A 76nW, 4kS/s 10-bit SAR ADC with offset cancellation for biomedical applications

This paper presents a 10-bit fully-differential rail-to-rail successive approximation (SAR) ADC designed for biomedical applications. The ADC, fabricated in a 180nm HV CMOS technology, features low switching energy consumption and employs a time-domain comparator which includes an offset cancellation mechanism. The power dissipated by the ADC is 76.2nW at 4kS/s and achieves 9.5 ENOB.Ministerio de Economía y Competitividad TEC2012-33634Office of Naval Research (USA) N0001414135

International migratory agreements: the paradox of adverse interest

This article seeks to explain the contradiction between the promises of welfare gains derived from the economic models recommending the removal of immigration restrictions and the realities experienced by countries attempting to apply restrictions to immigration flows. A formal model is built in which the strategic reaction of countries considers not only the benefits derived from migration but also the (economic and non-economic) costs that migration can generate in the host country. Strategic reactions drive what may be called the “paradox of adverse interest”: the fewer potential gains associated with liberalization of migration, the easier it becomes for nations to reach an unrestrictive agreement. The existence of two asymmetries (between the bargaining power of receiving and sending countries, and between the private nature of most of migration’s benefits and the social nature of its main costs) can hinder the agreement when the countries involved exhibit a high wage differential. Results suggest that permissive international agreements on migration are easier to reach in regional contexts, among countries with proximate economic conditions and levels of income

La implementación de planes de igualdad en las universidades españolas: análisis cualitativo comparado (QCA)

This paper studies the role of Spanish universities in the equality between women and men. The unit of analysis has been the equality plans developed by each of them, as well as the set of measures adopted by these institutions to apply and evaluate them. The analysis of the information has been done with the technique of qualitative compara­tive analysis (QCA). The result of analyzing 83 universities show that factors such as the quickness in creating equal­ity commissions, the creation of equality units or having the first equality plan are related to the quality in the application of the Organic Law of Equality and that public universities assume more than the private the application of the equal­ity plan. which are of obligatory application in accordance with the law. Based on the results obtained, it highlight the need to increase the sensitivity of the government teams towards the equality of women and men.Este trabajo analiza la implicación de las universidades es­pañolas en la igualdad entre mujeres y hombres. La unidad de análisis han sido los planes de igualdad desarrollados por cada una de ellas, así como el conjunto de medidas adop­tadas por estas instituciones para aplicarlos y evaluarlos. El análisis de la información se ha realizado con la técni­ca de análisis cualitativo comparado (QCA). El análisis de 83 universidades indica que factores como la celeridad en crear comisiones de igualdad, la creación de unidades de igualdad o la tenencia del primer plan de igualdad están relacionados con la calidad en la aplicación de la Ley Orgánica de Igualdad. Además, muestra que las universidades públi­cas ponen en marcha más que las privadas los planes de igualdad. A partir de los resultados obtenidos, se destaca la necesidad de incrementar la sensibilidad de los equipos de gobierno hacia la igualdad de mujeres y hombres

Improvement of functional neurological disorder after administration of esketamine nasal spray: a case report

Esketamina; Trastorn neurològic funcional; Paràlisi mixtaEsketamina; Trastorno neurológico funcional; Parálisis mixtaEsketamine; Functional neurological disorder; Mixed paralysisFunctional neurological disorder (FND) is a complex neuropsychiatric condition characterized by the presence of neurological symptoms and signs (either motor or sensory) that cannot be explained by any known medical or mental disease. It is frequently presented with psychiatric comorbidities, such as major depression. Its prognosis is poor, with low improvement or recovery rates at 1 year after their onset, and no particular treatment has demonstrated significant efficacy in this regard. Here, we describe the management of a patient affected by treatment-resistant depression (TRD) and FND characterized by mixed paralysis (sensory and motor) in the left arm, and who was successfully treated with esketamine nasal spray, achieving remission in both disorders. The US Food and Drug Administration and the European Medicines Agency recently approved esketamine, the S-enantiomer of ketamine, for treatment of TRD. It is a fast-acting drug that provides a rapid-onset improvement of depressive symptoms. We have presented the first case, to our knowledge, of functional neurological symptoms being successfully treated with esketamine in a patient with comorbid TRD. While the novelty of this data implies a clear need for further research, it is suggested that esketamine might be a useful tool for the treatment of FND, acting through different theorized mechanisms that are in tune with recent advances in knowledge of the etiopathology of FND.The authors received no financial support for the research, authorship, and/or publication of this article

Identification and functional analysis of missense mutations in the lecithin cholesterol acyltransferase gene in a Chilean patient with hypoalphalipoproteinemia

