Low intensity vs. self-guided Internet-delivered psychotherapy for major depression: A multicenter, controlled, randomized study

Background: Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system. Methods: The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed. Discussion: The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting

Co-ocurrencia de uranio, vanadio y molibdeno en acuíferos chaco-pampeanos (Argentina) : Fuentes, movilidad y procesos de concentración en diversas cuencas

Concentraciones anómalas de uranio (U), vanadio (V) y molibdeno (Mo), asociadas con arsénico en aguas subterráneas de la Llanura Chaco-Pampeana generan toxicidad que limitan su utilización e ingesta. Se muestran resúmenes estadísticos para las cuencas del río Salí y de Burruyacú (Tucumán), la llanura centro-norte de Santa Fe, las llanuras sudoriental de Córdoba, norte de La Pampa y sudeste de Buenos Aires.En acuíferos someros de la cuenca del río Salí, los máximos de U, V y Mo son, respectivamente: 125, 300 y 727 μgL-1; (medianas: 14,2, 77,3 y 10,9 μgL-1, respectivamente). En sedimentos (mg kg-1): 12,4, 99,0 y <2, respectivamente (medianas: 3,88, 85,0 y <2, respectivamente).Estas concentraciones están relacionadas con disolución de vidrio volcánico, lixiviación de sedimentos loésicos, sorción sobre superficie de óxidos y oxi-hidróxidos de Al, Fe y Mn, y desorción a valores de pH más altos, con formación de iones complejos estables, con alta movilidad.Anomalous concentrations of uranium (U), vanadium (V) and molybdenum (Mo), associated to ar senic (As) in groundwater from the Chaco-Pampean Plain causes toxicity, therefore utilization and consumption must be restricted. Statistical summaries from the Salí river and Burruyacú basins (Tucumán), the northern-central plain of Santa Fe, and the southeastern plains of Córdoba, northern La Pampa and southeastern Buenos Aires were shown. In shallow aquifers from the Salí river basin maxima concentrations of U, V and Mo are respectively: 125 μgL-1, 300 μgL-1, 727 μgL-1 (medians: 14.2, 77.3 and 10.9 μgL-1 respectively). In sediments (mg kg-1): 12.4, 99.0 and &lt;2 (medians: 3.88, 85.0 and &lt;2). Such concentrations are related to the volcanic-glass dissolution and leaching of loess-like sediments, sorption onto surface from Al-, Fe- and Mn oxides and oxihydroxides, and desorption at higher pH values and formation of stable complex-ions with high mobility.Universidad Nacional de La Plat

Nutrición en cuidados paliativos: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE

Los cuidados paliativos proporcionan una atención integral que tiene en cuenta los aspectos físicos, emocionales, sociales y espirituales del paciente con enfermedad terminal y su entorno familiar. El tratamiento nutricional debe formar parte activa de los equipos de cuidados paliativos. La necesidad de iniciar o no un tratamiento nutricional sigue siendo, desde hace décadas, uno de los principales problemas éticos a los que se enfrentan los profesionales dedicados a la nutrición clínica. El origen de tal controversia radica, fundamentalmente, en cómo se consideran la nutrición y la hidratación: cuidado/soporte o tratamiento médico. Los objetivos fundamentales del tratamiento nutricional en los pacientes en cuidados paliativos deben ser otros: la mejoría de la calidad de vida, de la supervivencia o de ambas. La decisión de indicar o no el tratamiento nutricional en cuidados paliativos debe tomarse tras considerar el pronóstico, la calidad de vida y la relación “riesgo/beneficio”. En relación a la alimentación por vía oral (con o sin suplementos orales), prevalece la idea de la “alimentación de confort”, que se basa en intentos de alimentación oral hasta que se produzcan la incomodidad y/o el rechazo del paciente. No existen evidencias que justifiquen el uso de nutrientes específicos, aunque desde hace años se señala la posibilidad de lograr beneficios cuando se utilizan ácidos grasos omega-3 en los pacientes con cáncer. En cuanto al tratamiento nutricional (enteral o parenteral), en ausencia de evidencia, las decisiones sobre si iniciar una nutrición artificial en un paciente paliativo deben tomarse teniendo en cuenta los deseos y creencias del paciente y sus familiares, y basarse en el consenso del equipo interdisciplinar sobre los objetivos que se persiguen al iniciarla

SilvAdapt.Net: A Site-Based Network of Adaptive Forest Management Related to Climate Change in Spain

