Polypill strategy at the heart of cardiovascular secondary prevention

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Cover Crop Effects on Nitrous Oxide Emissions: Role of Mineralizable Carbon

Nitrous oxide (N2O) emission from denitrification in agricultural soils often increases with N fertilizer and soil nitrate (NO3) concentrations. Overwintering cover crops in cereal rotations can decrease soil NO3 concentrations and may decrease N2O emissions. However, mineralizable C availability can be a more important control on N2O emission than NO3 concentration in fertilized soils, and cover crop residue provides mineralizable C input. We measured the effect of a winter rye (Secale cereale L.) cover crop on soil N2O emissions from a maize (Zea mays L.) cropping system treated with banded N fertilizer at three rates (0, 135, and 225 kg N ha–1) in Iowa. In addition, we conducted laboratory incubations to determine if potential N2O emissions were limited by mineralizable C or NO3 at these N rates. The rye cover crop decreased soil NO3 concentrations at all N rates. Although the cover crop decreased N2O emissions when no N fertilizer was applied, it increased N2O emissions at an N rate near the economic optimum. In laboratory incubations, N2O emissions from soils from fertilizer bands did not increase with added NO3, but did increase with added glucose. These results show that mineralizable C availability can control N2O emissions, indicating that C from cover crop residue increased N2O emissions from fertilizer band soils in the field. Mineralizable C availability should be considered in future evaluations of cover crop effects on N2O emissions, especially as cover crops are evaluated as a strategy to mitigate agricultural greenhouse gas emissions

El Cristo de la Humildad: una marcha de procesión inédita de Francisco Alonso López (1887-1948) para la Semana Santa de Granada

Holy Week in Granada began to take shape as we know it today in the last decades of the 19th century and the first decades of the 20th century, despite having evidence dating back to the 15th and 16th centuries. Parallel to the evolution of the festivity, we find musical evidences that will develop in the same way until the end of the 19th century. However, it was not until well into the 20th century that we find composers, compositions and musical groups linked to this celebration. In this context, the composer of zarzuelas from Granada, Francisco Alonso López (1887-1948), gives us a musical sample with El Cristo de la Humildad, a processional march with saeta dedicated to the Jesus Christ sculpture of the recently founded brotherhood, which is probably the first composition for modern Holy Week in Granada.La Semana Santa en Granada comienza a configurarse como la conocemos hoy día a partir de las últimas décadas del siglo XIX y las primeras del siglo XX, a pesar tener testimonios desde los siglos XV y XVI. Paralelamente a la evolución de la festividad, encontramos manifestaciones musicales que se irán desarrollando del mismo modo hasta llegar a finales del siglo XIX. Sin embargo, no será hasta bien entrado el siglo XX cuando hallemos compositores, composiciones y formaciones musicales ligadas a esta celebración. En este contexto, el compositor de zarzuelas granadino Francisco Alonso López (1887-1948), nos aporta una muestra musical cofrade con El Cristo de la Humildad, una marcha de procesión con saeta dedicada al titular de la recién fundada cofradía que pasa, previsiblemente, por ser la primera composición para la Semana Santa granadina moderna

Adaptive evolution is substantially impeded by Hill–Robertson interference in Drosophila

Hill–Robertson interference (HRi) is expected to reduce the efficiency of natural selection when two or more linked selected sites do not segregate freely, but no attempt has been done so far to quantify the overall impact of HRi on the rate of adaptive evolution for any given genome. In this work, we estimate how much HRi impedes the rate of adaptive evolution in the coding genome of Drosophila melanogaster. We compiled a data set of 6,141 autosomal protein-coding genes from Drosophila, from which polymorphism levels in D. melanogaster and divergence out to D. yakuba were estimated. The rate of adaptive evolution was calculated using a derivative of the McDonald–Kreitman test that controls for slightly deleterious mutations. We find that the rate of adaptive amino acid substitution at a given position of the genome is positively correlated to both the rate of recombination and the mutation rate, and negatively correlated to the gene density of the region. These correlations are robust to controlling for each other, for synonymous codon bias and for gene functions related to immune response and testes. We show that HRi diminishes the rate of adaptive evolution by approximately 27%. Interestingly, genes with low mutation rates embedded in gene poor regions lose approximately 17% of their adaptive substitutions whereas genes with high mutation rates embedded in gene rich regions lose approximately 60%. We conclude that HRi hampers the rate of adaptive evolution in Drosophila and that the variation in recombination, mutation, and gene density along the genome affects the HRi effect

