Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care

Aim: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. Methods: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. Results: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. Conclusions: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.info:eu-repo/semantics/publishedVersio

Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial

Background: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. Methods: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). Results: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. Discussion: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. Limitations: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. Trial registration: This trial was registered in ClinicalTrials.gov (NCT03762044). Date of registration: 23 November 2018. Prospectively Registered

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Supplementing the diet of dairy goats with dried orange pulp throughout lactation: I. Effect on milk performance, nutrient utilisation, blood parameters and production economics

Dried orange pulp (DOP) can be incorporated into ruminant diets, but no reports have considered this strategy during the entire lactation period in goats. Two experiments were performed using lactating Payoya goats. In experiment 1, to study the effect, over 180 days, of DOP on milk yield and composition, blood metabolites and economic values, 44 primiparous goats were allocated into three groups: control diet (concentrate plus lucerne) and DOP40 and DOP80 diets, in which DOP replaced 40% and 80%, respectively, of the cereals. Nutrient digestibility and rumen fermentation were also studied (experiment 2). The DOP diets did not affect milk yield and composition. DOP triggered lower intake and digestibility of ether extract and crude protein. Ruminal fermentation was unaffected by DOP, except for a decrease in butyrate for DOP80. The energy balance was unaltered by diet while the balance and retention of nitrogen decreased. Regarding plasma biochemistry, DOP supplementation caused changes that could indicate an improvement in hepatic function and reduced muscular damage and oxidative muscular stress. Moreover, DOP80 provided a profit increase of EUR 3.27/goat. In conclusion, the partial replacement of cereals by DOP is a profitable and healthy nutritional strategy in dairy goats and is suitable for the entire lactation period without compromising productivity.This research was supported by an agreement between the Excma. Diputación Provincial de Huelva, Spain and the University of Huelva entitled “Aprovechamiento de Subproductos de las Empresas Agroalimentarias para Alimentación del Ganado”

Siloxane removal for biogas purification by low cost mineral adsorbent

International audienceThe potential use of raw and expanded perlite as low-cost adsorbents for biogas purification has been investigated. The thermal expansion of perlite causes a reduction in the density of silanol groups from 2515.43 to 653.75 OH/nm2; in contrast, the specific surface area of perlite increased two-fold due to the thermal expansion. To determine the equilibrium adsorption capacity and the adsorption kinetics batch experiments were conducted. The adsorption capacities are in the following order: activated carbon (6.8 mg/g) andgt; silica gel (6.6 mg/g) andgt; expanded perlite (5.8 mg/g) andgt; raw perlite (5.6 mg/g) when compared at the same experimental conditions. The equilibrium adsorption data showed that perlite can be used to reduce the octamethylcyclotetrasiloxane concentration below 28 mg/m3, as recommended by leading manufacturers. The adsorption kinetics of octamethylcyclotetrasiloxane onto raw and expanded perlite followed the Linear-Driving Force model suggesting that the mass transfer is the rate-controlling step. In addition to its low cost, expanded perlite has the advantage of requiring lower desorption temperature (200 °C) for regeneration in comparison to the reported values for activated carbon (andgt;400 °C) and fast desorption kinetics (20 min), which could contribute to a cleaner production of biogas

Synthetic spectra for Lyman-α\alpha forest analysis in the Dark Energy Spectroscopic Instrument

International audienceSynthetic data sets are used in cosmology to test analysis procedures, to verify that systematic errors are well understood and to demonstrate that measurements are unbiased. In this work we describe the methods used to generate synthetic datasets of Lyman-$\alpha$ quasar spectra aimed for studies with the Dark Energy Spectroscopic Instrument (DESI). In particular, we focus on demonstrating that our simulations reproduces important features of real samples, making them suitable to test the analysis methods to be used in DESI and to place limits on systematic effects on measurements of Baryon Acoustic Oscillations (BAO). We present a set of mocks that reproduce the statistical properties of the DESI early data set with good agreement. Additionally, we use full survey synthetic data to forecast the BAO scale constraining power with DESI

