Estrategias óptimas de exploración de grafos parcialmente desconocidos

Durante los últimos años, muchas de las tareas en el campo de la robótica móvil se han comenzado a resolver mediante una formulación basada en grafos, en las que los nodos codifican las poses del robot y los arcos las restricciones entre estas. Una de las aplicaciones de esta formulación, consiste en resolver el problema de exploración autónoma de entornos reales a través de la exploración de grafos, entendiendo esta última como el proceso por el cual se recorren los arcos del mismo hasta visitar sus vértices atendiendo a un determinado criterio. Esta herramienta, se puede utilizar para resolver el paradigma de SLAM (Simultaneous Localisation and Mapping) Activo, el cual hace referencia a la capacidad por parte del robot de elegir la secuencia de movimientos que le permita minimizar la incertidumbre de su localización y del entorno que está reconstruyendo mientras ejecuta SLAM.En este Trabajo Fin de Grado se han estudiado, implementado y evaluadodistintos algoritmos de planificación de rutas en grafos, con el objetivo de compararlas ventajas y limitaciones de cada uno de ellos, y de encontrar el camino que ofrezca la mínima incertidumbre para así poder resolver el problema de SLAM Activo. Para ello, se han analizado varios grafos basados en poses construidos a partir de entornos reales. Además, se ha estudiado el uso de varias métricas de la matriz de covarianza,con el objetivo de analizar cuál es la que permite encontrar el conjunto de acciones que proporcione una incertidumbre óptima durante las tareas de exploración.Se ha conseguido implementar un algoritmo que representa el estado del arte que es capaz de encontrar el camino de mínima incertidumbre entre dos puntos. Además, se ha demostrado que la única manera de garantizar estas trayectorias es incluyendo una métrica de la misma en el algoritmo de búsqueda. En concreto, la que se basa en el determinante de la matriz de covarianza o de incertidumbre (criterio de optimalidad D). Finalmente, se ha comprobado que cuando se trabaja con una representación reducida del grafo se obtiene una clara mejora en los tiempos de cómputo al realizar varias búsquedas.<br /

Living in Drylands: Functional Adaptations of Trees and Shrubs to Cope with High Temperatures and Water Scarcity

Plant functioning and survival in drylands are affected by the combination of high solar radiation, high temperatures, low relative humidity, and the scarcity of available water. Many ecophysiological studies have dealt with the adaptation of plants to cope with these stresses in hot deserts, which are the territories that have better evoked the idea of a dryland. Nevertheless, drylands can also be found in some other areas of the Earth that are under the Mediterranean-type climates, which imposes a strong aridity during summer. In this review, plant species from hot deserts and Mediterranean-type climates serve as examples for describing and analyzing the different responses of trees and shrubs to aridity in drylands, with special emphasis on the structural and functional adaptations of plants to avoid the negative effects of high temperatures under drought conditions. First, we analyze the adaptations of plants to reduce the input of energy by diminishing the absorbed solar radiation through (i) modifications of leaf angle and (ii) changes in leaf optical properties. Afterwards, we analyze several strategies that enhance the ability for heat dissipation through (i) leaf size reduction and changes in leaf shape (e.g., through lobed leaves), and (ii) increased transpiration rates (i.e., water-spender strategy), with negative consequences in terms of photosynthetic capacity and water consumption, respectively. Finally, we also discuss the alternative strategy showed by water-saver plants, a common drought resistance strategy in hot and dry environments that reduces water consumption at the expense of diminishing the ability for leaf cooling. In conclusion, trees and shrubs living in drylands have developed effective functional adaptations to cope with the combination of high temperature and water scarcity, all of them with clear benefits for plant functioning and survival, but also with different costs concerning water use, carbon gain, and/or leaf cooling.This research was funded by Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA) grant number RTA2015-00054-C02-01, by Ministerio de Ciencia e Innovación grant number PID2019-106701RR-I00/AEI/10.13039/501100011033 and INERTIA project (PID-2019-111332-C22), project IMAGINA (Prometeu program/2019/110, GVA) and from Gobierno de Aragón H09_20R research group. Work of D.A.F. is supported by a FPI-INIA contract BES-2017-081208. CEAM is funded by Generalitat Valenciana