Instantaneous Amplitude and Frequency Modulations Detect the Footprint of Rotational Activity and Reveal Stable Driver Regions as Targets for Persistent Atrial Fibrillation Ablation

RATIONALE: Costly proprietary panoramic multielectrode (64-256) acquisition systems are being increasingly used together with conventional electroanatomical mapping systems for persistent atrial fibrillation (PersAF) ablation. However, such approaches target alleged drivers (rotational/focal) regardless of their activation frequency dynamics. OBJECTIVES: To test the hypothesis that stable regions of higher than surrounding instantaneous frequency modulation (iFM) drive PersAF and determine whether rotational activity is specific for such regions. METHODS AND RESULTS: First, novel single-signal algorithms based on instantaneous amplitude modulation (iAM) and iFM to detect rotational-footprints without panoramic multielectrode acquisition systems were tested in 125 optical movies from 5 ex vivo Langendorff-perfused PersAF sheep hearts (sensitivity/specificity, 92.6/97.5%; accuracy, 2.5-mm) and in computer simulations. Then, 16 pigs underwent high-rate atrial pacing to develop PersAF. After a median (interquartile range [IQR]) of 4.4 (IQR, 2.5-9.9) months of high-rate atrial pacing followed by 4.1 (IQR, 2.7-5.4) months of self-sustained PersAF, pigs underwent in vivo high-density electroanatomical atrial mapping (4920 [IQR, 4435-5855] 8-second unipolar signals per map). The first 4 out of 16 pigs were used to adapt ex vivo optical proccessing of iFM/iAM to in vivo electrical signals. In the remaining 12 out of 16 pigs, regions of higher than surrounding average iFM were considered leading-drivers. Two leading-driver + rotational-footprint maps were generated 2.6 (IQR, 2.4-2.9) hours apart to test leading-driver spatiotemporal stability and guide ablation. Leading-driver regions (2.5 [IQR, 2.0-4.0] regions/map) exactly colocalized (95.7%) in the 2 maps, and their ablation terminated PersAF in 92.3% of procedures (radiofrequency until termination, 16.9 [IQR, 9.2-35.8] minutes; until nonsustainability, 20.4 [IQR, 12.8-44.0] minutes). Rotational-footprints were found at every leading-driver region, albeit most (76.8% [IQR, 70.5%-83.6%]) were located outside. Finally, the translational ability of this approach was tested in 3 PersAF redo patients. CONCLUSIONS: Both rotational-footprints and spatiotemporally stable leading-driver regions can be located using iFM/iAM algorithms without panoramic multielectrode acquisition systems. In pigs, ablation of leading-driver regions usually terminates PersAF and prevents its sustainability. Rotational activations are sensitive but not specific to such regions. Single-signal iFM/iAM algorithms could be integrated into conventional electroanatomical mapping systems to improve driver detection accuracy and reduce the cost of patient-tailored/mechanistic approaches.This study was supported by the European Regional Development Fund and the Spanish Ministry of Science, Innovation and Universities (SAF2016-80324-R). The CNIC is supported by the Spanish Ministry of Science, Innovation and Universities and the Pro-CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).S

Teamwork: Assessment of teamwork competence in higher education

[EN] Teamwork is a competence highly demanded among workers and an academic field with an extensive specialized literature. Based on this knowledge that comes from the study of organizational behavior, this communication presents a model to understand teamwork in higher education settings. The theoretical model considers structural components (i.e., task interdependence and task uncertainty), processes (i.e., team development and team climate for learning) and results (i.e., team effectiveness). Moreover, an assessment tool (and attitude questionnaire with 42 items-Likert scale with a range from 1 to 7) is also presented to measure these critical components that can allow us to distinguish between effective and ineffective teams in higher education. First results of the application of these tools to 18 team students show good consistency values of the tools being able to distinguish among teams. Additionally, we propose a procedure to obtain aggregated measures per group from the members’ responses considering the degree of agreement among members.Navarro, J.; Bosch, JL.; Palacín, M.; Solé, M.; Berger, R.; Leiva, D.; Ceppi, F.... (2017). Teamwork: Assessment of teamwork competence in higher education. En Proceedings of the 3rd International Conference on Higher Education Advances. Editorial Universitat Politècnica de València. 1024-1032. https://doi.org/10.4995/HEAD17.2017.55071024103

Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study.

