University of Murcia

A rapid response system is an established concept developed in many hospitals worldwide. In recent years, Europe has seen significant progress, and advanced systems have been introduced in many states, including Nordic countries, Spain, and Italy, in addition to the well-established British system. In this chapter, we will highlight RRS implementation in these countries to illustrate the diversity of experiences. Europe serves as a microcosm of the world with early adopters, late adopters, and non-adopters.

Melatonin (MLT) is an indole derivative that exhibits hormone‐like activities in plants, regulating multiple aspects of growth and development. Due to its role in mitigating oxidative stress and facilitating osmoprotectant accumulation, MLT enhances abiotic stress tolerance, although the pathways and metabolic mechanisms involved remain unclear despite being studied in various crops. This work aimed to investigate the changes elicited by the exogenous MLT application at different concentrations (10, 50, 150 μM) and its role in mitigating the salinity stress in Lactuca sativa L. through metabolomics and phenotyping approaches. Our results clearly indicated that MLT increases photosynthetic efficiency at high dosage (150 μM) at either early or late salinity stress conditions ( p < 0.01). Untargeted metabolomics provided insight into the significant effect of salinity and MLT ( p < 0.01 in both cases, according to multivariate chemometrics), mediated by a broad reprogramming involving secondary metabolism, phytohormones, fatty acids and amino acids biosynthesis. In detail, 150 μM MLT induced an adjustment of the phytohormones profile to reduce the salinity‐induced damages. Our findings support the well‐known potential of melatonin in alleviating salinity stress. These findings address existing challenges in studying the molecular effects of MLT in mitigating abiotic stress, providing insights into the biochemical pathways that drive its effectiveness. In this sense, further research is acknowledged to provide a multidisciplinary high throughput perspective leading to its exploitation in a wide range of crops of agricultural and economic importance.

In recent years, educators have encountered significant shifts in teaching methodologies driven by rapid technological advancements and evolving demands in higher education. This transition has prompted adaptations in teaching practices and digital approaches, resulting in a broader paradigm shift across institutions. This study explores faculty perceptions and attitudes toward emerging pedagogies, focusing on their preparedness for digital and hybrid learning environments and the dynamics of teacher-student collaborative learning in these contexts. The research examines how faculty readiness can enhance adaptation to modern educational demands beyond any specific event or period. Utilising the FROCT scale—measuring readiness through comfort with risk, identity disruption, teaching norms, and equity and tenure norms—this research, conducted among Spanish university teachers, that highlight significant shifts in readiness perceptions after 2 years of compulsory online education. Furthermore, the study identifies gender and age disparities in teachers’ perceptions of online education readiness. These findings contributing to a better understanding of teacher preparation and performance in the post-pandemic educational landscape, specifically in online and blended education, where cognitive, metacognitive, and emotional dimensions play integral roles in fostering socialisation online and collaborative learning between educators and students.

Pathogenic mutations that cause rhodopsin misfolding lead to a spectrum of currently untreatable blinding diseases collectively termed retinitis pigmentosa. Small molecules to correct rhodopsin misfolding are therefore urgently needed. In this study, we utilized virtual screening to search for drug-like molecules that bind to the orthosteric site of rod opsin and improve its folding and trafficking. We identified and validated the biological effects of 2 non-retinoid compounds with favorable pharmacological properties that cross the blood–retina barrier. These compounds reversibly bind to unliganded rod opsin, each with a Kd comparable to 9-cis-retinal and improve opsin stability. By improving the internal protein structure network (PSN), these rod opsin ligands also enhanced the plasma membrane expression of total 36 of 123 tested clinical RP variants, including the most prevalent P23H variant. Importantly, these compounds protected retinas against light-induced degeneration in mice vulnerable to bright light injury and prolonged survival of photoreceptors in a retinitis pigmentosa mouse model for rod opsin misfolding.

