Family Refusal to Consent Donation: Retrospective Quantitative Analysis of Its Increasing Tendency and the Associated Factors Over the Last Decade at a Spanish Hospital.

Background Organ and tissue recovery remains limited by several factors. This study retrospectively analyzes the factors associated with family refusal to consent to donation at a high-donor-volume Spanish hospital. Methods Data regarding the annual number of potential donors and family refusal rates at hospital and regional levels were retrieved from 2008 to 2017. Descriptive, bivariate, and multivariate analyses were performed to detect those factors independently associated with family refusal. Results were cross-validated using the data from years 2018 and 2019 as the validation group. To explore potential inter-relations between factors a Multiple Correspondence Analysis was performed. Results A total of 601 family interviews for petition of consent were conducted between 2008 and 2017, 531 (88.4%) resulted in acceptance and 70 (11.6%) resulted in refusal of the donation. Lesser experience of the interviewers (odds ratio [OR], 2.980; P = .001), donation after brain death (OR, 2.485; P = .013), number of interviews conducted per family (OR, 1.892; P < .001), age of the main decision maker (OR, 1.025; P = .045), and high or middle attributed cultural levels (OR, 0.142; P < .001 and OR, 0.199; P < .001 respectively) were observed to be independently associated with the family final decision. The logistic regression model displayed good predictive power for both derivation and validation cohorts, with an overall predictive accuracy of 80.9% (95% confidence interval, 0.747-0.870; P < .001) and 74.4% (95% confidence interval, 0.635-0.854; P = .001), respectively. Conclusions Transplant coordination team members having a thorough knowledge of the family decision mechanisms may be a key factor in donation process optimization.post-print633 K

On Exact Series Solution of Strongly Coupled Mixed Parabolic Problems

This paper studies the construction of the exact solution for parabolic coupled systems of the type u(t) = Au-xx, A(1)u(0, t) + B(1)u(x)(0, t) = 0, A(2)u(l, t) + B(2)u(x)(l, t) = 0, 0 0, and u(x, 0) = f(x), where A(1), A(2), B-1, and B-2 are arbitrary matrices for which the block matrixThis research has been supported by the Universitat Politecnica de Valencia Grant PAID-06-11-2020. The third listed author has been partially supported by the Universitat Jaume I, Grant P1.1B2012-05.Soler Basauri, V.; Defez Candel, E.; Ferrer González, MV.; Camacho Vidal, FJ. (2013). On Exact Series Solution of Strongly Coupled Mixed Parabolic Problems. Abstract and Applied Analysis. 1-9. https://doi.org/10.1155/2013/52451419Alexander, M. H., & Manolopoulos, D. E. (1987). A stable linear reference potential algorithm for solution of the quantum close‐coupled equations in molecular scattering theory. The Journal of Chemical Physics, 86(4), 2044-2050. doi:10.1063/1.452154Melezhik, V. ., Puzynin, I. ., Puzynina, T. ., & Somov, L. . (1984). Numerical solution of a system of integrodifferential equations arising from the quantum mechanical three-body problem with coulomb interaction. Journal of Computational Physics, 54(2), 221-236. doi:10.1016/0021-9991(84)90115-3Lill, J. V., Schmalz, T. G., & Light, J. C. (1983). Imbedded matrix Green’s functions in atomic and molecular scattering theory. The Journal of Chemical Physics, 78(7), 4456-4463. doi:10.1063/1.445338Mrugal/a, F., & Secrest, D. (1983). The generalized log‐derivative method for inelastic and reactive collisionsa). The Journal of Chemical Physics, 78(10), 5954-5961. doi:10.1063/1.444610Jódar, L., Navarro, E., & Martin, J. A. (2000). Exact and analytic-numerical solutions of strongly coupled mixed diffusion problems. Proceedings of the Edinburgh Mathematical Society, 43(2), 269-293. doi:10.1017/s0013091500020927Jódar, L., & Ponsoda, E. (1995). Continuous numerical solutions and error bounds for time dependent systems of partial differential equations: Mixed problems. Computers & Mathematics with Applications, 29(8), 63-71. doi:10.1016/0898-1221(95)00030-3Navarro, E., Ponsoda, E., & Jódar, L. (1995). A matrix approach to the analytic-numerical solution of mixed partial differential systems. Computers & Mathematics with Applications, 30(1), 99-109. doi:10.1016/0898-1221(95)00071-6Navarro, E., Jódar, L., & Ferrer, M. V. (2002). Constructing eigenfunctions of strongly coupled parabolic boundary value systems. Applied Mathematics Letters, 15(4), 429-434. doi:10.1016/s0893-9659(01)00154-9Soler, V., Navarro, E., & Ferrer, M. V. (2006). Invariant properties of eigenfunctions for multicondition boundary value problems. Applied Mathematics Letters, 19(12), 1308-1312. doi:10.1016/j.aml.2005.06.01