Axicabtagene ciloleucel compared to tisagenlecleucel for the treatment of aggressive B-cell lymphoma

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-targeted chimeric antigen receptor (CAR) T cells approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). We performed a retrospective study to evaluate safety and efficacy of axi-cel and tisa-cel outside the setting of a clinical trial. Data from consecutive patients with R/R LBCL who underwent apheresis for axi-cel or tisa-cel were retrospectively collected from 12 Spanish centers. A total of 307 patients underwent apheresis for axi-cel (n=152) and tisa-cel (n=155) from November 2018 to August 2021, of which 261 (85%) received a CAR T infusion (88% and 82%, respectively). Median time from apheresis to infusion was 41 days for axi-cel and 52 days for tisa-cel (P=0.006). None of the baseline characteristics were significantly different between both cohorts. Both cytokine release syndrome and neurologic events (NE) were more frequent in the axi-cel group (88% vs. 73%, P=0.003, and 42% vs. 16%, P= 2 and progressive disease before lympho-depletion. Safety and efficacy results in our real-world experience were comparable with those reported in the pivotal trials. Patients treated with axi-cel experienced more toxicity but similar non-relapse mortality compared with those re-ceiving tisa-cel. Efficacy was not significantly different between both products

Axicabtagene ciloleucel compared to tisagenlecleucel for the treatment of aggressive B-cell lymphoma

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-targeted chimeric antigen receptor (CAR) T cells approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). We performed a retrospective study to evaluate safety and efficacy of axi-cel and tisa-cel outside the setting of a clinical trial. Data from consecutive patients with R/R LBCL who underwent apheresis for axi-cel or tisa-cel were retrospectively collected from 12 Spanish centers. A total of 307 patients underwent apheresis for axi-cel (n=152) and tisa-cel (n=155) from November 2018 to August 2021, of which 261 (85%) received a CAR T infusion (88% and 82%, respectively). Median time from apheresis to infusion was 41 days for axi-cel and 52 days for tisa-cel (P =0.006). None of the baseline characteristics were significantly different between both cohorts. Both cytokine release syndrome and neurologic events (NE) were more frequent in the axi-cel group (88% vs. 73%, P =0.003, and 42% vs. 16%, P <0.001, respectively). Infections in the first 6 months post-infusion were also more common in patients treated with axi-cel (38% vs. 25%, P =0.033). Non-relapse mortality was not significantly different between the axi-cel and tisa-cel groups (7% and 4%, respectively, P =0.298). With a median follow-up of 9.2 months, median PFS and OS were 5.9 and 3 months, and 13.9 and 11.2 months for axi-cel and tisa-cel, respectively. The 12-month PFS and OS for axi-cel and tisa-cel were 41% and 33% (P =0.195), 51% and 47% (P =0.191), respectively. Factors associated with lower OS in the multivariate analysis were increased lactate dehydrogenase, ECOG ≥2 and progressive disease before lympho-depletion. Safety and efficacy results in our real-world experience were comparable with those reported in the pivotal trials. Patients treated with axi-cel experienced more toxicity but similar non-relapse mortality compared with those receiving tisa-cel. Efficacy was not significantly different between both products

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

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

Morphological and physiological divergences within Quercus ilex support the existence of different ecotypes depending on climatic dryness

Background and Aims Several studies show apparently contradictory findings about the functional convergence within the Mediterranean woody flora. In this context, this study evaluates the variability of functional traits within holm oak (Quercus ilex) to elucidate whether provenances corresponding to different morphotypes represent different ecotypes locally adapted to the prevaling stress levels. Methods Several morphological and physiological traits were measured at leaf and shoot levels in 9-year-old seedlings of seven Q. ilex provenances including all recognized morphotypes. Plants were grown in a common garden for 9 years under the same environmental conditions to avoid possible biases due to site-specific characteristics. Key Results Leaf morphometry clearly separates holm oak provenances into 'ilex' (more elongated leaves with low vein density) and 'rotundifolia' (short and rounded leaves with high vein density) morphotypes. Moreover, these morphotypes represent two consistent and very contrasting functional types in response to dry climates, mainly in terms of leaf area, major vein density, leaf specific conductivity, resistance to drought-induced cavitation and turgor loss point. Conclusions The 'ilex' and 'rotundifolia' morphotypes correspond to different ecotypes as inferred from their contrasting functional traits. To the best of our knowledge, this is the first time that the combined use of morphological and physiological traits has provided support for the concept of these two holm oak morphotypes being regarded as two different species. © 2014 The Author 2014.We thank Juli G. Pausas for his assistance with the statistical analyses of the cavitation curves. This work was supported by Gobierno de Aragón (A54 research group), the projects AGL2010–21153-C02-02, CGL-2011–30531-CO2-02 and CSD2007-00067 funded by the Spanish government, and GA243888 funded by the EC. CEAM is supported by the Generalitat Valenciana. The work of J.J.P.P. is supported by a ‘Juan de la Cierva’-MINECO post-doctoral contract. J.J.C. acknowledges the support of ARAID.Peer Reviewe

