Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effects on Intestinal Mucosal Morphology, Productive Parameters and Microbiota Composition after Supplementation with Fermented Defatted Alperujo (FDA) in Laying Hens

The olive oil sector is currently adapting its traditional function to also become a supplier of high-value by-products that possess antioxidant, anti-inflammatory and antimicrobial properties. In this study, we evaluated the effect of the fermented defatted alperujo (FDA) on the intestinal health of laying hens. The morphology of the duodenal and cecal mucosa, the composition of the intestinal microbiota and the productivity of a batch of laying hens were evaluated after FDA supplementation. At early life stages, significant differences (p < 0.001) were observed in duodenal villi height and in crypt depth of both the duodenum and the cecum in the FDA-supplemented group, indicating improved intestinal health in this group. Microbiota composition in the hatchery group supplemented with FDA had a higher abundance of Actinobacteria, Firmicutes and Proteobacteria, and higher bacterial diversity. During the production period, significant differences (p < 0.05) were observed in the number of broken eggs from the supplemented group. We conclude that FDA supplementation improves the absorption capacity of the intestinal mucosa and modifies the intestinal microbiota to favor a greater immune response, leading to an increase in egg production

La biblioteca escolar del IES El Brocense : centro de recursos, innovación y aprendizaje

El trabajo obtuvo un premio de la Modalidad B de los Premios Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2011Se describe cómo se puso en marcha la nueva biblioteca del centro y el Proyecto de Biblioteca Escolar por el que se rige su funcionamiento, que incluía un Plan de Lectura y otro de Formación Documental y que tiene por objetivo rentabilizar las posibilidades de uso pedagógico de una biblioteca escolar integrada con el currículoExtremaduraES