[EN] Adaptive forest management (AFM) is an urgent need because of the uncertainty regarding how changes in the climate will affect the structure, composition and function of forests during the next decades. Current research initiatives for the long-term monitoring of impacts of silviculture are scattered and not integrated into research networks, with the consequent losses of opportunities and capacity for action. To increase the scientific and practical impacts of these experiences, it is necessary to establish logical frameworks that harmonize the information and help us to define the most appropriate treatments. In this context, a number of research groups in Spain have produced research achievements and know-how during the last decades that can allow for the improvement in AFM. These groups address the issue of AFM from different fields, such as ecophysiology, ecohydrology and forest ecology, thus resulting in valuable but dispersed expertise. The main objective of this work is to introduce a comprehensive strategy aimed to study the implementation of AFM in Spain. As a first step, a network of 34 experimental sites managed by 14 different research groups is proposed and justified. As a second step, the most important AFM impacts on Mediterranean pines, as one of the most extended natural and planted forest types in Spain, are presented. Finally, open questions dealing with key aspects when attempting to implement an AFM framework are discussed. This study is expected to contribute to better outlining the procedures and steps needed to implement regional frameworks for AFM.A.J. Molina is beneficiary of an "APOSTD" fellowship (APOSTD/2019/111) funded by the Generalitat Valenciana. M. Moreno-de las Heras is beneficiary of a Serra Hunter fellowship (UB-LE-9055) funded by the Generalitat de Catalunya. F.J. Ruiz-Gomez is supported by a postdoctoral fellowship of the Junta de Andalucia (Sevilla, Spain), and the European Social Fund 2014-2020 Program (DOC_0055). The authors received national and international funding through the following projects: SILVADAPT.NET (RED2018-102719-T), ESPECTRAMED (CGL2017-86161-R), Life-FOREST CO2 (LIFE14 CCM/ES/001271), ALTERACLIM (CGL2015-69773-C2-1-P), INERTIA (PID2019-111332RB-C22-BDV), CEHYRFO-MED (CGL2017-86839-C3-2-R), DEHESACLIM (IB16185), RESILIENTFORESTS (LIFE17 CCA/ES/000063), Rhysotto (PID2019-106583RB-I00), AGL2017-83828C2-2-R, RTI2018-096884-B-C31, ESPAS (CGL2015-65569-R), and caRRRascal (RTI2018-095037-B-I00).Molina Herrera, A.; Navarro Cerrillo, R.; Pérez-Romero, J.; Alejano, R.; Bellot, JF.; Blanco, JA.; Camarero, JJ.... (2021). SilvAdapt.Net: A Site-Based Network of Adaptive Forest Management Related to Climate Change in Spain. Forests. 12(12):1-27. https://doi.org/10.3390/f12121807127121

Effect of COMBinAtion therapy with remote ischemic conditioning and exenatide on the Myocardial Infarct size: a two-by-two factorial randomized trial (COMBAT-MI)

Remote ischemic conditioning (RIC) and the GLP-1 analog exenatide activate different cardioprotective pathways and may have additive effects on infarct size (IS). Here, we aimed to assess the efficacy of RIC as compared with sham procedure, and of exenatide, as compared with placebo, and the interaction between both, to reduce IS in humans. We designed a two-by-two factorial, randomized controlled, blinded, multicenter, clinical trial. Patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention (PPCI) within 6 h of symptoms were randomized to RIC or sham procedure and exenatide or matching placebo. The primary outcome was IS measured by late gadolinium enhancement in cardiac magnetic resonance performed 3–7 days after PPCI. The secondary outcomes were myocardial salvage index, transmurality index, left ventricular ejection fraction and relative microvascular obstruction volume. A total of 378 patients were randomly allocated, and after applying exclusion criteria, 222 patients were available for analysis. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. IS was similar between groups for the RIC (24 ± 11.8% in the RIC group vs 23.7 ± 10.9% in the sham group, P = 0.827) and the exenatide hypotheses (25.1 ± 11.5% in the exenatide group vs 22.5 ± 10.9% in the placebo group, P = 0.092). There were no effects with either RIC or exenatide on the secondary outcomes. Unexpected adverse events or side effects of RIC and exenatide were not observed. In conclusion, neither RIC nor exenatide, or its combination, were able to reduce IS in STEMI patients when administered as an adjunct to PPCI

Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain

This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure ?nished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant ?short term? result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.Ministerio de SanidadInstituto de Salud Carlos II

Engineering of III-Nitride Semiconductors on Low Temperature Co-fired Ceramics

This work presents results in the feld of advanced substrate solutions in order to achieve high crystalline quality group-III nitrides based heterostructures for high frequency and power devices or for sensor applications. With that objective, Low Temperature Co-fred Ceramics has been used, as a noncrystalline substrate. Structures like these have never been developed before, and for economic reasons will represent a groundbreaking material in these felds of Electronic. In this sense, the report presents the characterization through various techniques of three series of specimens where GaN was deposited on this ceramic composite, using diferent bufer layers, and a singular metal-organic chemical vapor deposition related technique for low temperature deposition. Other single crystalline ceramic-based templates were also utilized as substrate materials, for comparison purposes

Comment on "Evidence from acoustic imaging for submarine volcanic activity in 2012 off the west coast of El Hierro (Canary Islands, Spain)" by Pérez NM, Somoza L, Hernández PA, González de Vallejo L, León R, Sagiya T, Biain A, González FJ, Medialdea T, Barrancos J, Ibáñez J, Sumino H, Nogami K and Romero C [Bull Volcanol (2014) 76:882-896]

Versión del editor2,205

Isoconversional kinetic analysis applied to five phosphoniumcation-based ionic liquids

Thermal degradation of five phosphonium cation-based ionic liquids ([P66614][BEHP], [P66614][(iC8)2PO2],[P66614][NTf2], [P44414][DBS] and [P4442][DEP]) was studied using dynamic methodology (25–600◦C at 5,10 and 20◦C/min) in both inert (nitrogen) and reactive (oxygen) atmospheres. In addition, isothermalexperiments (90 min at 200, 225 and 250◦C) were carried out with [P66614][(iC8)2PO2]. Results indicatethat thermal stability is clearly dominated by the coordination ability of the anion, with [P66614][NTf2] out-performing the other ones in both pyrolytic and oxidising conditions. Although the thermal degradationmechanism is affected by atmospheric conditions, the degradation trend remains practically constant.As the dynamic methodology usually overestimates the long-term thermal stability, an isoconversionalmethodology is better for predicting the long-term thermal stability of these ionic liquids in order to beused as base oil or additive in lubricants formulation. Finally, the model-free methodology can predict atlower costs the ILs performance in isothermal conditions