Synthetic spectra for Lyman-α\alpha forest analysis in the Dark Energy Spectroscopic Instrument

International audienceSynthetic data sets are used in cosmology to test analysis procedures, to verify that systematic errors are well understood and to demonstrate that measurements are unbiased. In this work we describe the methods used to generate synthetic datasets of Lyman-$\alpha$ quasar spectra aimed for studies with the Dark Energy Spectroscopic Instrument (DESI). In particular, we focus on demonstrating that our simulations reproduces important features of real samples, making them suitable to test the analysis methods to be used in DESI and to place limits on systematic effects on measurements of Baryon Acoustic Oscillations (BAO). We present a set of mocks that reproduce the statistical properties of the DESI early data set with good agreement. Additionally, we use full survey synthetic data to forecast the BAO scale constraining power with DESI

Climate and Oceanographic Change in the Atlantic of northern Spain

Esta obra ofrece una síntesis de la información recogida en las series temporales de observaciones oceánicas del IEO en la región atlántica del norte de España iniciadas en 1943 con el registro mareográfico; muestra evidencias de cambios interanuales en la física, la química y la biología del océano en relación con los factores climáticos, y estima los impactos más probables del clima en el océano futuro. Este volumen continúa la serie de estudios de la influencia del cambio climático en el mar iniciada con el Cambio climático en el Mediterráneo español (Vargas Yánez et al., 2010). En este caso, el enfoque es multidisciplinar, empleando, por primera vez, series de observaciones recogidas de forma coordinada y simultánea. A lo largo de sus ochos capítulos, se analiza la variabilidad climática atmosférica reciente y su influencia sobre las condiciones oceanográficas de la región, especialmente en relación con la intensidad y frecuencia del afloramiento de aguas profundas que determina, en gran medida, el aporte estacional de nutrientes a la superficie y, por tanto, la producción biológica. Se describen las tendencias en el nivel del mar a partir de las medidas de los mareógrafos de la zona con una estimación de los niveles extremos esperados a largo plazo. Se realiza un análisis comparativo –entre Galicia y el Cantábrico– de la variabilidad en los nutrientes inorgánicos y se determinan los elementos limitantes de la producción primaria en cada zona. Finalmente, se analizan las variaciones en las comunidades de fitoplancton, picoplancton y zooplancton como indicadoras de cambios en el ecosistema pelágico, destacando las fluctuaciones en la biomasa y producción primaria, base de la red trófica pelágica de la región, y la presencia de medusas y salpas y su relación con el clima.This book presents a synthesis of the oceanic time-series observations of IEO in the Atlantic region of northern Spain. These series, starting in 1943 with tide-gauges, reveal evidence of interanual changes in physical, chemical and biological properties of the ocean that were related to climatic factors, allowing to estimate future impacts of climate on the ocean. The volume continues the series started with “Climate Change in the Spanish Mediterranean” (Vargas Yánez et al., 2010). In this case the study is multidisciplinary, including for the first time series obtained in coordinated and simultaneous observational programs. The eight chapters first analyse recent climatic variability and its influence on the regional oceanography, particularly in relation to the intensity and frequency of the deep-water upwelling that largely determines the seasonal inputs of nutrients and primary production in this region. Next, the main trends in sea level revealed by tidal gauges along with the estimates of expected extreme levels are described. The variability in inorganic nutrients and the identification of limiting elements for primary production were presented as a comparative analysis between Galicia (in the West) and the Mar Cantábrico (in the east). Finally, the variability in the composition of the plankton communities, including phytoplankton, picoplankton and zooplankton, is analysed as indicative of changes in the pelagic ecosystem. Particular attention is given to the fluctuations in primary biomass and production and to the presence of salps and jellyfish in relation to climate.Versión del edito