Laboratorio virtual de Neuromarketing para el análisis del Comportamiento del Consumidor

[ES] La presente propuesta de innovación docente tiene como objetivo mejorar la adquisición de las competencias vinculadas a la obtención, análisis e interpretación de datos sobre el Comportamiento del Consumidor, toma de decisiones y trabajo en equipo. Para ello, se integran las TICs en el aula mediante el uso de un laboratorio virtual donde se aplica la técnica de eye-tracking o seguimiento ocular, ampliamente utilizada en Neuromarketing. Los laboratorios virtuales se presentan como una metodología innovadora que permite aumentar la motivación del alumnado, al recibir formación en técnicas de investigación más novedosas que demandan las empresas en el mercado laboral. La propuesta consiste en analizar estímulos de marketing de diversa índole a través del laboratorio virtual, a partir del cual se obtienen datos cualitativos y cuantitativos que pueden exportarse para un análisis más profundo y para la elaboración de futuras estrategias de marketing, con impacto en las organizaciones. En una primera fase, los alumnos realizan el análisis de los estímulos de marketing de forma individual, con el objetivo de que cada uno de ellos aprenda a llevar a cabo un estudio de seguimiento ocular. En una segunda fase, trabajan de forma cooperativa en grupos reducidos para elaborar métricas agregadas de la atención prestada hacia esos estímulos de marketing. Finalmente, manteniendo los grupos, toman decisiones y elaboran estrategias de marketing que permiten mejorar el estímulo inicialmente testado. La aplicación de esta propuesta en el aula ha evidenciado una mejor adquisición de los conceptos teórico-prácticos impartidos en la asignatura, así como un aumento de la motivación y participación por parte del alumnado

DIVULGA: Comunicación multimodal para la divulgación del conocimiento científico y académico en la red

La divulgación del conocimiento científico es una responsabilidad social que la Universidad debe abordar desde la perspectiva de la investigación y la innovación. El proyecto incentiva a usar la comunicación multimodal en la red para divulgar ciencia

DIVULGA.net: internacionalización de la divulgación del conocimiento científico y académico en internet

El proyecto DIVULGA.net tiene la finalidad específica de internacionalizar la difusión de conocimiento científico y académico, en una iniciativa liderada por alumnos UCM y cuyo propósito es incorporar a estudiantes de universidades extranjeras. De este modo se pueden crear sinergias que fortalezcan una red en internet de divulgación de cultura científica con los universitarios como agentes principales

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

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

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Análisis de los pacientes fallecidos dentro de una Unidad de Patología Compleja. Características y manejo al final de la vida