Stop Hypertension with SLP/UCM I

El Proyecto Stop Hipertensión con ApS/UCM pretende aportar nuestro granito de arena a la lucha contra la hipertensión arterial (HTA), utilizando una herramienta educativa de aprendizaje en servicio (ApS), que permita a los estudiantes de los Grados en ciencias de la salud de la UCM aprender a la vez que realizan un servicio público. La hipertensión arterial (HTA) es un problema de salud pública y un importante factor de riesgo de padecer enfermedades cardiovasculares (ECV). Su diagnóstico está determinado por la medida de la presión arterial (PA) por lo que es de extrema importancia asegurar una medida fiable y válida. La automedida de la PA (AMPA) consiste en la medida de la PA por el propio paciente o un familiar, habitualmente en su domicilio, y es una herramienta útil para el diagnóstico y control de la HTA. Pero ¿sabemos medirnos de forma correcta la PA? ¿Usamos bien los tensiómetros? ¿Sabemos interpretar los registros de la PA y cuándo consultar al médico? Realizar AMPA correctamente no es fácil y exige un esfuerzo extraordinario de recursos humanos y económicos por parte de los profesionales de Atención Primaria. Por ello son necesarias nuevas estrategias para capacitar a la población en AMPA. Con este Proyecto nos proponemos luchar contra la HTA a través de la metodología educativa de aprendizaje-servicio que combina objetivos académicos con el servicio comunitario. El alumnado de los grados de Ciencias de la Salud de la UCM forman a la población en la correcta AMPA, asesorándoles sobre el uso correcto de los tensiómetros, enseñándoles a interpretar los resultados y alertándoles de cuándo acudir al médico. En el curso 2022-2023, el servicio público se ha dirigido principalmente al colectivo de mayores por ser especialmente vulnerables a padecer ECV en los Ayuntamientos de Coslada, Alcobendas y Alcorcón, y en las residencias Afanias y Neurovida, y a la población general que acuda a la Facultad durante la Semana de la Ciencia CAM/UCM 2022, a la Feria de la Salud de Coslada y a la campaña contra la HTA de la UCM junto con el Servicio de Medicina del Trabajo. Hemos demostrado que este proyecto es una herramienta rentable y efectiva en la lucha contra la HTA, vinculando la salud pública, los recursos de los ayuntamientos y la universidad. Se cubre así una necesidad y servicio social que podría salvar muchas vidas con recursos de bajo costo, cumpliendo con los objetivos del desarrollo sostenible y con los objetivos de la Sociedad Española de Hipertensión (SEH-LELHA) y de la estrategia HEARTS de la OPS/OMS. Los estudiantes se dan cuenta de la realidad de la Salud pública al tener contacto directo con la población, realizando un servicio a la sociedad, y desarrollándose profesionalmente. Agrademos su colaboración a: Los ayuntamientos de Coslada, Alcorcón y Alcobendas de Madrid. Las residencias de mayores Afanias y Neurovida. Las Sociedades científicas SEH-LELHA, SECF y SEAPEC. El Dr. Orduñez, lider de la estrategia HEARTS PAHO/WHO Los colegios profesionales COFM y CODEM. Las empresas River International S.L. (Beurer) and Peroxfarma S.L. (Omrom)Oficina APS UCMDepto. de FisiologíaFac. de FarmaciaTRUEunpu