Pressures on honey bee health have substantially increased both colony mortality and beekeepers’ costs for hive management across Europe. Although technological advances could offer cost-effective solutions to these challenges, there is little research into the incentives and barriers to technological adoption by beekeepers in Europe. Our study is the first to investigate beekeepers’ willingness to adopt the Bee Health Card, a molecular diagnostic tool developed within the PoshBee EU project which can rapidly assess bee health by monitoring molecular changes in bees. The Bee Health Card, based on MALDI BeeTyping®, is currently on level six of the Technology Readiness Level scale, meaning that the technology has been demonstrated in relevant environments. Using an on-line survey from seven European countries, we show that beekeepers recognise the potential for the tool to improve colony health, and that targeted economic incentives, such as subsidises, may help reduce cost being a barrier to the adoption and frequent use of the tool. Based on the description of the tool, 43% of beekeepers appear to be moderately confident in the effectiveness of the Bee Health Card. This confidence could increase if the tool was easy to use and not time consuming, and a higher confidence could also contribute to raising the probability of accepting extra costs linked to it. We estimate that, in the worst-case scenario, the cost per single use of the Bee Health Card should be between €47–90 across a range of European countries, depending on the labour and postage costs. However, the monetary benefits in terms of honey production could exceed this. In order to successfully tackle colony health issues, it is recommended using the BHC five times per year, from the end to the beginning of winter. Finally, we discuss the knowledge needs for assessing beekeeper health tools in future research.

Compared to aziridines, azaphosphiridines, which formally result from the replacement of a carbon atom by phosphorus, have been much less studied. In this work, accurate values for one of the most prominent properties, the ring strain energy (RSE), have been theoretically examined for a wide range of azaphosphiridine derivatives. Strongly related aspects of interest for developing the use of azaphosphiridines in heteroatom and polymer chemistry are ring opening reactions and polymerisations, the latter facilitated by their significantly high RSE. While methyl groups have little influence on the RSE, complexation with different metal moieties increases the RSE in all cases, and an increase was also found upon oxidation to the corresponding P-oxides and other σ5λ5-P derivatives. The highest RSE was found for the P-protonated azaphosphiridinium cation and azaphosphiridines with exocyclic double bonds. A correlation of the RSEs with the relaxed force constants of the endocyclic ring bonds and AIM-derived parameters in the ring critical points, such as the electron density, ρ(r), and the Lagrangian of the kinetic energy, G(r), was found. A relatively low barrier to P-C bond cleavage via nucleophilic attack of MeNH2 on phosphorus points to the possibility of ring-opening polymerisation.

Objectives: This study aimed to develop an anamnesis checklist for oral contraceptive (OC) choice focused on their safety profile and associated risk factors. Study Design: This study involved eight health care professionals in Spain, including six gynecologists and two internists, selected for their expertise in contraception counseling. We employed the design-thinking process, structured in five phases: empathizing with patients’ needs, defining key areas of impact, devising innovative solutions, prototyping ideas into testable proposals, and validating prototypes. This process involved an analysis of the available literature, online discussions, and an online survey to evaluate importance and frequency of variables in anamnesis. Medians were computed for each variable, and the study group collaboratively determined the variables to include in the anamnesis checklist. Results: Women must be informed about contraceptive options, according to health care professionals. Body mass index, smoking status, blood pressure, and personal history were identified and prioritized as variables to consider during OC counseling. Participants emphasized the need to individualize the treatment, highlightling the safety profile of progestin-only pills over OCs due to the lack of increased venous thromboembolism risk. Conclusions: The study emphasizes the importance of an anamnesis prior to prescribing an oral hormonal contraceptive, as well as the most relevant risk factors that should be analyzed. A checklist was developed to facilitate safe OC prescribing.

Background Accurate body fat distribution assessment is essential for managing cardiovascular disease and metabolic disorders. Although several methods are available for segmental fat analysis, few studies have examined the validity of affordable methods such as Bioelectrical Impedance Analysis (BIA) against the reference method, Dual-Energy X-ray Absorptiometry (DXA). This study aimed to assess the validity of BIA as compared to DXA for segmental fat mass assessment, and to develop anthropometric multivariate regression models that offer a cost-effective alternative for health professionals in clinical and public health settings. Methods Cross-sectional study that included 264 young adults (161 males, mean age = 23.04 ± 5.61 years; and 103 females, mean age = 22.29 ± 5.98 years). Segmental fat mass was measured using DXA and BIA, and anthropometric measurements were collected following the ISAK protocol. Results Significant differences were found between DXA and BIA for segmental fat mass (p < 0.001). Sex significantly influenced the results (p < 0.05), while BMI and hydration status had no significant impacts. The Bland-Altman analysis revealed significant differences (p < 0.001) between BIA and DXA for fat mass in the upper and lower limbs. Trunk fat mass also differed significantly in males and females (p < 0.001), except for the overall sample (p = 0.088). Anthropometric multivariate regression models showed a high predictive accuracy for both females (R²=0.766–0.910; p < 0.001) and males (R²=0.758–0.887; p < 0.001). Key predictors of segmental fat mass included body mass (r = 0.606–0.867; p < 0.001), skinfold thickness (r = 0.688–0.893; p < 0.001), and waist girth (r = 0.883 − 0.810; p < 0.001). Peripheral skinfolds were highly predictive for upper and lower limbs, while waist girth was relevant for trunk fat mass. Conclusions DXA and BIA are not interchangeable for segmental fat analysis due to the significant differences observed. However, the anthropometric multivariate regression models developed provide a cost-effective and reliable alternative for predicting segmental fat mass in clinical settings where DXA is unavailable. Trial registration Not applicable.