PURPOSE The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain. PATIENTS AND METHODS An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated. RESULTS After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments. CONCLUSION CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.This study was funded by Ferrer.S

Potential Protective Effect of Oleanolic Acid on the Components of Metabolic Syndrome: A Systematic Review

The high prevalence of obesity is a serious public health problem in today’s world. Both obesity and insulin resistance favor the development of metabolic syndrome (MetS), which is associated with a number of pathologies, especially type 2 diabetes mellitus, and cardiovascular diseases. This serious problem highlights the need to search for new natural compounds to be employed in therapeutic and preventive strategies, such as oleanolic acid (OA). This research aimed to systematically review the effects of OA on the main components of MetS as well as oxidative stress in clinical trials and experimental animal studies. Databases searched included PubMed, Medline, Web of Science, Scopus, EMBASE, Cochrane, and CINAHL from 2013 to 2019. Thus, both animal studies (n = 23) and human clinical trials (n = 1) were included in our review to assess the effects of OA formulations on parameters concerning insulin resistance and the MetS components. The methodological quality assessment was performed through using the SYRCLE’s Risk of Bias for animal studies and the Jadad scale. According to the studies in our review, OA improves blood pressure levels, hypertriglyceridemia, hyperglycemia, oxidative stress, and insulin resistance. Although there is scientific evidence that OA has beneficial effects in the prevention and treatment of MetS and insulin resistance, more experimental studies and randomized clinical trials are needed to guarantee its effectiveness.The results reported in the study are from the doctoral thesis of the main author and belong to the Clinical Medicine and Health Public Programme (B 12.56.1) of the University of Granada, Spain. F.-A. Á is granted with a pre-doctoral FPU grant (University of Granada, Spain). This work was also supported by a research initiation fellowship of the University of Granada, Spai

Editorial independence and conflict of interest in clinical practice guidelines on care of ulcers and chronic wounds

Objective: to evaluate the editorial independence and declaration of conflicts of interest expressed in the Clinical Practice Guidelines (CPGs) on prevention and treatment of ulcers and chronic wounds. Methodology: systematic review of current national and international GPCs on vascular leg ulcers (VLU), diabetic foot ulcers (DFU), pressure ulcers (PU) and malignant ulcers (MU). Evaluation Domain 6 (item # 22 and # 23) AGREE II Instrument (Appraisal of Guidelines Research and Evaluation). Review by 6 experts and intra-observer analysis. Results: 26 CPGs were analyzed (12 on PU, 7 on DFU, 6 on VLU and 1 on MU). 80.7% of CPGs were international publications. 10 CPG fully complied with the Dominion 6 AGREE II, 13 did so partially, and 3 not comply. Relating to item 22 (editorial independence), the average value achieved was 62.5%, while for item 23 (conflicts of interest) an 83.92% was obtained. Conclusions: 73% of CPGs comply successfully the Domain 6 AGREE II; Still, GPC-UVP should raise their standard of editorial quality. The item 22 (editorial independence) was the least fulfilled and the most difficult to assess by reviewers, it must be a section to improve in future editions of CPGs. Keywords: clinical practice guidelines, editorial independence, conflict of interest, ethics, AGREE, ulcers.Comunicación - póster presentada en: 27th Conference of the European Wound Management Association (EWMA 2017) in cooperation with WCS Knowledge Centre Wound Care: "Change, opportunities and challenges - Wound management in changing healthcare systems" celebrado en Amsterdam (The Neatherlands), el 3 y 5 de Mayo 2017