La arquitectura como elemento narrativo en Assassins Creed II

El videojuego Assassin´s Creed II (ACII) puede ser considerado un videojuego narrativo en el que la arquitectura constituye un elemento importante en el relato que subyace al juego. Por otra parte, la representación de las ciudades italianas del siglo XV en ACII es central en la transmisión de la historia detrás del juego, haciendo que la arquitectura sea a su vez elemento narrativo que evoca el relato que lo subyace a partir de su comprensión y de la interacción que tiene el jugador con esta. El propósito de este artículo es examinar la manera como este videojuego y la ficción que construye utilizan la arquitectura como escenario del relato y como un elemento narrativo de la misma. Además, examinaremos cómo la interacción que permite el videojuego aporta herramientas para entender la historia de la arquitectura que, por hacer parte del universo lúdico, han sido tradicionalmente dejadas de lado.Assassins Creed II (ACII) can be considered a narrative game where architecture is an important element of the story behind the game. Meanwhile, representation of fifteenth century Italian cities in ACII is fundamental in the transmission of the background story of the game, making architecture a narrative element that evokes the story behind the game through the understanding of architecture and the interaction with it. The purpose of this paper is to examine the way in which this videogame and the story behind it, use architecture both as scenario for the story and as a narrative element. Moreover, the paper considers how interaction in videogames provides tools for understanding architectural history and how these tools have been traditionally dismissed since they belong to the world of play

Chronological and biological aging of the human left ventricular myocardium: Analysis of microRNAs contribution

Aging is the main risk factor for cardiovascular diseases. In humans, cardiac aging remains poorly characterized. Most studies are based on chronological age (CA) and disregard biological age (BA), the actual physiological age (result of the aging rate on the organ structure and function), thus yielding potentially imperfect outcomes. Deciphering the molecular basis of ventricular aging, especially by BA, could lead to major progresses in cardiac research. We aim to describe the transcriptome dynamics of the aging left ventricle (LV) in humans according to both CA and BA and characterize the contribution of microRNAs, key transcriptional regulators. BA is measured using two CA-associated transcriptional markers: CDKN2A expression, a cell senescence marker, and apparent age (AppAge), a highly complex transcriptional index. Bioinformatics analysis of 132 LV samples shows that CDKN2A expression and AppAge represent transcriptomic changes better than CA. Both BA markers are biologically validated in relation to an aging phenotype associated with heart dysfunction, the amount of cardiac fibrosis. BA-based analyses uncover depleted cardiac-specific processes, among other relevant functions, that are undetected by CA. Twenty BA-related microRNAs are identified, and two of them highly heart-enriched that are present in plasma. We describe a microRNA-gene regulatory network related to cardiac processes that are partially validated in vitro and in LV samples from living donors. We prove the higher sensitivity of BA over CA to explain transcriptomic changes in the aging myocardium and report novel molecular insights into human LV biological aging. Our results can find application in future therapeutic and biomarker research