Meteolab as an educational tool for Meteorology in the Classroom

El Presente proyecto es una continuación de proyectos anteriores dentro de la plataforma de divulgación Meteolab. Meteolab es un proyecto de divulgación de Meteorología y Clima que tiene su origen en 2002, cuando se comenzaron a diseñar experimentos de bajo coste con materiales caseros para la Semana de la Ciencia de la Comunidad de Madrid (CAM). Con los años, se generó un conocimiento que se materializó en 2010 con la concesión de un Proyecto de Innovación Educativa (PIE) financiado por la Universidad Complutense de Madrid (UCM), dirigido por Belén Rodríguez de Fonseca. Gracias a este primer proyecto en el que trabajaron muchos profesores y alumnos de ciencias de la atmósfera, se gestó un portal web (meteolab.fis.ucm.es) en el que los experimentos se explicaban y se grababan para impulsar su difusión. Más adelante, en un segundo proyecto de Innovación Educativa, dirigido por la profesora Maria Luisa Montoya, los contenidos fueron traducidos al inglés. En concreto, los experimentos que componen Meteolab tienen como principal objetivo entender los principios y variables que determinan el comportamiento de las masas de aire en la atmósfera y de agua en el océano. La idea consiste en visualizar con experimentos sencillos las leyes físicas que gobiernan la atmósfera y el océano: movimientos horizontales y verticales, cambios de estado, mezcla y equilibrio, así como la interacción entre componentes. Se persigue observar los procesos meteorológicos familiares, como son la formación de una nube, los tornados, la convección, la formación de borrascas o la lluvia, entendiendo los procesos físicos que los producen. Finalmente, Meteolab permite también visualizar fenómenos climáticos como el efecto invernadero, el fenómeno de El Niño, el deshielo del Ártico, la influencia de los volcanes en el clima o la subida del nivel del mar. Existe un catálogo de experimentos, la mayoría de los cuales pueden consultarse a través del portal meteolab.fis.ucm.es, encontrándose todos ellos físicamente localizados en el Laboratorio Elvira Zurita de la Facultad de Ciencias Físicas. Tras la experiencia acumulada durante los 18 años de existencia de Meteolab, en los que se han adecuado las explicaciones de los experimentos a distintos niveles de dificultad (infantil, primaria, secundaria, bachillerato y Universidad de mayores), se ha sugerido la idoneidad de adaptar los contenidos a los estudiantes del Grado en Física y del Máster en Meteorología y Geofísica de la UCM. Así, por ejemplo, cuando se explica la formación de una nube, se puede ir complicando el discurso dependiendo de los diferentes ciclos de la enseñanza. De esta manera, para un nivel de escuela primaria uno sólo tiene que explicar que el aire se enfría al ascender, y al enfriarse se forman gotas de agua que forman las nubes. Al llegar a secundaria, los estudiantes aprenden el concepto de presión atmosférica y la relación entre la temperatura, la presión y el volumen de una parcela de aire. Más adelante, en el Grado en Física, se estudia la tensión de vapor, la expansión adiabática y la existencia de núcleos de condensación. Finalmente, en el Máster en Meteorología se aprenden los distintos procesos de nucleación y tipos de nubes. Todos estos conceptos van complicando la explicación, por lo que un mismo experimento puede explicarse tanto en una escuela infantil como en una Universidad. Es por ello, que, aprovechando la plataforma de divulgación Meteolab, hemos decidido dar un paso adelante y adaptar y ampliar los contenidos de Meteolab, para así poder integrarlos en los currícula del Grado en Física y del Máster en Meteorología y Geofísica de la UCM. Con todo ello, los objetivos del presente proyecto han sido: -Implementar los experimentos de Meteolab en el Aula, tanto en las asignaturas de Grado como en las de Máster. -Adaptar los contenidos existentes del portal web Meteolab (meteolab.fis.ucm.es) a las asignaturas relacionadas con Meteorología del Grado en Física y del Máster en Meteorología y Geofísica, con el fin de visualizar procesos físicos que se explican en el aula. -Añadir a Meteolab nuevos contenidos en relación con la dinámica de la atmósfera y el cambio climático. -Evaluar la mejora de la comprensión por parte del alumnado de los procesos que tienen lugar principalmente en la atmósfera y el océano, y su relación con el clima y su variabilidad.This project is a continuation of previous projects within the Meteolab outreach platform. Meteolab is a Meteorology and Climate outreach project that has its origins in 2002, when low-cost experiments with homemade materials were designed for the Science Week of the Community of Madrid (CAM). Over the years, knowledge was generated and materialized in 2010 with the award of an Educational Innovation Project (PIE) funded by the Complutense University of Madrid (UCM), directed by Belén Rodríguez de Fonseca. Thanks to this first project, in which many teachers and students of atmospheric sciences worked, a web portal was created (meteolab.fis.ucm.es) in which the experiments were explained and recorded to promote their dissemination. Later, in a second Educational Innovation project, directed by Professor Maria Luisa Montoya, the contents were translated into English. Specifically, the main objective of the experiments that make up Meteolab is to understand the principles and variables that determine the behavior of air masses in the atmosphere and water masses in the ocean. The idea is to visualize with simple experiments the physical laws that govern the atmosphere and the ocean: horizontal and vertical movements, state changes, mixing and equilibrium, as well as the interaction between components. The aim is to observe meteorological processes, such as cloud formation, tornadoes, convection, squall formation or rain, understanding the physical processes that produce them. Finally, Meteolab also allows to visualize climatic phenomena such as the greenhouse effect, the El Niño phenomenon, the melting of the Arctic ice, the influence of volcanoes on the climate or the rise in sea level. There is a catalog of experiments, most of which can be consulted through the portal meteolab.fis.ucm.es, all of which are physically located in the Elvira Zurita Laboratory of the Faculty of Physical Sciences. After the experience accumulated during the 18 years of existence of Meteolab, in which the explanations of the experiments have been adapted to different levels of difficulty ( primary, secondary, high school and senior university), it has been suggested the suitability of adapting the contents to the students of the Degree in Physics and the Master in Meteorology and Geophysics of the UCM. Thus, for example, when explaining the formation of a cloud, the discourse can be complicated depending on the different teaching cycles. Thus, for an elementary school level, one only has to explain that the air cools as it rises, and as it cools, water droplets form and form clouds. By high school, students learn the concept of atmospheric pressure and the relationship between temperature, pressure and volume of a parcel of air. Later, in the Bachelor's Degree in Physics, vapor tension, adiabatic expansion and the existence of condensation nuclei are studied. Finally, in the Master's Degree in Meteorology, the different processes of nucleation and types of clouds are learned. All these concepts complicate the explanation, so that the same experiment can be explained both in a kindergarten and in a university. That is why, taking advantage of the Meteolab dissemination platform, we have decided to take a step forward and adapt and expand the contents of Meteolab, in order to integrate them into the curricula of the Degree in Physics and the Master in Meteorology and Geophysics of the UCM. With all this, the objectives of the present project have been: -Implement Meteolab experiments in the classroom, both in undergraduate and master's degree courses. -To adapt the existing contents of the Meteolab web portal (meteolab.fis.ucm.es) to the subjects related to Meteorology of the Degree in Physics and the Master in Meteorology and Geophysics, in order to visualize physical processes that are explained in the classroom. -Add to Meteolab new contents related to atmospheric dynamics and climate change. -To evaluate the improvement of the students' understanding of the processes that take place mainly in the atmosphere and the ocean, and their relationship with climate and its variability.Depto. de Física de la Tierra y AstrofísicaFac. de Ciencias FísicasFALSEsubmitte