Nonminimal non-Abelian quantum vector fields in curved spacetime

ACKNOWLEDGMENTS I thank C. Garcia-Recio for suggestions on the manuscript and A. O. Barvinsky for critical remarks. This work has been partially supported by MCIN/AEI/10.13039/ 501100011033 under Grant No. PID2020–114767GBI00, by the Junta de Andalucía (Grant No. FQM-225), by the FEDER/Junta de Andalucía-Consejería de Economía y Conocimiento 2014-2020 Operational Program under Grant No. A-FQM-178-UGR18, and by the Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía and European Regional Development Fund (ERDF), Ref. SOMM17/6105/UGR.The quantum effective action of nonminimal vector fields with Abelian or non-Abelian gauge degrees of freedom in curved spacetime is studied. The Proca or Yang-Mills fields are coupled to a local masslike term acting in both coordinate and gauge spaces. Pathologies due to gauge invariance in the ultraviolet are avoided through the introduction of a non-Abelian version of the Stueckelberg field. It is found that the breaking of gauge invariance induced by the mass term affects only the tree-level part of the effective action. The ultraviolet divergent part of the effective action to one loop is obtained using the method of covariant symbols and dimensional regularization. Formulas are given valid for any spacetime dimension and explicit results are shown for the two-dimensional case. As already happened for a single vector field, the ultraviolet divergences are local but not of polynomial type.MCIN/AEI/10.13039/ 501100011033 under Grant No. PID2020–114767GBI00Junta de Andalucía (Grant No. FQM-225)FEDER/Junta de Andalucía-Consejería de Economía y Conocimiento 2014-2020 Operational Program under Grant No. A-FQM-178-UGR18Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía and European Regional Development Fund (ERDF), Ref. SOMM17/6105/UG

Renormalization of vector fields with mass-like coupling in curved spacetime

Using the method of covariant symbols we compute the divergent part of the effective action of the Proca field with non-minimal mass term. Specifically a quantum abelian vector field with a non-derivative coupling to an external tensor field in curved spacetime in four dimensions is considered. Relatively explicit expressions are obtained which are manifestly local but non polynomial in the external fields. Our result is shown to reproduce existing ones in all particular cases considered. Internal consistency with Weyl invariance is also verified.This work has been partially supported by the Spanish MINECO (Grant no. FIS2017-85053-C2-1-P) and by the Junta de Andalucía (Grant no. FQM-225). This study has been partially financed by the Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía and European Regional Development Fund (ERDF), ref. SOMM17/6105/UGR

Baryonic susceptibilities, quark-diquark models, and quark-hadron duality at finite temperature

Fluctuations of conserved charges such as baryon number, electric charge, and strangeness may provide a test for completeness of states in lattice QCD for three light flavors. We elaborate on the idea that the corresponding susceptibilities can be saturated with excited baryonic states with an underlying quark-diquark structure with a linearly confining interaction. Using Polyakov-loop correlators, we show that in the static limit, the quark-diquark potential coincides with the quark-antiquark potential in marked agreement with recent lattice studies. We thus study in a quark-diquark model the baryonic fluctuations of electric charge, baryon number, and strangeness—χBQ, χBB, and χBS—by considering a realization of the hadron resonance gas model in the light flavor sector of QCD. These results are obtained by using the baryon spectrum computed within a relativistic quark-diquark model, leading to an overall good agreement with the spectrum obtained with other quark models and with lattice data for the fluctuations.This work is supported by the Spanish MINECO and European FEDER funds (Grants No. FIS2014-59386-P and No. FIS2017-85053-C2-1-P), Junta de Andalucía (Grant No. FQM-225), and by the Consejería de Conocimiento, Investigación y Universidad of the Junta de Andalucía and European Regional Development Fund (ERDF) Grant No. SOMM17/6105/UGR. The research of E. M. is also supported by the Ramón y Cajal Program of the Spanish MINECO (Grant No. RYC-2016-20678)

Quark–Hadron Duality at Finite Temperature

At low temperatures, we expect that all QCD observables are defined in terms of hadrons. This includes the partition function as well as the Polyakov loop in all representations. We analyze the physics underlying a microscopic derivation of the hadron resonance gas.This work has been supported by Plan Nacional de Altas Energías FPA2011- 25948, DGI FIS2011-24149, Junta de Andalucía grant FQM-225, Generalitat de Catalunya grant 2014-SGR-1450, Spanish MINECO’s Consolider-Ingenio 2010 Programme CPAN (CSD2007-00042) and Centro de Excelencia Severo Ochoa Programme grant SEV-2012-0234. The research of E.M. has been supported by the Juan de la Cierva Program of the Spanish MINECO, and by the European Union under a Marie Curie Intra-European Fellowship (FP7-PEOPLE-2013-IEF

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

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Association between HLA DNA Variants and Long-Term Response to Anti-TNF Drugs in a Spanish Pediatric Inflammatory Bowel Disease Cohort

The genetic polymorphisms rs2395185 and rs2097432 in HLA genes have been associated with the response to anti-TNF treatment in inflammatory bowel disease (IBD). The aim was to analyze the association between these variants and the long-term response to anti-TNF drugs in pediatric IBD. We performed an observational, multicenter, ambispective study in which we selected 340 IBD patients under 18 years of age diagnosed with IBD and treated with anti-TNF drugs from a network of Spanish hospitals. Genotypes and failure of anti-TNF drugs were analyzed using Kaplan-Meier curves and Cox logistic regression. The homozygous G allele of rs2395185 and the C allele of rs2097432 were associated with impaired long-term response to anti-TNF drugs in children with IBD after 3 and 9 years of follow-up. Being a carrier of both polymorphisms increased the risk of anti-TNF failure. The SNP rs2395185 but not rs2097432 was associated with response to infliximab in adults with CD treated with infliximab but not in children after 3 or 9 years of follow-up. Conclusions: SNPs rs2395185 and rs2097432 were associated with a long-term response to anti-TNFs in IBD in Spanish children. Differences between adults and children were observed in patients diagnosed with CD and treated with infliximab