GlyCon: glycaemic control of stress hyperglycaemia in intensive care units

Background and aims Untreated stress-induced hyperglycaemia in critically ill patients has been associated with harmful effects, which can even be fatal. Current evidence about the optimal glycaemic targets, and the most effective and safest methods of glycaemic control (GC) in intensive care units (ICU), is contradictory. GlyCon study aimed to investigate the effectiveness, efficiency and safety of the monitoring and insulin treatment methods for GC implemented in the seven ICUs of an NHS ICU network in the UK. In addition, GlyCon study also aimed to explore the contents of the local protocols for GC of these ICUs, as well as the views of ICU professionals about several aspects of GC. Methodology A multi-method study was undertaken, comprising three sub‑studies: (1) a document review of the protocols for GC designed by and implemented at each of the participating ICUs, using techniques of inductive content analysis and descriptive statistics; (2) an online survey to ICU medical and nursing staff, on their opinion about effective GC, and deviations from protocol instructions, which was analysed using descriptive statistics and logistic regression; (3) A retrospective study about the methods and outcomes of GC, based on a review of electronic and manual medical records of a stratified random sample of 146 patients admitted to the seven participating ICUs during 2012 and 2013. The main analyses of association between the exposures and the primary outcome measure (percentage of time with glycaemic levels of 4‑10mmol/L, or TIR, which was transformed into the odds of being within that range at any time, or odds of IR), were mainly based on generalised estimating equations using the logit link, and autoregressive correlation structure. Secondary outcome measures of time‑efficiency and safety were also investigated, and analysed using univariate statistics and multiple log‑linear regression. Results The protocols for GC implemented in the seven ICUs differed greatly in their target patients, target glycaemic levels, recommended methods for monitoring, and insulin titration algorithms, among others. Most of the 40 respondents to the survey agreed that TIR≥75% constitutes good GC and TIR<50% constitutes poor GC. Opinions were divided on intermediate levels of TIR, with professionals having more experience in intensive care tending to rate such intermediate TIR as poor GC more often than their less experienced colleagues. Most of the proposed protocol deviations were considered as major by at least two thirds of the respondents. Professionals’ role (nurse vs. physician) and their number of years of experience were significantly associated with different views. The blood glucose (BG) monitoring frequencies and insulin hourly dosages, at each glycaemic status, differed by ICU, and between patients with and without diabetes. Non‑adherence to protocol instructions regarding BG monitoring and insulin infusion rates occurred more often than not. The median (IQR) TIR was 91% (81‑96%) and 56% (34‑71%) among patients without and with diabetes, respectively. A number of time-dependent and time-constant factors were associated with higher odds of IR at any time. Time-constant protective factors included: having spent more than 20% of admission time receiving insulin during hyperglycaemia, certain ICU protocols, and lower levels of severity on admission. Time-dependent protective factors were: the number of hours from admission, and the dobutamine and insulin hourly dosages. Time-dependent detrimental factors were: non‑adherence to protocol insulin instructions, the hourly nutritional energy administered, and the hourly dosage of certain drugs, including adrenaline and hydrocortisone. Conclusions Protocols for GC, practice of GC, and outcomes of GC, all differed significantly across hospitals. Some protocols seemed more effective, time‑efficient or safe than others, but there was a high incidence of non‑adherence to protocol instructions in all ICUs. This contrasts with professionals rating deviations from protocols as major, more often than not. Certain monitoring and insulin treatment methods for GC were more effective, and some were more time‑efficient than others, particularly among patients without diabetes. There is a clear need for protocols to include different recommendations for patients with diabetes, as well as to formally emphasise the importance of GC also in patients without diabetes. ICU multidisciplinary teams should be involved in the development of these protocols, and their views should be accounted for in research studies about the effectiveness of GC in the ICU

Metamorfosis del ritmo dinámico silente a la pasividad del cuerpo en la ficción

In its beginnings, silent cinema emphasised the expressive and communicative potential of the body by exacerbating gestures and actions. However, current fictional cinema is confronted with an opposite tendency: the passivity of body movement. This study analyses the representation of the body in three films of current silent cinema from a triple perspective: movement, immersion and technology. The results confirm the predominance of the mind over the body.El cine mudo en sus inicios destacó la potencialidad expresiva y comunicativa del cuerpo con el exacerbamiento de la gestualidad y las acciones. Sin embargo, el cine de ficción actual se enfrenta a una tendencia contraria: la pasividad del movimiento del cuerpo. Este estudio analiza la representación del cuerpo de tres películas del cine silente actual desde un triple enfoque: el movimiento, la inmersión y la tecnología. Los resultados confirman la predominancia de la mente frente al cuerpo

Methodology for the analysis and comparison of protocols for glycaemic control in intensive care.