This study introduces a novel and sustainable approach using Ionic Liquids (ILs) as a non‐innocent solvent that enhances the performance of the basic catalysts to depolymerize polyurethane foam wastes (PUFWs) through hydrolysis, alcoholysis or aminolysis under mild conditions. The system is stable, fully recoverable, and reusable. Hydrolysis of PUFWs can occur in just 2 minutes at 95–98 °C, producing a white polyol that is easily separated and reused in new polyurethane synthesis. The method was successfully scaled up to depolymerize 200 g of PUFW per batch (1 kg overall depolymerization system). This scalability, combined with the medium‘s reusability without loss of effectiveness, highlights its strong potential for industrial applications.

Activating photosensitizers with long-wavelength excitation is an important parameter for effective photodynamic therapy due to the minimal toxicity of this light, its superior tissue penetration, and excellent spatial resolution. Unfortunately, most Ir(III) complexes suffer from limited absorption within the phototherapeutic window, rendering them ineffective against deep-seated and/or large tumors, which poses a significant barrier to their clinical application. To address this issue, several efforts have been recently made to shift the absorption of Ir(III) photosensitizers to the deep-red/near-infrared region by using different strategies: functionalization with organic fluorophores, including porphyrinoid compounds, and ligand design via π-extension and donor-acceptor interactions. In this Frontier, we highlight such new developments and the ongoing challenges in this field.

Ageing underlies functional decline of the brain and is the primary risk factor for several neurodegenerative conditions, including Alzheimer’s disease (AD). However, the molecular mechanisms that cause functional decline of the brain during ageing, and how these contribute to AD pathogenesis, are not well understood. The objective of this study was to identify biological processes that are altered during ageing in the hippocampus and that modify Ad risk and lifespan, and then to identify putative gene drivers of these programmes. We integrated common human genetic variation associated with human lifespan or Ad from genome-wide association studies with co-expression transcriptome networks altered with age in the mouse and human hippocampus. Our work confirmed that genetic variation associated with Ad was enriched in gene networks expressed by microglia responding to ageing and revealed that they were also enriched in an oligodendrocytic gene network. Compellingly, longevity-associated genetic variation was enriched in a gene network expressed by homeostatic microglia whose expression declined with age. The genes driving this enrichment include CASP8 and STAT3, highlighting a potential role for these longevity-associated genes in the homeostatic functions of innate immune cells, and these genes might drive ‘inflammageing’. Thus, we observed that gene variants contributing to ageing and AD balance different aspects of microglial and oligodendrocytic function. Furthermore, we also highlight putative Ad risk genes, such as LAPTM5, ITGAM and LILRB4, whose association with Ad falls below genome-wide significance but show strong co-expression with known Ad risk genes in these networks. Indeed, five of the putative risk genes highlighted by our analysis, ANKH, GRN, PLEKHA1, SNX1 and UNC5CL, have subsequently been identified as genome-wide significant risk genes in a subsequent genome-wide association study with larger sample size, validating our analysis. This work identifies new genes that influence ageing and AD pathogenesis, and highlights the importance of microglia and oligodendrocytes in the resilience of the brain against ageing and AD pathogenesis. Our findings have implications for developing markers indicating the physiological age of the brain and new targets for therapeutic intervention.