Health literacy and its relation to continuing with breastfeeding at six months post-partum in a sample of Spanish women

Aim To explore the relation between health literacy (HL) and continuing breastfeeding (BF) at 6 months post-partum. Design Observational, longitudinal and prospective study between December 2018–May 2019. The STROBE checklist was used. Methods 114 mother/baby pairings from a Spanish Hospital were included. Mothers’ health literacy was studied with the Newest Vital Sign and Short Assessment of Health Literacy for Spanish Adults 50 (SAHLSA-50). Before hospital discharge, BF efficiency was studied using the LATCH BF score and BF continuity was followed for 6 months. Survival analysis and Cox regression were done. Results Health literacy levels and BF effectiveness were adequate before hospital discharge. At 6 months post-partum, less than half the sample still exclusively breastfed. The main reason for early exclusive BF cessation was lower than the recommended newborn weight gain. The HL level acted as a protective factor against abandonment of BF

Virological Correlates of IgM–IgG Patterns of Response to SARS-CoV-2 Infection According to Targeted Antigens

The virological meaning of the different patterns of serology in COVID-19 has been little examined in clinical settings. Asymptomatic subjects with IgM-spike (S) and IgG-nucleocapsid (N) determinations by chemiluminescence were studied for SARS-CoV-2 shedding in respiratory secretions by transcription-mediated amplification (TMA). In subjects showing IgM-S positive and IgG-N negative, IgG-S was determined by lateral flow assay. A total of 712 individuals were tested: 30.0% presented IgM-S(+)/IgG-N(−), 25.8% had IgM-S(+)/IgG-N(+) and 44.2% had IgM-S(−)/IgG-N(+); the proportion with TMA(+) were comparable in these three groups: 12.1, 8.7 and 10.5%, respectively. In individuals with IgM-S(+)/IgG-N(−), IgG-S(+) was detected in 66.5%. The frequency of IgM-S(+)/IgG-S(−) in the total population was 10.0%, of whom 24.1% had TMA(+); the chances for TMA(+) in subjects with an IgM-S(+) alone pattern were 2.4%. Targeting of the same SARS-CoV-2 antigen seems to be better for the characterization of IgM/IgG patterns of response. IgM-S(+) alone reactivity is rare, and a small proportion is associated with viral shedding

Unexpected high toughness of Samia cynthia ricini silk gut

Silk gut fibers were produced from the silkworm Samia cynthia ricini silk glands by the usual procedure of immersion in a mildly acidic solution and subsequent stretching. The morphology of the silk guts was assessed by scanning electron microscopy, and their microstructure was assessed by infrared spectroscopy and X-ray diffraction. It was found that both naturally spun and Samia silk guts share a common semicrystalline microstructure. The mechanical characterization of the silk guts revealed that these fibers show an elastomeric behavior when tested in water, and exhibit a genuine ground state to which the fiber may revert independently of its previous loading history. In spite of its large cross-sectional area compared with naturally spun silk fibers, Samia silk guts show values of work to fracture up to 160 MJ m, much larger than those of most of their natural counterparts, and establish a new record value for this parameter in silk guts

Development and Validation of the Breastfeeding Literacy Assessment Instrument (BLAI) for Obstetric Women

Background: Despite international efforts to protect and promote exclusive breastfeeding (EBF) for infants up to six months of age, global rates of EBF continue to fall short of the targets proposed by the WHO for 2025. Previous studies have shown a relationship between the level of health literacy and the duration of EBF, although this relationship was not determinant, probably due to the use of a generic health literacy questionnaire. Therefore, this study aims to design and validate the first specific breastfeeding literacy instrument. Methods: A Breastfeeding Literacy instrument was developed. Content validation was carried out by a group of 10 experts in health literacy, breastfeeding or instrument validation, obtaining a Content Validity index in Scale (S-CVI/Ave) of 0.912. A multicentre cross-sectional study was carried out in three Spanish hospitals to determine the psychometric properties (construct validity and internal consistency). The questionnaire was administered to 204 women during the clinical puerperium. Results: The Kaiser-Meier-Oklin Test (KMO = 0.924) and Bartlett's Test of Sphericity (X2 = 3119.861; p ≤ 0.001) confirmed the feasibility of the Exploratory Factor Analysis, which explained 60.54% of the variance with four factors. Conclusions: The Breastfeeding Literacy Assessment Instrument (BLAI) consisting of 26 items was validated.This research was funded by Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) grant number UGP-20-250 2nd Call for R&D&I Grants in Nursing, 2020.S

