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New therapeutic strategies have been established in chronic wound healing procedures, such as the use of platelet-rich plasma (PRP). There is currently still uncertainty about the effectiveness, cost-effectiveness and real safety of PRP in promoting chronic wound healing and what specific types of chronic wounds can benefit most from its use.
We conducted a systematic review of available scientific literature on the effectiveness, safety and cost-effectiveness of PRP compared to placebo, standard care or alternative topical therapies for the treatment of chronic wounds in adults. Overall effect size was estimated through a meta-analysis. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals for a 5-year horizon, from the perspective of the Spanish National Health Service (NHS) for the PRP versus standard treatment in patients with diabetic foot ulcers. The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis.
Sixteen RCTs and four observational studies were included for the effectiveness and safety meta-analysis. The primary outcome was the proportion of chronic wounds completely healed: 143 patients out of 334 (42.8 percent) were cured in the standard treatment arm and 251 patients out of 375 (66.9 percent) in the PRP arm, relative risk (RR) 1.68 (95% CI: 1.22–2.31). It was unclear whether there was a difference in the risk of infection (RR 0.53, 95% CI: 0.10–2.71) or adverse events (RR 1.05, 95% CI: 0.29–3.88) between PRP and standard care. Three studies were considered for the cost-effectiveness analysis. In the base case analysis, PRP led to higher QALYs and healthcare costs with an estimated incremental cost-effectiveness ratio (ICER) of EUR 41,767 (USD 48,323)/QALY.
PRP treatment is more expensive and more effective than standard treatment. The estimated ICER is above the acceptability threshold in Spain.
This work is part of the interlaboratory collaboration to study the stability of organic solar cells containing PCDTBT polymer as a donor material. The varieties of the OPV devices with different device architectures, electrode materials, encapsulation, and device dimensions were prepared by seven research laboratories. Sets of identical devices were aged according to four different protocols: shelf lifetime, laboratory weathering under simulated illumination at ambient temperature, laboratory weathering under simulated illumination, and elevated temperature (65 °C) and daylight outdoor weathering under sunlight. The results generated in this study allow us to outline several general conclusions related to PCDTBT-based bulk heterojunction (BHJ) solar cells. The results herein reported can be considered as practical guidance for the realization of stabilization approaches in BHJ solar cells containing PCDTBT.
Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.
Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].
Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.
Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.
The usual emotional experience of the person (affective style) is an influential factor in therapeutic assimilation. Based on a dynamic model of affect shaped dimensionally by the valence and arousal axes (core affect) that fluctuate over time according to the specific context of the individual, its relationship with different variables was investigated and the changes after a 6-month intervention in a specialized hospital unit (N = 103) were observed. The orthogonal structure of core-affect was confirmed. Emotional valence appeared to be positively related to social skills (r = .375; p < .01) and self-esteem (r = .491; p < .01) and negatively to depressive symptoms (r = –.631; p < .01), general disturbance (r = –.395; p < .01) and suicidality (r = –.490; p < .01). Emotional arousal is associated with impulsivity (r = .345; p < .01). The group of patients with an affective style characterized by negative valence and low arousal core-affect gained less therapeutic benefit compared to those with positive valence core-affect (p < .05). Throughout the treatment, valence became more positive (d = .26; IC 95%: 1.9 – 7.2; p = .001), arousal increased (d = .23; IC 95%: 0.2 – 1.7; p = .015) and variability decreased (d = –.44; IC 95%: (–2.9) – (–1.1); p = .001). Changes in the core-affect are related to therapeutic improvement. Adjusting expectations of change can reduce therapeutic frustration, which is as common as it is harmful in the treatment of severe personality disorders.
Observing the supernovae (SNe) associated to the different types of gamma-ray bursts (GRBs) is one of the few means to study their progenitors. In the past years, it has become clear that GRB-like events are more heterogeneous than previously thought. There is a marked difference between long GRBs, which are produced by the collapse of very massive stars and are normally associated with broad-lined type Ic SNe, and short bursts, which occur when two compact objects merge and that, at least in some cases, can produce an associated kilonova. Moreover, the SNe associated with different sub-types of long GRBs are also seen to differ, especially those associated with ultra-long duration GRBs. To address this issue in a systematic way we started an observing programme in 2010 at the 10.4m GTC telescope. Here we present some results of our programme, including the detection of 12 new GRB-SNe. Highlights of our sample are the discovery of the first spectroscopic SN associated with a highly energetic (Eγ, iso ~ 1054 erg) “cosmological” burst (GRB 130427A), the study of the SN associated with a shock-breakout GRB (GRB 140606B) and the SN associated with the peculiar ultra-long GRB 101225A at z = 0.85. The sample includes also the follow-up of several short GRBs in search for kilonovae emission (GRB 130603B and GRB 160821B are important examples). Amongst our latest results we present the photometric and spectroscopic observations of the SNe associated with GRB 150818A and GRB 161219B.