Background Seasonal migrant farmworkers (SMF) make up a significant part of Spain's agricultural labour force. Due to precarious labour conditions, housing insecurity and factors related to migration, SMF are at risk of specific health issues and occupational accidents. In addition, migrants in Spain face barriers when accessing healthcare services. This study explores factors that influence the acceptability of healthcare services among SMF in Spain from the point of view of professionals working with this population. Methods Semi‐structured interviews were conducted among 92 professionals working with SMF in four regions of Spain, including NGO workers, healthcare workers, employees of worker unions, public social services and governmental institutions. A thematic content analysis was performed using Atlas.ti. Results Professionals identified several barriers and facilitators that influence the acceptability of healthcare services among SMF. The main identified barriers were language, different perceptions of health and healthcare between SMF and Spanish professionals, a limited understanding of the Spanish healthcare system, and precarious working and living conditions. The main identified facilitators were professionals taking time to explain healthcare procedures and rights to SMF and support and information from friends, family and other community members. Discussion and Conclusion To overcome barriers, the use of translational services and cultural mediators should be increased. In addition, educational interventions are needed for migrants to better understand the Spanish healthcare system and for healthcare workers to provide culturally appropriate care to migrant patients. Finally, it needs to be considered that inequalities in health and healthcare between SMF and the Spanish native‐born population reach beyond healthcare institutions. They are rooted in structural factors, which include their living and working conditions, social exclusion, and discrimination. Patient or Public Contribution As this study, which is part of a bigger project, aimed to focus on healthcare access mainly from the healthcare system perspective, patients and service users were not involved in this part. Another sub‐study within the project will focus on the experience of SMF. Caregivers were included as study participants and despite not having been directly included in the study design, the open‐ended questions used in this study allowed them to bring up the topics they considered important in the context of this study.

Active breaks can be a reference framework for promoting physical activity at schools, hence the important of ascertaining which variables can promote or hinder their implementation. The goal was to analyse the relationship between the perceived barriers and teacher beliefs and benefits of implementing active breaks by analysing the mediating role of the teachers’ physical activity. Method: 109 teachers participated (70.6% females; M age = 38.59, SD = 11.08). An ad hoc questionnaire on active breaks and the International Physical Activity Questionnaire were used for the teachers’ physical activity. Results: low level of perceived barriers to active breaks increased beliefs and benefits for their implementation in the classroom. Conclusions: this study shows that teachers’ physical activity was not a variable that determined the implementation of active breaks in the classroom. Therefore, other personal and/or contextual factors related to the adoption and implementation of active breaks should be explored.

We aimed to determine the persisting effects of various exercise modalities and intensities on functional capacity after periods of training cessation in older adults. A comprehensive search was conducted across the Cochrane Library, PubMed/MEDLINE, Scopus, and Web of Science Core Collection up to March 2024 for randomized controlled trials examining residual effects of physical exercise on functional capacity in older adults ≥ 60 years. The analysis encompassed 15 studies and 21 intervention arms, involving 787 participants. The exercise and training cessation periods ranged from 8 to 43 weeks and 4 to 36 weeks, respectively. Meta‐analyses were performed using change scores from before the physical exercise to after the training cessation. The effect sizes (ES) were calculated as the standardized mean differences between the intervention and control groups' change scores. Subgroup analyses and meta‐regressions explored the influence of participant characteristics, the magnitude of the effect produced by the initial training program, various exercise modalities (resistance and multicomponent training) and intensities (high and low), and subdomains of functional capacity (agility, balance, standing ability, walking ability, and stair walking). The findings revealed that exercise interventions had a significant effect on preserving functional capacity after training cessation (ES = 0.87; p < 0.01). This protective effect was consistent across various exercise modalities and intensities (ES ≥ 0.67; p ≤ 0.04). The benefits obtained during the training program were positively associated with the residual effects observed after training cessation (β = 0.73; p < 0.01), while age negatively influenced the persisting adaptations (β = −0.07; p < 0.01). Current evidence suggests that exercise‐based interventions, irrespective of modality and intensity, are highly effective in preventing functional declines after training cessation among older adults.

Artichoke (Cynara cardunculus var. scolymus) is a traditional component of the Mediterranean diet, and an important source of bioactive and nutritional compounds (phenolic compounds, inulin, dietary fiber, vitamins, minerals, etc.). However, an important amount of artichoke by-products is discarded during industrial processing, whose waste represents a rich source of bioactive and nutritional compounds. A current trend for food engineering is the valorization of these rich plant by-products to contribute to the circular economy model and resource optimization. However, the edible part of the artichoke and its by-products have different compositions and behave differently when subjected to several food manufacturing operations. This behavior has not been deeply studied in many cases and especially for artichoke by-products. To contribute to that, the first part of this review deeply reviewed the bioactive and nutritional profile of artichoke by-products, as well as its comparison with the artichoke edible part. In the second part, we reviewed the effects of industrial operations (conditioning, transformation, preservation) on the bioactive and nutritional compounds of artichoke by-products and edible parts. Therefore, we hope that this review will be a valuable tool for food engineering to develop new processes for the conservation and revaluation of these important bioactive and nutritional compounds, both from the edible part of the artichoke and its by-products.