RATIONALE, AIMS, AND OBJECTIVES: The practice of glycaemic control of critically ill patients admitted to intensive care units (ICUs) is guided by clinical management protocols, designed locally by the ICUs. These protocols differ significantly in their aims and methods. The aim of this study was to develop a standardized methodology for the systematic and objective analysis and comparison of protocols for glycaemic control implemented in any ICU. METHOD: The protocols for glycaemic control implemented in seven ICUs of a UK-based ICU network were analysed using techniques of inductive content analysis, through an open coding process and the framework method. This involved the identification and classification of protocol instructions for glycaemic control, as well as of the processes and decisions pertaining to each of these instructions. These were used to develop a framework for the structured and systematic description and comparison of the protocols' contents, and to develop a technique for the protocols' graphic visualization. RESULTS: The following elements were identified or developed: (1) 35 quantifiable variables and 11 non-quantifiable subjects that could be present in an ICU protocol for glycaemic control, to be used as a framework for the description and comparison of contents; (2) a technique for condensing a protocol into a single, comprehensive flowchart; (3) using these flowcharts, a method for assessing the complexity and comprehensiveness of the protocols. CONCLUSIONS: The methodology developed in this study will allow for any future work analysing the contents of glycaemic control protocols to be carried out in a structured and standardized way. This may be done either as a standalone study, or as the essential first step in any investigation on the impact of new protocols. In turn, the methodology will facilitate the performance of regional, national, and international comparisons, demonstrating the usefulness of this study at a global scale

Tasas de erosión, transporte y sedimentación en un medio estuárico: el Río Miñor (Ría de Vigo, Pontevedra)

The Miñor river is one o f the 35 minor currents entering the Ría de Vigo (Pontevedra) at Baiona Bay,; close to the SE margin o f the Ría. The present study was carried out over two periods: from May 97 to July 98 and from May 00 to May 01. In this paper we carry out a hydraulic and sedimentologic approach o f the Miñor river, making an estimation of the total fresh-water discharge and sediment input transported as suspended and dissolved loads. The final aim of this study is to calculate erosion rates at the catchment, sediment yield, transport and the nature of the sediments accumulated at the estuarine area. In view of the average discharge for both periods o f time (2.7 m3/s y 6.7 m3/s) and the catchment area (75.6 m2) is possible to estimate suspended and dissolved sediment yields. Mean values for suspended sediments are 25.76 t/km2a for 97/98 and 139.74 t/ km2a for 00/01 and those for dissolved loads of 109 t/km2a y 204 t/km2a, respectively. Finally, considering an average rock density of 2 .7 g/cm3 we can estimate mechanical denudation rates of 9.54 m3/km2a during 97/98 and 51.76 m3/km2a during 00/01. Chemical denudation rates are 40.46 m3/km2a for the first period and 75.56 m3/km2a for the second. Data obtained during 00/01 interval can be considered as maximum values, bearing in mind the very unusually high rainfall conditions

Sistema CRISPR/Cas: Edición genómica de precisión

La función original de los sistemas CRISPR/Cas es destruir el DNA de virus bacterianos. Este sistema ha evolucionado para identificar y cortar secuencias de diferentes DNA de virus de DNA evitando la infección. En la célula, está compuesto de genes Cas que producen nucleasas guiadas por RNA capaces de cortar el DNA. Si el RNA guía encuentra DNA de un virus con el que se puede emparejar, recluta a la nucleasa Cas9 que lo corta. Este sistema es utilizado in vitro para editar genes basándose en la producción de rupturas de doble cadena y su posterior reparación. Actualmente existen varias plataformas para el diseño de RNAs guía, aunque también es posible realizarlo de forma manual. Los componentes del sistema son entregados a la célula mediante un plásmido o una ribonucleoproteína. En esta revisión nos centraremos en la función original de CRISPR/Cas en procariotas y en cómo los investigadores la han modificado para proporcionar nuevas técnicas de edición de genomas. Discutiremos sobre las ventajas de esta nueva técnica, las formas en que podemos utilizarla y algunas de las limitaciones que aún encontramos en su aplicación

¿Cómo contribuyen la autoestima y la inteligencia emocional en la pasión armoniosa por el aprendizaje? Un análisis incremental sobre factores sociodemográficos y ayuda percibida de compañeros/as del equipo.