Obstetric–neonatal care during birth and postpartum in symptomatic and asymptomatic women infected with SARS-CoV-2: a retrospective multicenter study

This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions

Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients—Results of a Spanish multicenter cohort

Preliminary results of this study were presented at the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held in Amsterdam, The Netherlands, from 13 to 16 April, 2019 (oral communication O‐0699).Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram‐negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended‐spectrum β‐lactamase‐producing Enterobacteriaceae [14%] or carbapenem‐resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5‐2) was administered for a median of 7 days (IQR: 3‐10). Clinical cure (remission of UTI‐attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow‐up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98‐112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016)—cofinanced by the European Development Regional Fund “A way to achieve Europe”; the Group for Study of Infection in Transplantation and the Immunocompromised Host (GESITRA‐IC) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); and the Spanish Network for Research in Renal Diseases (REDInREN RD16/0009). MFR holds a research contract “Miguel Servet” (CP 18/00073) from the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III

Unraveling the effect of silent, intronic and missense mutations on VWF splicing : contribution of next generation sequencing in the study of mRNA

Large studies in von Willebrand disease patients, including Spanish and Portuguese registries, led to the identification of >250 different mutations. It is a challenge to determine the pathogenic effect of potential splice site mutations on VWF mRNA. This study aimed to elucidate the true effects of 18 mutations on VWF mRNA processing, investigate the contribution of next-generation sequencing to in vivo mRNA study in von Willebrand disease, and compare the findings with in silico prediction. RNA extracted from patient platelets and leukocytes was amplified by RT-PCR and sequenced using Sanger and next generation sequencing techniques. Eight mutations affected VWF splicing: c.1533+1G>A, c.5664+2T>C and c.546G>A (p.=) prompted exon skipping; c.3223-7_3236dup and c.7082-2A>G resulted in activation of cryptic sites; c.3379+1G>A and c.7437G>A) demonstrated both molecular pathogenic mechanisms simultaneously; and the p.Cys370Tyr missense mutation generated two aberrant transcripts. Of note, the complete effect of three mutations was provided by next generation sequencing alone because of low expression of the aberrant transcripts. In the remaining 10 mutations, no effect was elucidated in the experiments. However, the differential findings obtained in platelets and leukocytes provided substantial evidence that four of these would have an effect on VWF levels. In this first report using next generation sequencing technology to unravel the effects of VWF mutations on splicing, the technique yielded valuable information. Our data bring to light the importance of studying the effect of synonymous and missense mutations on VWF splicing to improve the current knowledge of the molecular mechanisms behind von Willebrand disease. identifier:02869074

Unraveling the effect of silent, intronic and missense mutations on VWF splicing: contribution of next generation sequencing in the study of mRNA

Large studies in von Willebrand disease patients, including Spanish and Portuguese registries, led to the identification of >250 different mutations. It is a challenge to determine the pathogenic effect of potential splice site mutations on VWF mRNA. This study aimed to elucidate the true effects of 18 mutations on VWF mRNA processing, investigate the contribution of next-generation sequencing to in vivo mRNA study in von Willebrand disease, and compare the findings with in silico prediction. RNA extracted from patient platelets and leukocytes was amplified by RT-PCR and sequenced using Sanger and next generation sequencing techniques. Eight mutations affected VWF splicing: c.1533+1G>A, c.5664+2T>C and c.546G>A (p.=) prompted exon skipping; c.3223-7_3236dup and c.7082-2A>G resulted in activation of cryptic sites; c.3379+1G>A and c.7437G>A) demonstrated both molecular pathogenic mechanisms simultaneously; and the p.Cys370Tyr missense mutation generated two aberrant transcripts. Of note, the complete effect of three mutations was provided by next generation sequencing alone because of low expression of the aberrant transcripts. In the remaining 10 mutations, no effect was elucidated in the experiments. However, the differential findings obtained in platelets and leukocytes provided substantial evidence that four of these would have an effect on VWF levels. In this first report using next generation sequencing technology to unravel the effects of VWF mutations on splicing, the technique yielded valuable information. Our data bring to light the importance of studying the effect of synonymous and missense mutations on VWF splicing to improve the current knowledge of the molecular mechanisms behind von Willebrand disease. clinicaltrials.gov identifier:02869074