Cine en compañía para prevenir enfermedades

El proyecto “Cine en compañía para prevenir enfermedades” es continuación del proyecto iniciado en 2017 (INNOVA-Docencia 18/2018, ApS-UCM 18/2019) y se encuadra en el campo de Salud Pública, higiene y prevención de enfermedad, dirigido a personas desfavorecidas o en riesgo de exclusión social. En esta edición se ha ampliado el área de conocimiento y profesores participantes, incluyendo no solo enfermedades infecciosas, como en ediciones anteriores, sino otras del ámbito de la Bioquímica y Biología Molecular. El proyecto es multidisciplinar e interfacultativo (21 tutores: profesores, colaboradores postdoctorales, doctorandos, estudiantes participantes en ediciones anteriores y técnico de laboratorio, de las Facultades de Farmacia, Biología y Medicina y del Hospital 12 de Octubre) y en él han participado 41 estudiantes de distintos Grados (Biología, Bioquímica, Ciencia y Tecnología de los Alimentos, Derecho, Farmacia, Ingeniería Electrónica) y Postgrados (Máster en Biología Sanitaria, y en Microbiología y Parasitología: Investigación y Desarrollo; Doctorado en Bioquímica y Biología Molecular) y participantes en la asignatura Transversal “Ciencia para la Sociedad”. La necesidad social detectada y atendida es la situación de algunos colectivos, por ejemplo, personas sin hogar, mujeres en exclusión, adictos a drogas, presidiarios o familias residentes en áreas no salubres, de una mayor exposición a determinadas enfermedades debido a sus condiciones de vida (enfermedades infecciosas, mentales, metabólicas derivadas de adicciones o alcoholismo), además de que encuentran escasas posibilidades de conocer cómo prevenirlas y la forma adecuada de recibir tratamiento. Adicionalmente, y no menos importante, acusan una carencia severa de compañía, atención y escucha de sus necesidades. Los estudiantes de universidad que cursan estudios en el campo de Ciencias y Ciencias de la Salud estudian estas enfermedades, por lo que pueden ayudar a estos colectivos en la mejora de prácticas higiénico-sanitarias, así como al acceso a la información para su prevención y tratamiento. Las actividades desarrolladas en el proyecto han consistido en el acompañamiento y desarrollo de una actividad lúdica mediante la proyección de películas comerciales que traten una enfermedad de interés en el colectivo a atender, seguida de coloquio para ayudar a conocer las formas adecuadas de prevención y tratamiento. Los equipos de 4-5 estudiantes (de distintas titulaciones y cursos) y dos tutores (senior y junior) han realizado varias visitas a centros sociales atendidos por Fundaciones con las que existe convenio de la UCM (centros de día para personas sin hogar, mujeres en exclusión, discapacitados o presidiarios, gestionados por Cáritas, Hogar-Sí, Diaconía, Medinacelli). Han investigado en profundidad las enfermedades que afectan y de interés del grupo atendido, seleccionado y analizado críticamente películas adecuadas, preparado materiales divulgativos (carteles, juegos) y diseñado y analizado encuestas para evaluar su actividad por parte de las personas atendidas y los coordinadores de los centros. Los resultados de las encuestas a todos los participantes (tutores, estudiantes, centros) y la recogida de opiniones y memorias de los estudiantes muestran una alta consecución de los objetivos de aprendizaje previstos, refuerzo de contenidos específicos de los estudios y, sobre todo, trabajo y adquisición de competencias transversales como trabajo en equipo, coordinación y asunción de responsabilidades, análisis crítico o expresión científica divulgativa. En cuanto a los objetivos de servicio, destaca la utilidad del proyecto en atención e información a los colectivos, la aplicación de los estudios a situaciones reales en atención a personas desfavorecidas y el valor social del proyecto

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

La renovación de la palabra en el bicentenario de la Argentina : los colores de la mirada lingüística

El libro reúne trabajos en los que se exponen resultados de investigaciones presentadas por investigadores de Argentina, Chile, Brasil, España, Italia y Alemania en el XII Congreso de la Sociedad Argentina de Lingüística (SAL), Bicentenario: la renovación de la palabra, realizado en Mendoza, Argentina, entre el 6 y el 9 de abril de 2010. Las temáticas abordadas en los 167 capítulos muestran las grandes líneas de investigación que se desarrollan fundamentalmente en nuestro país, pero también en los otros países mencionados arriba, y señalan además las áreas que recién se inician, con poca tradición en nuestro país y que deberían fomentarse. Los trabajos aquí publicados se enmarcan dentro de las siguientes disciplinas y/o campos de investigación: Fonología, Sintaxis, Semántica y Pragmática, Lingüística Cognitiva, Análisis del Discurso, Psicolingüística, Adquisición de la Lengua, Sociolingüística y Dialectología, Didáctica de la lengua, Lingüística Aplicada, Lingüística Computacional, Historia de la Lengua y la Lingüística, Lenguas Aborígenes, Filosofía del Lenguaje, Lexicología y Terminología

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Juan Caramuel y la primera historia de la arquitectura

La Arquitectura civil recta y obliqua, de Juan Caramuel de Lobkowitz, es la primera instancia en la que un tratado de arquitectura incluye la historia de la disciplina como parte fundamental de sus contenidos. Este artículo describe cómo Caramuel construye su relato, las fuentes y ejemplos que utiliza. Asimismo, indaga sobre las intenciones de Caramuel al incluir la historia dentro de la educación del arquitecto. Se invita a pensar la historia como una posición moderna frente al pasado y la necesidad del arquitecto de conocer los ejemplos notables de arquitectura de las épocas precedentes para poder construir sobre ellas y contribuir al progreso de la disciplina