Objetivos Por tanto, el objetivo de este estudio fue explorar si la autoestima y la inteligencia emocional (IE) contribuyen a una mayor pasión armoniosa controlando el efecto de potenciales variables influyentes como factores sociodemográficos y ayuda percibida por parte de los compañeros/as del grupo de trabajo. Metodología En la investigación participó una muestra total de 313 estudiantes (266 mujeres) de cuatro grados y dos posgrados de la Universidad de Málaga, de 19 a 55 años (Media: 22,59; s.d.: 4,7). En todas las asignaturas se llevó a cabo una metodología de aprendizaje basado en proyectos, con equipos de trabajo. La recogida de datos se llevó a cabo en el curso 2023/24 mediante cuestionarios de autoinforme. Los participantes cumplimentaron cuestionarios de variables sociodemográficas, ayuda percibida (emocional, instrumental e informacional), autoestima, inteligencia emocional, y pasión armoniosa; a través de una plataforma online de Google Forms. Para el análisis de datos, se llevó a cabo una regresión lineal jerárquica con pasión armoniosa como variable dependiente, incluyendo en el primer paso, los factores sociodemográficos (edad y género); en el segundo, las tres dimensiones de ayuda percibida; en el tercero, la autoestima; y en el cuarto, la inteligencia emocional. Resultados. Nuestros resultados revelaron que la edad se asoció a una mayor pasión armoniosa. La ayuda percibida (particularmente, la ayuda informacional) contribuyó con una porción significativa de la Pasión armoniosa más allá de los efectos de edad y género. La autoestima explicó un porcentaje significativo de la varianza de pasión armoniosa controlando los efectos del género, edad y ayuda percibida. Y finalmente, la IE contribuyó varianza explicativa de Pasión armoniosa controlando el efecto de edad, género, ayuda percibida y autoestima.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

La evaluación en los SPOC: análisis de modelos e instrumentos

The evaluation varies according to the methodology and students to whom the teaching process is directed, since it is adapted to their context and level of instruction. In relation to the object of our study, SPOCs (Small Private Online Course), maintain different variations in terms of assessment models and instruments. The way of evaluating in the SPOC varies according to the students to whom the course is directed, the design of the SPOC itself and the approach that the teacher himself wants to give. The main objective of this research is to analyze the evaluation models and instruments that are implemented in SPOCs. The aim is to understand how assessment is carried out in SPOCs, through the most current lines of research. For this, the research has been carried out through a theoretical study of the current and specific bibliography on the subject. The results reflect a preference, in terms of purpose, for summative assessment. In relation to the moment of collecting information, the initial evaluation together with the final one, are the most used models. As for the evaluating agent, self-evaluation is the most widely implemented model. Among the instruments, self-evaluations and test-type tests are the most widely used tools to collect evidence on the learning process. In conclusion, despite the fact that the pedagogical characteristics of SPOCs favor the adoption of evaluation models and instruments, the agreement on evaluation models and tools is subordinated to the specific intention of each SPOC.La evaluación varía según la metodología y alumnado al que va dirigido el proceso de enseñanza, ya que esta se adapta a su contexto y nivel de instrucción. En relación con el objeto de nuestro estudio, los SPOC (del inglés Small Private Online Course), mantienen diferentes variaciones en cuanto a los modelos e instrumentos de evaluación. La forma de evaluar en los SPOC varía según el alumnado al que va dirigido el curso, el propio diseño del SPOC y el enfoque que el propio docente quiera darle.&nbsp; El objetivo principal de esta investigación es analizar los modelos e instrumentos de evaluación que se implementan en los SPOC. Se pretende comprender como se desarrolla la evaluación en los SPOC, a través de las líneas de investigación más actuales. Para ello, la investigación se ha llevado a cabo a través de un estudio teórico de la bibliografía actual y especifica en la materia. Los resultados reflejan una preferencia, en lo que respecta a la finalidad, por la evaluación sumativa. En relación con el momento de recogida de información, la evaluación inicial junto con la final, son los modelos más utilizados. En cuanto al agente evaluador, la autoevaluación es el modelo más implementado. Entre los instrumentos, las autoevaluaciones y las pruebas tipo test son las herramientas más implementadas para recoger evidencias sobre el proceso de aprendizaje. Como conclusión, pese a que las características pedagógicas de los SPOC favorecen la adopción de unos modelos e instrumentos de evaluación, el acuerdo sobre modelos y herramientas de evaluación queda subordinado a la intención concreta de cada SPOC.&nbsp