Excessive attention to pain is a common psychological characteristic among people who suffer from chronic pain. The Pain Vigilance and Awareness Questionnaire (PVAQ) is an internationally accepted tool to assess this feature, although there is no validated version of this measure for Spanish people with fibromyalgia. Since this pain syndrome mainly affects women, the aim of this study was to determine the psychometric properties of the PVAQ in Spanish women with fibromyalgia. A group of 242 women diagnosed with fibromyalgia aged between 20 and 66 years participated in the study. The goodness of fit of several structures of the PVAQ reported in previous studies was compared via confirmatory factor analysis. A two-factor solution (active vigilance and passive awareness) of the 9-item shortened version (PVAQ-9) was identified as the most appropriate (RMSEA = .08, NNFI = .96, CFI = .97, GFI = .87). It showed good reliability (internal consistency α = .82), convergent validity and divergent validity (p < .01). The optimal cutoff point for identifying fibromyalgia women with worse daily functioning was a score of 24.5, with a sensitivity of .71 and a specificity of .75. The relevance of vigilance to pain for clinical research in fibromyalgia is discussed.
A 15-m-thick, fluvial sedimentary record of the NW Iberian lower Miño River was studied. Grain-size analyses were performed and twelve samples were dated using optically stimulated luminescence dating techniques, documenting a 1300-yr-old reconstructed fluvial record that does not match with known climate fluctuations in the area, but is linked instead to the construction of a series of ancient fishing weirs (pesqueiras). The sedimentation phases are in agreement with known episodes of increased population density, which suggests active use of the pesqueiras. A number of sedimentation hiatuses in the fluvial record point towards damage to the pesqueiras during large-scale flooding in the Miño River basin, and a sudden drop in population probably due to the arrival of the plague in the 13th century AD. The oldest sedimentation phases started just after 700 AD, and we infer that the first pesqueiras were constructed around this time. This timing coincides with the transition of the NW Iberian landscape towards a more intensively used agricultural landscape, as evidenced from other geo-archeological investigations. The results demonstrate that the pesqueiras are several hundreds of years older than known from historical records, but not so old as to date back to the Roman occupation.
Whether or not it is time for germination is a dilemma for annuals since they have only a single opportunity to reproduce successfully. This is critical for species living in stressful and unpredictable environments such as Mediterranean habitats. In order to clarify the environmental cues of germination, four annuals of different families, all of them occurring very frequently on gypsum soils, were selected and their germination observed under 14 climate scenarios, mimicking temperature and photoperiod conditions from autumn to spring, at two levels of water availability (continuous irrigation versus an initial single irrigation event followed by a progressive soil desiccation). In spring scenarios, two seed-storage conditions were compared: dry cold and room conditions. In the absence of water limitation, germination decreased from early autumn to late spring. Water scarcity always reduced germination, especially in early spring. Our results suggest a facultative winter germination behaviour and highlight the crucial role of dry cold storage in reducing spring germination. In conclusion, Mediterranean ephemerals showed a very plastic germination response that allows them to take advantage of favourable environmental conditions from autumn to spring. This environmental cueing is combined with the ability to dilute the risk through a variable rate of seed dormancy that, according to bet-hedging strategies, increases from secure autumn to riskier spring.
Speleothem growth requires humid climates sufficiently warm to stimulate soil CO2 production by plants. We compile 283 U/Th dates on 21 stalagmites from six cave systems in the NW coast of Spain to evaluate if there are patterns in stalagmite growth that are evidence of climatic forcing. In the oldest stalagmites, from marine oxygen isotope stage (MIS) 7–5, growth persists through the glacial period. Hiatuses and major reductions in growth rate occur during extreme minima in summer insolation. Stalagmites active during the last interglaciation cease growth at the MIS 5–4 boundary (74 ka), when regional sea-surface temperature cooled significantly. During MIS 3, only two stalagmites grew; rates were highest between 50 and 60 ka during the maximum in summer insolation. One stalagmite grew briefly at 41 ka, 36.5 and 28.6 ka, all during warm phases of the Dansgaard–Oeschger cycles. A pronounced Holocene optimum in stalagmite growth occurs from 9 to 6 ka. The cessation of most growth by 4.1 ka, coincident with broad increases in aridity over the Mediterranean and areas influenced by the North African Monsoon, suggest that regions such as NW Spain, with dominant Atlantic moisture sources, also experienced increased aridity at this time.
We examined the intention to comply with mandatory hurricane evacuation orders among respondents living in coastal areas with pronounced poverty by demographic and location characteristics.
A 3-county door-to-door survey was conducted with 1 randomly selected resident per household. Households were selected using a 2-stage cluster sampling strategy and stratified by county. The final sample included 3088 households in 100 census tracts across 3 counties.
