pattern

Recovery of dialysis patients with COVID-19 : health outcomes 3 months after diagnosis in ERACODA

Background. Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods. We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results. In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions. Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

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

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