Associations of accumulated persistent organic pollutants in breast adipose tissue with the evolution of breast cancer after surgery

Dr. JP Arrebola is under contract within the Ramón y Cajal Program (RYC-2016-20155, Ministerio de Economía, Industria y Competitividad, Spain). This study was supported by research grants from Instituto de Salud Carlos III, Junta de Andalucía and European Regional Development Fund – FEDER (PI-0513/2012, PI16/01858, PI18/01573, PI20/01568).Chronic exposure to persistent organic pollutants (POPs) is suspected to contribute to the onset of breast cancer, but the impact on the evolution of patients after diagnosis is unclear. We aimed to analyze the contribution of long-term exposure to five POPs to overall mortality, cancer recurrence, metastasis, and development of second primary tumors over a global follow-up of 10 years after surgery in breast cancer patients in a cohort study. Between 2012 and 2014, a total of 112 newly diagnosed breast cancer patients were recruited from a public hospital in Granada, Southern Spain. Historical exposure to POPs was estimated by analyzing their concentrations in breast adipose tissue samples. Sociodemographic data were collected through face-to-face interviews, while data on evolution tumor were retrieved from clinical records. Statistical analyses were performed using Cox regression (overall survival, breast cancer recurrence or metastasis) and binary logistic regression models (joint outcome variable). We also tested for statistical interactions of POPs with age, residence, and prognostic markers. The third vs first tertile of hexachlorobenzene concentrations was associated with a lower risk of all-cause mortality (Hazard Ratio, HR = 0.26; 95 % Confidence Interval, CI = 0.07-0.92) and of the appearance of any of the four events (Odds Ratio = 0.37; 95 % CI = 0.14-1.03). Polychlorinated biphenyl 138 concentrations were significantly and inversely associated with risk of metastasis (HR = 0.65; 95 % CI = 0.44-0.97) and tumor recurrence (HR = 0.69; 95 % CI = 0.49-0.98). Additionally, p,p & PRIME;dichlorodiphenyldichloroethylene showed inverse associations with risk of metastasis in women with ER-positive tumors (HR = 0.49; 95 % CI = 0.25-0.93) and in those with a tumor size <2.0 cm (HR = 0.39; 95 % CI = 0.18-0.87).Ministerio de Economía, Industria y Competitividad, Spain RYC-2016-20155Instituto de Salud Carlos IIIJunta de AndalucíaEuropean Regional Development Fund – FEDER (PI-0513/2012, PI16/01858, PI18/01573, PI20/01568)University of Granada / CBU

LipoDDx: a mobile application for identification of rare lipodystrophy syndromes

Background: Lipodystrophy syndromes are a group of disorders characterized by a loss of adipose tissue once other situations of nutritional deprivation or exacerbated catabolism have been ruled out. With the exception of the HIV-associated lipodystrophy, they have a very low prevalence, which together with their large phenotypic heterogeneity makes their identification difficult, even for endocrinologists and pediatricians. This leads to significant delays in diagnosis or even to misdiagnosis. Our group has developed an algorithm that identifies the more than 40 rare lipodystrophy subtypes described to date. This algorithm has been implemented in a free mobile application, LipoDDx®. Our aim was to establish the effectiveness of LipoDDx®. Forty clinical records of patients with a diagnosis of certainty of most lipodystrophy subtypes were analyzed, including subjects without lipodystrophy. The medical records, blinded for diagnosis, were evaluated by 13 physicians, 1 biochemist and 1 dentist. Each evaluator first gave his/her results based on his/her own criteria. Then, a second diagnosis was given using LipoDDx®. The results were analysed based on a score table according to the complexity of each case and the prevalence of the disease. Results: LipoDDx® provides a user-friendly environment, based on usually dichotomous questions or choice of clinical signs from drop-down menus. The final result provided by this app for a particular case can be a low/high probability of suffering a particular lipodystrophy subtype. Without using LipoDDx® the success rate was 17 ± 20%, while with LipoDDx® the success rate was 79 ± 20% (p < 0.01).Project financed with an intramural grant from the Xunta de Galicia, ED341b 2017/19. S.S-I was awarded a Research Fellowship, granted by the Asociación Española de Familiares y Afectados de Lipodistrofias (AELIP).S