Findings suggest that the majority of residents living in areas prone to hurricanes intend to comply with mandatory evacuation orders regardless of income level. Variation in intention to comply with mandatory evacuation orders is shown by age, gender, ethnicity, education, acculturation, county, and distance from shoreline.
The demonstrated high intention to comply with evacuation orders in impoverished areas suggests a need for improved planning to evacuate the most vulnerable residents. Demographic and location characteristics associated with decreased intention to comply may be considered for targeting messages and education before disasters to modifying intentions and plans to evacuate. (Disaster Med Public Health Preparedness. 2013;7:46-54)
Recently, the number of cryptic species known has increased considerably, showing that species diversity has in many cases been underestimated in the past. Parmelia sulcata is a widely distributed species and one of the most common taxa in temperate Europe. The first intra-specific molecular studies on P. sulcata showed an unexpectedly high genetic variability. In the present work, we study the biodiversity of this taxon including specimens from four continents and using three molecular markers (nuITS, nuIGS rDNA, and partial β-tubulin gene). Two monophyletic groups of P. sulcata were encountered; one of these is epitypified as P. sulcata s. str and the other one is segregated as the new cryptic species P. encryptata sp. nov. Issues surrounding the lectotypification of Parmelia sulcata have also been elucidated.
Several viologen electrochromic devices with different thicknesses on glass substrates were constructed, using a mixture of 4,4’-bipyridine and 1-bromoethane. The thickness of each device was fixed using a thermoplastic spacer. The devices were electrochemically tested with optical and impedance analysis. The range of the transmittance change is highly dependent on thickness. The electrical behavior of the material and the physical and chemical characteristics are derived from the proposed electrical equivalent circuit model. A simple Randles circuit including a Warburg diffusion impedance element, a charge transfer resistance and a double layer capacitive element is proposed for the fittings process. Variations on thickness of internal layer of devices lead to use a short or an open circuit Warburg element. A threshold potential, from which the device is colored, indicates the charge diffusion effects.
Objective: This study analyzes the role of a number of cognitive-affective dimensions in the experience and coping of pain in patients with fibromyalgia (FM). Specifically, it was examined whether anxiety, depression, pain catastrophizing and pain-related anxiety predict the pain perception and the self-efficacy expectations in these patients. Method: Seventy-four fibromyalgia patients were asked to complete a questionnaire survey including the Chronic Pain Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Pain Anxiety Symptoms Scale-20, the Pain Catastrophizing Scale, and the Short-form McGill Pain Questionnaire. Results: Some relevant correlation and predicting patterns were identified. Physiological anxiety was the best predictor of the sensorial dimension of pain. Pain fear was a significant predictor of the pain intensity. Helplessness was the best predictor of the affective dimension of pain, whereas depression was a significant predicting variable of the self-efficacy expectations. Conclusions: This study shows the relevance of the pain-related anxiety in the pain perception, and of the depression in the self-efficacy expectations in FM patients. Clinical applications of the findings and further research lines in this area are discussed.
Cortical and cancellous bones were demineralized and deproteinized using 1 N
HCl and 6% NaOCl, respectively. Experiments were performed at 37°C. The rate
constants were calculated and the structural features of untreated and
completely demineralized and deproteinized samples were studied by scanning
electron microscopy, showing that intact, contiguous structures were
obtained. For both cases, the rate constant was higher for cancellous bone
than the cortical bone.
The yield stress evaluation as a function of water content for slip-prone clayey soils due to rainfall is studied in this work, particularly, the clayey soil from the region Teziutlán-Puebla-México. Yield stress was calculated as a function of water content using the slump test in cylindrical geometry. Results show a critical point of water content where yield stress decreases dramatically, and those values were related to the historical daily rain data. It was found a maximum precipitation millimeters that triggers the landslide, but still is low compared with the historical reported data.
In the present study, the efficacy of a formal mentoring program applied to fourth and fifth year students of the Psychology Faculty of the Complutense University is assessed. In this program, fifth-year students took on the role of mentors and fourth-year students, the role of mentees. To assess the efficacy, the group of mentors was compared with a group of non-mentors and the group of mentees with a group of non-mentees, before and after the program, taking into account the variables related to career development function (knowledge acquired of the academic setting and satisfaction with the career of Psychology) and the psychosocial function (self-concept, self-esteem, self-efficacy, and involvement).
The results show a statistically significant increase in the knowledge acquired about the academic setting as a consequence of the program, both in the group of mentors and in the group of mentees. Moreover, the mentors achieved a better average grade in the subjects of the specialty of Work Psychology. There were no statistically significant differences between the experimental group and the control group in satisfaction with the career of Psychology, or in self-concept, self-esteem, or self-efficacy.