Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

Educación. Contextos sociales y propensión a aprender

Nuestras sociedades están inmersas, desde hace algunos años, en interminables debates y movilizaciones en torno a la educación. Se ha ido configurando una creciente demanda ciudadana exigiendo una educación de calidad e igualdad de oportunidades en el acceso a ella. Por otra parte se han instaurado prácticas recurrentes de medición de los logros educativos, haciendo uso de patrones de carácter universal, que permiten a los distintos actores involucrados cotejar lo que está ocurriendo en sus respectivos países comparándolo con lo que ocurre en otros países

Middle Pleistocene human occupation in the interior of the Iberian Peninsula during cold climate conditions: Zooarchaeology and taphonomy of ETB-H02 site in the Manzanares valley (Madrid, Spain)

Evidence suggesting human occupation in the interior of the Iberian Peninsula during cold periods of the Middle Pleistocene is scarce. The Estanque de Tormentas (ETB-H02) site (Manzanares Valley, Madrid) matches with a MIS 6 or MIS 7 cold event, which allows us to tackle the study of the human occupation of the highlands of the Spanish Meseta during a cold climate event. ETB-H02 is one of the few Middle Pleistocene open air sites of the Iberian Peninsula where lithic industry associated with faunal remains has been preserved. The bone remains have been recovered from several different stratigraphic levels excavated in an area 1029m2. It can be inferred from the taphonomic and zooarcheological analyses of those remains that occasional human occupations occurred at this site, during which lithic tools were used for processing individuals of aurochs, horses, wild donkeys and deer. In addition, carcasses of animals that probably died due to natural causes have been preserved. Some were modified by carnivores although not intensively, judging by the scarce number of tooth marks. In conclusion, ETB-H02 supports the hypothesis that the continental climate and the height of the highlands of the Iberian Peninsula were not an obstacle to occupation in the Middle Pleistocene cold times. Besides, unlike other sites of the interior of the Iberian Peninsula that show occasional occupations, in ETB-H02 the human occupation happened recurrently, as human-processed faunal remains have been recovered from different levels and sub-levels, implying repeated visits to this environment, which would offer specific advantages regarding the exploitation of animal resources

Visiones

El trabajo obtuvo un Premio Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2017/2018. Modalidad BSe presenta un proyecto llevado a cabo en la Escuela Oficial de Idiomas de Plasencia (Cáceres) que tenía como objetivo principal el uso de la lengua a través de actividades eminentemente comunicativas que fomenten las relaciones y la convivencia. Se desarrollaron 4 actividades: 'Visiones de Plasencia, El mercado' que pretendía mostrar la visión que los turistas y vecinos extranjeros tienen de Plasencia; 'Visiones de Europa', que consistió en contactar con un ilustrador gráfico y se le encargaron ilustraciones de 5 ciudades europeas, en torno a las cuales se realizaron distintas tareas; 'Visiones culturales' en la que teniendo como base siete ilustraciones de personajes famosos que destacaban por su labor profesional y contribución cultural se investigó sobre su vida y 'Visiones personales' que se construyó con retratos de la ciudad de Plasencia elaborados por los propios alumnos del centro (selfies)ExtremaduraES

Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presented.ISSN:0029-5515ISSN:1741-432