La ‘anomalía deambulatoria’ en la antigua Iberia. ‘Monosándalos’, héroes heridos y jóvenes danzantes

In this paper we analyze some elements of the Iberian iconography related to the general subject of the ambulatory anomaly, which are frequent in the Ancient Mediterranean. These themes are the monosandals, the injuries in the leg of the hero and dances of young people. In our opinion, these Iberian representations are related to ritual practices well documented in the Ancient Mediterranean. This relationship illustrates the high degree of contact between the Iberian and the Mediterranean World and the feasible existence of a common cultural character or koiné.En el presente artículo se analizan diversos motivos presentes en la iconografía ibérica, relacionables con el tema más general, muy presente en el Mediterráneo antiguo, de la anomalía deambulatoria: el monosandalismo, las heridas en la pierna del héroe y los grupos de jóvenes danzantes. Se proponen hipótesis para interpretar estas representaciones presentes en el mundo ibérico a través de diversas prácticas mítico-rituales que encontramos bien documentadas en el Mediterráneo antiguo. Esta relación nos hablaría del profundo grado de identidad del mundo ibero con el resto de culturas mediterráneas y con una koiné cultural común

Diseño y desarrollo de un tribómetro pin-on-disk de bajo coste

[ES] Hoy en día, los materiales en la industria están en contacto con diversas superficies que, como consecuencia, desgastan la misma y en ocasiones producen el fallo o la fatiga de estos. El objetivo de este proyecto es el diseño y fabricación de un tribómetro, máquina de laboratorio dedicada a realizar ensayos tribológicos, es decir; realizar pruebas de desgaste en diferentes tipos de materiales, con y sin lubricación, analizar el comportamiento de los mismos e interpretar los resultados obtenidos. Se precisan estos ensayos para determinar cuál es el material adecuado, en cada caso, ya sea metal o polímero, para soportar mejor la fricción durante los ciclos de trabajo y así garantizar el buen funcionamiento en servicio.[EN] Today, the materials in the industry are in contact with a variety of surfaces that, as result, wear the same and sometimes cause the fault or the fatigue of these. The objective of this project is the design and manufacture of a laboratory machine tribometer, dedicated to testing Tribology; Wear testing in different types of materials, with and without lubrication, to analyze the behavior of the same and interpret the results. These trials are needed to determine which is the suitable material, in each case, either metal or polymer, to better withstand the friction during the working cycles, and thus ensure the proper functioning in service.[CA] Hui en dia, els materials en la indústria estan en contacte amb diverses superfícies que, com a conseqüència, desgasten la mateixa i de vegades produïxen la fallada o la fatiga d'estos. L'objectiu d'este projecte és el disseny i fabricació d'un tribòmetre, màquina de laboratori dedicada a realitzar assajos tribológicos, és a dir; realitzar proves de desgast en diferents tipus de materials, amb i sense lubricació, analitzar el comportament dels mateixos i interpretar els resultats obtinguts. Fan falta estos assajos per a determinar quin és el material adequat, en cada cas, ja siga metall o polímer, per a suportar millor la fricció durant els cicles de treball i així garantir el bon funcionament en servici.Teodoro Grau, D. (2018). Diseño y desarrollo de un tribómetro pin-on-disk de bajo coste. http://hdl.handle.net/10251/115391TFG

Ambulatory anomaly in the ancient Iberia. ‘Monosandals’, injured heroes and young dancers

En el presente artículo se analizan diversos motivos presentes en la iconografía ibérica, relacionables con el tema más general, muy presente en el Mediterráneo antiguo, de la anomalía deambulatoria: el monosandalismo, las heridas en la pierna del héroe y los grupos de jóvenes danzantes. Se proponen hipótesis para interpretar estas representaciones presentes en el mundo ibérico a través de diversas prácticas mítico-rituales que encontramos bien documentadas en el Mediterráneo antiguo. Esta relación nos hablaría del profundo grado de identidad del mundo ibero con el resto de culturas mediterráneas y con una koiné cultural común.In this paper we analyze some elements of the Iberian iconography related to the general subject of the ambulatory anomaly, which are frequent in the Ancient Mediterranean. These themes are the monosandals, the injuries in the leg of the hero and dances of young people. In our opinion, these Iberian representations are related to ritual practices well documented in the Ancient Mediterranean. This relationship illustrates the high degree of contact between the Iberian and the Mediterranean World and the feasible existence of a common cultural character or koiné.Este trabajo se ha realizado en el marco del proyecto HAR2009-13141 del MICINN. Queremos agradecer los comentarios de los revisores anónimos que en la medida de lo posible hemos incorporado al texto y que han contribuido a refinar nuestra argumentación

Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?

Enteral nutrition; Intensive care unit; MortalityNutrició enteral; Unitat de Cures Intensives; MortalitatNutrición enteral; Unidad de Cuidados Intensivos; MortalidadBackground & aims: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for ≥72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for ≤14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95%CIs) were reported. Results: We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following characteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 ± 3.3 vs 8.4 ± 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 ± 2.1 vs 5.2 ± 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Conclusions: Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

Complementary parenteral nutrition; Critically ill patients; Enteral nutritionNutrición parenteral complementaria; Pacientes críticamente enfermos; Nutrición enteralNutrició parenteral complementària; Pacients crítics; Nutrició enteralBackground: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PN-EN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94 ± 6.72 Kcal/kg/day) and protein (1.01 ± 0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95 ± 0.43 vs 1.17 ± 0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18-0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91-0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81-0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943.The present study was funded by the Spanish Society of Metabolism and Nutrition (SENPE: Sociedad Española de Nutrición y Metabolismo): Best Working Group Project Award at the SENPE National Congress in 2022

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Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy

Background and aimsDespite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN.MethodsAdult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores).ResultsOf a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053–1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098–1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057–1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001–1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210–0.687, p = 0.016) was associated with lower need of PN.ConclusionA higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.Clinical trial registrationClinicalTrials.gov: NCT03634943

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PNEN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94 +/- 6.72 Kcal/kg/day) and protein (1.01 +/- 0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95 +/- 0.43 vs 1.17 +/- 0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18-0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91-0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81-0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943