Objective: To describe the medical and epidemiological characteristics of children with complex chronic conditions who died during their follow-up by an specialized medical team. Secondary goal was to compare the characteristics of the studied group with the rest of the patients from this unit, to assess the terminal admission and the hospital use in the last year of life. Material and methods: Retrospective, descriptive, observational study of children with complex chronic conditions followed by an specialized medical team of La Paz Children’s Hospital, from January 2014 to December 2016. Results: Among the 238 patients, 20 died. From dying children, the 3 most prevalent complex chronic conditions (CCC) were neuromuscular (19/20), respiratory (18/20) and technology dependence (17/20). All the patients who died had 3 or more CCC and required at least one kind of medical technology support. Limitation of therapeutic effort was agreed on 14 out of 20 patients. The most common cause of death was respiratory. Children with CCC were more likely to die in the hospital (18/20), specifically in the inpatient ward (13). During the terminal admission, 7/17 needed hemodynamic support, 16/17 respiratory support, 17/17 venous, subcutaneous and intraosseous accesses, 9/17 CPR maneuvers, 5/17 surgical interventions and 7/17 other invasive interventions. Children with CCC stayed at the hospital a median of 15 days, 9 of which were in the pediatric intensive care unit (PICU). In the last year of life, children with complex chronic conditions had a median of 2 hospital admissions and 1 in the PICU, with median length of stay of 40 and 4 days respectively. Conclusions: Children with complex chronic conditions are pluripathological, and have high medical technology dependency. Most of them died at the hospital, after long stays, under an elevated number of invasive procedures. This approach must be reconsidered, especially for patients with therapeutic effort limitation, because if the objective is not curative, the measures should be adjusted to the real objective and be proportionate.Objetivo: Describir las características clínico-epidemiológicas de los niños fallecidos durante su seguimiento por una Unidad de Patología Compleja. Los objetivos secundarios fueron comparar estas características con las de los pacientes no fallecidos, describir el ingreso del fallecimiento y el último año de vida. Material y método: Estudio observacional descriptivo retrospectivo de pacientes atendidos por la Unidad de Patología Compleja del Hospital Universitario Infantil La Paz, desde Enero de 2014 a Diciembre de 2016. Resultados: De los 238 pacientes atendidos, 20 fallecieron durante su seguimiento. En los fallecidos, las condiciones crónicas complejas (CCC) más frecuentes fueron la neuromuscular (19/20), la respiratoria (18/20) y la de soporte (17/20). Todos los fallecidos tenían 3 o más CCC y contaban con algún tipo de soporte tecnificado domiciliario. En 14 de los 20 pacientes se había consensuado la “adecuación del esfuerzo terapéutico”. La causa más frecuente de exitus fue la respiratoria. La mayoría de los pacientes fallecieron en el hospital (18/20), fundamentalmente en la planta de hospitalización (13). Durante el ingreso terminal, 7/17 precisaron soporte hemodinámico, 16/17 soporte ventilatorio, 17/17 canalización de vías, 9/17 maniobras de RCP, 5/17 intervenciones quirúrgicas y 7/17 otros procedimientos invasivos. La mediana de días de estancia hospitalaria en el ingreso terminal fue de 15 días y de 9 días en cuidados intensivos. En el último año de vida, los niños con patología crónica compleja (NPCC) tuvieron una mediana de 2 ingresos en el hospital y 1 en cuidados intensivos, con medianas de estancia de 40 y 4 días respectivamente. Conclusiones: Los NPCC son pacientes pluripatológicos, con elevada dependencia de tecnología. En nuestra serie el fallecimiento se produjo mayoritariamente en los hospitales, con estancias prolongadas y sometidos a un elevado número de procedimientos invasivos. Este enfoque debiera ser reconsiderado, especialmente en los pacientes en situación de “adecuación del esfuerzo terapéutico”, ya que si el objetivo es no curativo, las medidas deben ajustarse a este objetivo y ser proporcionadas

Biallelic MADD variants cause a phenotypic spectrum ranging from developmental delay to a multisystem disorder

In pleiotropic diseases, multiple organ systems are affected causing a variety of clinical manifestations. Here, we report a pleiotropic disorder with a unique constellation of neurological, endocrine, exocrine, and haematological findings that is caused by biallelic MADD variants. MADD, the mitogen-activated protein kinase (MAPK) activating death domain protein, regulates various cellular functions, such as vesicle trafficking, activity of the Rab3 and Rab27 small GTPases, tumour necrosis factor-α (TNF-α)-induced signalling and prevention of cell death. Through national collaboration and GeneMatcher, we collected 23 patients with 21 different pathogenic MADD variants identified by next-generation sequencing. We clinically evaluated the series of patients and categorized the phenotypes in two groups. Group 1 consists of 14 patients with severe developmental delay, endo- and exocrine dysfunction, impairment of the sensory and autonomic nervous system, and haematological anomalies. The clinical course during the first years of life can be potentially fatal. The nine patients in Group 2 have a predominant neurological phenotype comprising mild-to-severe developmental delay, hypotonia, speech impairment, and seizures. Analysis of mRNA revealed multiple aberrant MADD transcripts in two patient-derived fibroblast cell lines. Relative quantification of MADD mRNA and protein in fibroblasts of five affected individuals showed a drastic reduction or loss of MADD. We conducted functional tests to determine the impact of the variants on different pathways. Treatment of patient-derived fibroblasts with TNF-α resulted in reduced phosphorylation of the extracellular signal-regulated kinases 1 and 2, enhanced activation of the pro-apoptotic enzymes caspase-3 and -7 and increased apoptosis compared to control cells. We analysed internalization of epidermal growth factor in patient cells and identified a defect in endocytosis of epidermal growth factor. We conclude that MADD deficiency underlies multiple cellular defects that can be attributed to alterations of TNF-α-dependent signalling pathways and defects in vesicular trafficking. Our data highlight the multifaceted role of MADD as a signalling molecule in different organs and reveal its physiological role in regulating the function of the sensory and autonomic nervous system and endo- and exocrine glands