Keeping up appearances. Ways of representing the local powers in the rural world of Cordoba in Modern Times

With this essay we try to go in depth into the knowledge of the lifestyle of the ruling classes in the rural communities from Cordoba in the Modern period. For this we analyze the ways of distinction of these groups in the various scenes where most of their daily life passed. We will realize how privileged classes lived surrounded by all kinds of luxuries and comforts, which allowed them to have a great social recognition. This lifestyle entailed a considerable economic expense that not all the families could face up; despite this, many of these families went on doing it, so far as to get themselves heavily into debt just to be recognized as one of the group members.Con en este trabajo pretendemos profundizar en el conocimiento del estilo de vida de las clases dirigentes de las comunidades rurales cordobesas en la época Moderna. Para ello abordamos el análisis de las formas de distinción de estos grupos en los distintos escenarios en los que discurrió la mayor parte de la vida cotidiana de los mismos . Comprobaremos cómo las clases privilegiadas vivían rodeadas de todo tipo de lujos y comodidades, lo que les permitió gozar de un gran reconocimiento social. Este estilo de vida conllevaba la realización de un importante gasto económico que no todas las familias podían afrontar, a pesar de lo cual muchas de ellas continuaron haciéndolo, llegando incluso a endeudarse fuertemente con tal de ser reconocidos como integrantes del grupo

Guardar las apariencias. Formas de representación de los poderes locales en el medio rural cordobés en la época moderna

With this essay we try to go in depth into the knowledge of the lifestyle of the ruling classes in the rural communities from Cordoba in the Modern period. For this we analyze the ways of distinction of these groups in the various scenes where most of their daily life passed. We will realize how privileged classes lived surrounded by all kinds of luxuries and comforts, which allowed them to have a great social recognition. This lifestyle entailed a considerable economic expense that not all the families could face up; despite this, many of these families went on doing it, so far as to get themselves heavily into debt just to be recognized as one of the group members.Con en este trabajo pretendemos profundizar en el conocimiento del estilo de vida de las clases dirigentes de las comunidades rurales cordobesas en la época Moderna. Para ello abordamos el análisis de las formas de distinción de estos grupos en los distintos escenarios en los que discurrió la mayor parte de la vida cotidiana de los mismos . Comprobaremos cómo las clases privilegiadas vivían rodeadas de todo tipo de lujos y comodidades, lo que les permitió gozar de un gran reconocimiento social. Este estilo de vida conllevaba la realización de un importante gasto económico que no todas las familias podían afrontar, a pesar de lo cual muchas de ellas continuaron haciéndolo, llegando incluso a endeudarse fuertemente con tal de ser reconocidos como integrantes del grupo

Analysis of the Damage Evolution in Steel Specimens under Tension by Means of XRCT

When a steel specimen is tested under tension, damage usually develops evenly all along the specimen, finally necking and leading to the typical cup-cone fracture surface. Nevertheless, some steels present an unusual fracture pattern consisting on a plane fracture surface with a dark region in the centre of the fracture zone. In this contribution, the authors analyse the evolution of the internal damage by using X-ray computed tomography (XRCT) on 3mm-diametre specimens of two steels. The specimens are tested in subsequent loading steps, after each of which it is unloaded and analysed with XRCT. This procedure helps to identify the evolution of damage developed inside each specimen at predefined strain levels. XRCT reveals a very high initial porosity in the material with the cup-cone fracture pattern and a very low initial porosity in the other. In the latter, fracture is triggered by a concentrated internal damage that can be seen as an internal notch which produces a stress concentration that leads to the eventual failure

Protocolo transdiagnóstico PsicAP de entrenamiento cognitivo-conductual en grupo para trastornos emocionales

Anxiety disorders and depression are highly prevalent today. The PsicAP clinical trial showed that adding 7 sessions of group cognitive-behavioural training with a transdiagnostic approach to the usual treatment of emotional disorders in adult primary care patients increased efficacy and cost-effectiveness in reducing symptom levels, reduced disability and improved quality of life. In this work, these 7 sessions of the PsicAP protocol of transdiagnostic treatment are described, aimed at intervening on the factors common to the different disorders: cognitive distortions and emotional regulation strategies. It is an intervention based on learning through psychoeducation, cognitive restructuring, relaxation, behavioural techniques and relapse prevention. It concludes by arguing about the usefulness of this protocol to reduce the gap between research and clinical practice, something necessary in today's societyLos trastornos de ansiedad y la depresión son altamente prevalentes en la sociedad actual. El ensayo clínico PsicAP demostró que añadir 7 sesiones de entrenamiento cognitivo-conductual en grupo con enfoque transdiagnóstico al tratamiento habitual de trastornos emocionales en pacientes adultos de atención primaria aumentó la eficacia y coste-efectividad para reducir los niveles de síntomas, redujo la discapacidad y mejoró la calidad de vida. En este trabajo se describen esas 7 sesiones del protocolo PsicAP de tratamiento transdiagnóstico, dirigido a la intervención sobre los factores comunes a los distintos trastornos: las distorsiones cognitivas y las estrategias de regulación emocional. Se trata de una intervención basada en el aprendizaje mediante psicoeducación, reestructuración cognitiva, relajación, técnicas conductuales y prevención de recaídas. Se concluye argumentando sobre la utilidad de este protocolo para reducir la brecha entre investigación y práctica clínica, algo necesario en la sociedad actua

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

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

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

Analysis of the Damage Evolution in Steel Specimens under Tension by Means of XRCT

When a steel specimen is tested under tension, damage usually develops evenly all along the specimen, finally necking and leading to the typical cup-cone fracture surface. Nevertheless, some steels present an unusual fracture pattern consisting on a plane fracture surface with a dark region in the centre of the fracture zone. In this contribution, the authors analyse the evolution of the internal damage by using X-ray computed tomography (XRCT) on 3mm-diametre specimens of two steels. The specimens are tested in subsequent loading steps, after each of which it is unloaded and analysed with XRCT. This procedure helps to identify the evolution of damage developed inside each specimen at predefined strain levels. XRCT reveals a very high initial porosity in the material with the cup-cone fracture pattern and a very low initial porosity in the other. In the latter, fracture is triggered by a concentrated internal damage that can be seen as an internal notch which produces a stress concentration that leads to the eventual failure