Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial)

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.This study was awarded a Health Research Fund (Fondo de Investigaciones Sanitarias/FIS) grant, dossier No. PI12/01161 of the Carlos III Institute of Health and the Ministry of Sciences, Innovation and Universities.S

Employment generation by small firms in Spain

Despite the relevance in terms of policy, we still know little in Spain about where and by whom jobs are created, and how that is affecting the size distribution of firms. The main innovation of this paper is to use a rich database that overcomes the problems encountered by other firm-level studies to shed some light on the employment generation of small firms in Spain. We find that small firms contribute to employment disproportionately across all sectors of the economy although the difference between their employment and job creation share is largest in the manufacturing sector. The job creators in that sector are both new and established firms whereas only new small firms outperform their larger counterparts in the service sector. The large annual job creation of the small firm size class is shifting the firm size distribution towards the very small production units, although not uniformly across industries of different technology intensit

Automated High-Content Live Animal Drug Screening Using C. elegans Expressing the Aggregation Prone Serpin α1-antitrypsin Z

The development of preclinical models amenable to live animal bioactive compound screening is an attractive approach to discovering effective pharmacological therapies for disorders caused by misfolded and aggregation-prone proteins. In general, however, live animal drug screening is labor and resource intensive, and has been hampered by the lack of robust assay designs and high throughput work-flows. Based on their small size, tissue transparency and ease of cultivation, the use of C. elegans should obviate many of the technical impediments associated with live animal drug screening. Moreover, their genetic tractability and accomplished record for providing insights into the molecular and cellular basis of human disease, should make C. elegans an ideal model system for in vivo drug discovery campaigns. The goal of this study was to determine whether C. elegans could be adapted to high-throughput and high-content drug screening strategies analogous to those developed for cell-based systems. Using transgenic animals expressing fluorescently-tagged proteins, we first developed a high-quality, high-throughput work-flow utilizing an automated fluorescence microscopy platform with integrated image acquisition and data analysis modules to qualitatively assess different biological processes including, growth, tissue development, cell viability and autophagy. We next adapted this technology to conduct a small molecule screen and identified compounds that altered the intracellular accumulation of the human aggregation prone mutant that causes liver disease in α1-antitrypsin deficiency. This study provides powerful validation for advancement in preclinical drug discovery campaigns by screening live C. elegans modeling α1-antitrypsin deficiency and other complex disease phenotypes on high-content imaging platforms

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

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Multi-bridging polymers. Synthesis and behaviour in aqueous solution

We synthesized novel hydrophobically end-capped poly(N,N-dimethylacrylamide) (PDMA) star polymers of variable functionality by the RAFT procedure. The properties of these polymers in aqueous solutions were characterised by means of DLS, SANS, and rheology measurements. It was observed that they form interconnected aggregates with a correspondingly increased viscosity. Although the static structure of these systems does not depend to a larger extent on the number of hydrophobic stickers per polymer, the dynamic properties and in particular the rheological properties vary substantially with the number of arms. An increase of non-diffusive relaxation with increasing number of arms is observed by DLS and this complex dynamic behaviour is correlated to an increase of the elastic properties of the formed aggregate networks

1977: Hopes Fulfilled—Building Democracy in Turbulent Economic Times

2016-2019. Crisis económicas: cambios y retos. Una perspectiva histórica2018-2020. Grupo de Investigación Consolidable de la Generalitat Valenciana – Economic History – Valencia (EH-V).2020-2024. Puntos de inflexión históricos En el crecimiento económico, España 1808-2008Este capítulo analiza la coyuntura de cambio económico y político que significó el año de 1977 para la historia de España. Se defiende que esta fecha constituyó un punto de inflexión en la historia económica española porque la grave crisis económica y financiera estuvo acompañada de importantes cambios políticos e institucionales asociados a la transición política después de la muerte de Franco en 1975. Pero también fue un momento determinante debido a la naturaleza fundamental de las reformas implementadas a partir de 1977. En un contexto de crisis y transición política, la sociedad española difícilmente habría podido absorber un ajuste más radical sin la existencia de reformas. Las reformas pusieron a la economía en el camino de la modernización. También actuaron como un mecanismo de reconciliación nacional y sirvieron para demostrar la legitimidad de un gobierno democrático para introducir medidas que eran necesarias pero impopulares, debido a los posibles costos sociales a corto plazo. Una de las características clave de las reformas fue que se lograron mediante la negociación entre nuevos actores políticos y sociales, sindicatos y partidos políticos, lo que facilitó la implementación de políticas de ajuste salarial. El ejemplo más evidente de este proceso negociador fue el crecimiento sostenido del gasto social y la construcción del primer estado de bienestar nacional, como política compensatoria. También se pone de relieve en el trabajo que algunas reformas quedaron pendientes y algunos problemas no se resolvieron. Un ejemplo es el fracaso en términos de desempleo y del mercado laboral. Aunque todos los países europeos vieron aumentar las tasas de desempleo en la década de 1980, en 1982 la tasa de desempleo española fue la más alta de todos los países de la OCDE. Además, la persistencia de una alta tasa de desempleo fue consistente con una continua disminución de la desigualdad de ingresos, que había comenzado a principios de la década de 1970 y continuó descendiendo hasta 1986, lo que puede interpretarse como un signo de la efectividad de los estabilizadores automáticos lanzados en los Pactos de la Moncloa de 1977. En términos de política monetaria, tanto en bancos públicos como privados, los cambios fueron más lentos de lo deseado, aunque se dieron los primeros pasos en la dirección acertada. La introducción de un sistema tributario moderno y la construcción del estado de bienestar representaron una clara ruptura con el régimen de Franco y sentaron las bases para la futura convergencia e integración externa de la economía española.Ministerio de Economía y CompetitividadGeneralitat ValencianaMinisterio de Ciencia, Innovación y Universidade

Interactions between microemulsion droplets decorated with hydrophobically modified polymers: A small-angle neutron scattering study

The shape and interactions between model microemulsion droplets (R = 8.2 nm, polydispersity 20%) either decorated with hydrophilic-hydrophobic diblock (PEO-m: C12H25-(EO)n, MPEO = 5.2 kg/mol), or with telechelic triblock copolymers (PEO-2m: C12H25-(EO)2n-C12H25 , MPEO = 10.4 kg/mol) have been studied by small angle neutron scattering (SANS). The results as a function of droplet and copolymer concentration have been compared to the reference case of the bare microemulsion. Using Porod representations, the average bare droplet size was found to be independent of microemulsion concentration in the range studied here, up to some 13%v. Upon addition of copolymer (from r=0 to 30 hydrophobic stickers per droplet), the average droplet radius was unaffected. The interactions between bare and decorated droplets have been analyzed using the structure factor S(q), at first in a model-free way based on its low-q limit S(q→0). This analysis provides clear evidence on the concentration-dependent repulsive or attractive nature of the contributions to the pair droplet-droplet pair potential of the copolymers. Model pair potentials describing the steric repulsions and attractions by copolymer bridging are used to describe the low-q behavior of the structure factor based on an integral equation approach, giving a quantitative estimate of the range and amplitude of the potentials. Moreover, they provide an explanation for the observed transient clustering in terms of a shallow minimum of the total potential