Small fetuses, with estimated fetal weight (EFW) below the tenth percentile, are classified as fetal growth restriction (FGR) or small for gestational age (SGA) based on prenatal ultrasound. FGR fetuses have a greater risk of stillbirth and perinatal complications and may benefit from serial ultrasound scans to guide early delivery. Abnormal serum angiogenic factors, such as the soluble fms-like tyrosine kinase-1 (sFlt-1):placental growth factor (PlGF) ratio, have shown potential to more accurately distinguish FGR from SGA, with fewer false positives. This randomized controlled trial compared a management protocol based on the sFlt-1:PlGF with EFW and Doppler ultrasound in avoiding adverse perinatal outcomes in small fetuses after 36 weeks of gestation. A total of 1,088 pregnant women with singleton pregnancies were randomized to either the Doppler-based (control) or the sFlt-1:PlGF-based (intervention) protocol. The primary outcome, neonatal acidosis or Cesarean delivery as a result of abnormal cardiotocography, was assessed in 1,013 participants. The incidence was 10.5% in the intervention group and 10.0% in the control group (absolute difference, 0.53 (−3.21 to 4.26)), with the upper limit of the confidence interval <8.5%, confirming noninferiority. Thus, the sFlt-1:PlGF was noninferior to EFW and Doppler ultrasound in avoiding neonatal acidosis or Cesarean delivery owing to nonreassuring fetal status in small fetuses after 36 weeks (ClinicalTrials.gov registration: NCT04502823).

There is no diagnostic test for primary immune thrombocytopenia (ITP). Certain microRNAs have shown to have diagnostic potential in ITP. We validated 12 microRNAs identified from two previous studies to find a diagnostic biomarker. The study included two ITP cohorts (n = 61) and healthy controls (n = 28). The first ITP cohort involved 24 patients from the Prolong study, patients with newly diagnosed/persistent ITP (<1 year) treated with corticosteroids ± IVIG but relapsed/failed to respond. The second cohort comprised 37 patients from ITP biobank, Østfold Hospital, Norway, patients had different disease stages and therapies. Twelve microRNAs were measured: miR‐199a‐5p, miR‐33a‐5p, miR‐195‐5p, miR‐130a‐3p, miR‐144‐3p, miR‐146a‐5p, miR‐222‐3p, miR‐374b‐5p, miR‐486‐5p, miR‐1341‐5p, miR‐766‐3p and miR‐409‐3p. miR‐199a‐5p, miR‐33a‐5p, miR‐374b‐5p, miR‐146a‐5p and miR‐409‐3p were expressed differentially in the entire ITP cohort compared to controls; of those only miR‐199a‐5p showed good discriminative ability between ITP and controls with area under the curve (AUC) of 0.718 (95% CI: 0.599–0.836). In the Prolong cohort (ITP < 1 year), miR‐199a‐5p and miR‐374b‐5p showed very good discriminative ability between ITP and controls with AUC of 0.824 (0.708–0.940) and 0.806 (0.688–0.924) respectively. This study confirmed that miR‐199a‐5p has good discriminative ability between primary ITP and healthy controls, thus may be a diagnostic biomarker of ITP.

Background: Accurate segmentation of the left ventricular myocardium in cardiac MRI is essential for developing reliable deep learning models to diagnose left ventricular non-compaction cardiomyopathy (LVNC). This work focuses on improving the segmentation database used to train these models, enhancing the quality of myocardial segmentation for more precise model training. Methods: We present a semi-automatic framework that refines segmentations through three fundamental approaches: (1) combining neural network outputs with expert-driven corrections, (2) implementing a blob-selection method to correct segmentation errors and neural network hallucinations, and (3) employing a cross-validation process using the baseline U-Net model. Results: Applied to datasets from three hospitals, these methods demonstrate improved segmentation accuracy, with the blob-selection technique boosting the Dice coefficient for the Trabecular Zone by up to 0.06 in certain populations. Conclusions: Our approach enhances the dataset’s quality, providing a more robust foundation for future LVNC diagnostic models.