Lecithin-cholesterol acyltransferase (LCAT) is a plasma enzyme that esterifies cholesterol in high- and low-density lipoproteins (HDL and LDL). Mutations in LCAT gene causes familial LCAT deficiency, which is characterized by very low plasma HDL-cholesterol levels (Hypoalphalipoproteinemia), corneal opacity and anemia, among other lipid-related traits. Our aim is to evaluate clinical/biochemical features of a Chilean family with a proband showing clinical signs of familial LCAT deficiency, as well as to identify and assess the functional effects of LCAT mutations. LCAT sequencing identified rare p.V333 M and p.M404 V missense mutations in compound heterozygous state in the proband, as well the common synonymous p.L363 L variant. LCAT protein was detected in proband’s plasma, but with undetectable enzyme activity compared to control relatives. HEK-293 T transfected cells with vector expression plasmids containing either p.M404 V or p.V333 M cDNA showed detectable LCAT protein expression both in supernatants and lysates from cultured cells, but with much lower enzyme activity compared to cells transfected with the wild-type sequence. Bioinformatic analyses also supported a causal role of such rare variations in LCAT lack of function. Additionally, the proband carried the minor allele of the synonymous p.L363 L variant. However, this variant is unlikely to affect the clinical phenotype of the proband given its relatively high frequency in the Chilean population (4%) and its small putative effect on plasma HDL-cholesterol levels. Conclusion: Genetic, biochemical, in vitro and in silico analyses indicate that the rare mutations p.M404 V and p. V333 M in LCAT gene lead to suppression of LCAT enzyme activity and cause clinical features of familial LCAT deficiency.This work was supported by Proyecto FONDECYT 1150416 and Proyecto Interdisciplina VRI-PUC II15024 from the Dirección de Investigación, Pontificia Universidad Católica de Chile. Genotyping of GOCS was performed in the in the Human Genotyping laboratory at the Spanish National Cancer Research Centre, a member of CeGen (PRB2-ISCIII), and was supported by grant PT13/ 0001/0005 of PE I + D + i 2013-2016 funded by ISCIII and ERDF (Fondo Europeo de Desarrollo Regional). This research was partially supported by the supercomputing infrastructure of the NLHPC (ECM-02). L.V. and C.B. were supported by VRI, Pontificia Universidad Católica de Chile (Proyecto Investigación Interdisciplinaria VRI-PUC II15024). TG was supported by “Beca de Magíster Nacional” CONICYT. L.V. was additionally supported by FONDECYT postdoctoral grant 3170038. We express our gratitude to the proband and relatives

Plan de Acción Tutorial Integrado, en Educación

En el proyecto que se presenta se parte no solamente de una amplia trayectoria de los Grados de la Facultad de Ciencias de la Educación de la UGR en orientación universitaria, sino, además, de una necesidad patente plasmada en los Objetivos Estratégicos que se incluyen dentro del Sistema para la Garantía de la Calidad de la Facultad; siendo el segundo objetivo “Orientación y tutoría académica”, y una de sus acciones (Plan Director 19-21): Crear curriculum complementario para los estudiantes (desarrollo de competencias transversales a través de un PAT). Otras acciones relacionadas y en las que continuamos trabajando en el Plan Director 22 24 son Establecer acciones de tutorización coordinadas y complementarias al PAT, formar a los tutores de grupo-curso, establecer un plan general de orientación profesional y empleabilidad, potenciar la orientación académica y profesional de los estudiantes NEAE, entre otras. Con el diseño del Plan de Acción Tutorial Integrado, en Educación, se pretende desarrollar en el estudiantado de los Grados en Pedagogía, Ed. Social, Ed. Infantil y Ed. Primaria, competencias transversales que complementen su formación académica y le ayuden en su desarrollo académico, personal y profesional. En él participará profesorado, alumnado y PAS de la Facultad, no solamente para fomentar su sentimiento de pertenencia y favorecer un clima de comunidad universitaria, sino además, para enriquecerse unos a otros, aprendiendo juntos, solventando dudas, guiando, orientando y haciendo que el paso por la Universidad de todo el alumnado que participe del mismo, sea lo más enriquecedor y productivo posible, logrando un elevado rendimiento académico, un adecuado desarrollo personal y un posterior futuro profesional colmado de éxitos. Para ello se ha llevado a cabo un análisis de necesidades mediante el Cuestionario para detección de necesidades formativas transversales del alumnado en la Facultad de Ciencias de la Educación (Escala de competencias transversales del cuestionario CECTGRA de Martínez y González, 2018), a partir del cual se diseñan diferentes talleres orientados a cada curso según sus intereses, motivaciones y necesidades, haciendo una posterior evaluación de los resultados y un análisis de los mismos. Se ha logrado además del diseño del PAT, dotar de unidad a todas las actividades que desde la Facultad se realizaban en torno a la orientación del estudiantado. Se ha realizado un esfuerzo porque los resultados obtenidos se vean reflejados en las diferentes materias, no solamente a nivel transversal sino de forma directa. Por ejemplo, al trabajarse la normativa APA se ha introducido este punto en las rúbricas de evaluación de diferentes asignaturas para, de este modo, relacionar su aprendizaje con la evaluación y rendimiento académico. Al centrarse el primer curso fundamentalmente en el análisis de necesidades, la asistencia ha sido mucho mayor en el segundo curso (21-22), haciendo especial hincapié en la difusión de las actividades, siguiendo el Plan de Comunicación del Centro, a través de la web de la Facultad y de la figura de los tutores de grupo curso. Un objetivo a largo plazo, es incluir las competencias aprendidas en los talleres dirigidos al estudiantado de 4º en la calificación del Trabajo Fin de Grado. Este punto no ha dado tiempo a consolidarlo en dos cursos académicos, pero seguiremos trabajando en ello ya que consideramos que es fundamental además de poder dar de esta forma respuesta a una de las alegaciones realizadas por la DEVA en el informe de la renovación de la acreditación de los Grados.This project is based not only on a wide trajectory of the Degrees of the Faculty of Education Sciences of the UGR in university orientation, but, in addition, from a patent need embodied in the Strategic Objectives that are included within the System for the Guarantee of the Quality of the Faculty; the second objective being "Academic guidance and tutoring", and one of its actions (Master Plan 19-21): Create complementary curriculum for students (development of transversal competences through a PAT). Other related actions and in which we continue to work in the Master Plan 22 24 are To establish coordinated and complementary tutoring actions to the PAT, to train the group-course tutors, to establish a general plan of professional orientation and employability, to enhance the academic and professional orientation of the NEAE students, among others. With the design of the Integrated Tutorial Action Plan, in Education, it is intended to develop in the students of the Degrees in Pedagogy, Social Ed., Infant Ed. and Primary Ed., transversal competences that complement their academic training and help them in their academic, personal and professional development. It will involve teachers, students and PAS of the Faculty, not only to promote the feeling of belonging of the same and favor a climate of university community, but, in addition, to enrich each other, learning together, solving doubts, guiding, guiding and making the passage through the University of all the students who participate in it, as enriching and productive as possible, achieving a high academic performance, a competent personal development and a subsequent professional future full of successes. To this end, a needs analysis has been carried out (through the Questionnaire for the detection of transversal training needs of students in the Faculty of Education Sciences (Scale of transversal competences of the CECTGRA questionnaire of Martínez y González, 2018), reflected in different workshops oriented to each course according to their interests, motivations and needs, making a subsequent evaluation of the results and analysis of them. It has been achieved in addition to the design of the PAT, to provide unity to all the activities that from the Faculty were carried out around the orientation of the students. We have worked so that the results obtained are reflected in the different subjects, not only at a transversal level but directly. For example, when working on the APA regulations, it has been introduced in the evaluation rubrics of different subjects in order to relate their learning with evaluation and academic performance. By focusing the first course mainly on the analysis of needs, the attendance has been much higher in the second year (21 22), with special emphasis on the dissemination of the activities, following the Communication Plan of the Center, through the website of the Faculty and the figure of the tutors of the course group. A long-term objective is to include the skills learned in the workshops of the 4th grade students in the TFG qualification. This point has not given time to consolidate it in two academic years but we will continue working on it since we consider that it is fundamental in addition to being able to respond in this way to one of the allegations made by the DEVA in the report of the renewal of the accreditation of the Degrees.Unidad de Calidad, Innovación Docente y Prospectiva. Universidad de Granada

Similarities and differences in the lifestyles of populations using mode 3 technology in North Africa and the south of the Iberian Peninsula

In the geohistorical region of the Strait of Gibraltar, which includes the south of the Iberian Peninsula and North Africa, important research has been carried out in recent years. This research has allowed us to document the presence of human groups as early as the Middle Pleistocene. Classical anthropology refers to these groups using various terms Homo Neanderthalensis in the south of Europe and Homo sapiens sapiens in North Africa). The current records exhibit important similarities concerning lithic technology (the so-called ‘Mode 3’, ‘Mousterian’ or ‘Middle Stone Age’), and the exploitation of marine resources. From an anthropological or cultural perspective, both groups were hunter-gatherers with similar lifestyles. Bearing these similarities in mind, three hypotheses are here presented

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

Trends in incidence and outcomes of revision total hip arthroplasty in Spain: A population based study

<p>Abstract</p> <p>Background</p> <p>To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain.</p> <p>Methods</p> <p>We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends.</p> <p>Results</p> <p>32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01).</p> <p>The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period</p> <p>The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008.</p> <p>After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively).</p> <p>Conclusions</p> <p>The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.</p