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Two new sites, identified during a survey of the Tajuña River Valley, central Iberia, show evidence of both flint extraction and working, specifically for the production of long blades. These are an important addition to the limited number of such sites known in Eurasia.
Acute otitis media (AOM) is one of the most common childhood infections. Recurrent AOM (rAOM) is defined as the presence of three or more AOM episodes in a period of six months. We describe the methodology used to update the recommendation of the 2018 Spanish National Antimicrobial Therapeutic Guide on the use of antibiotic treatments for rAOM in children.
Methods
We followed the GRADE-ADOLOPMENT approach to update the recommendation on antibiotic treatment for rAOM. Firstly, the research question was framed in a Population, Intervention, Comparison, and Outcome format. A comprehensive search strategy was developed, the results of which were screened according to the inclusion criteria. The selected studies were reviewed, and the quality of the evidence was assessed. Subsequently, an Evidence to Decision (EtD) framework was created and the new evidence was presented to the Guideline Development Group (GDG), which updated the recommendation on rAOM treatment in children.
Results
Among the 1,934 references identified by the database searches, only one guideline from the National Institute for Health and Care Excellence (NICE91, updated in 2022) met our inclusion criteria. This CPG included five individual studies comparing antibiotic treatments for rAOM. None of the studies demonstrated a significant advantage for any treatment. The overall quality of the evidence for these comparisons was considered low. A GRADE EtD framework was elaborated using the NICE91 recommendations but contextualized to the Spanish National Health System. Based on the evidence, the GDG did not modify the current recommendation provided in 2018.
Conclusions
The overall quality of the available evidence regarding antibiotic use for rAOM in children was considered low. Further research is therefore needed to resolve the controversy and increase confidence in the appropriateness of using antibiotics in the treatment of rAOM, thereby improving the quality of life of children with this condition.
Innovative public procurement (IPP) is a driver of innovation across sectors. IPP involves the strategic acquisition of cutting-edge technologies and solutions by public entities in collaboration with the private sector. This approach aims to leverage the potential of “omics” technologies, such as genomics and proteomics, within the public sector to advance healthcare solutions.
Methods
The IPP process comprises key phases such as needs identification, solicitation preparation, execution, evaluation and awarding, and impact and assessment. The methodology applied was based on the Rapid Assessment Tool for Omics Technologies developed by the Andalusian Agency for Health Technology Assessment, accompanied by clinical validity reports from the impact and evaluation phase of the Technical Office for IPP of Andalusia. The aim was to assess the clinical validation results of two omics technologies, that is, two diagnostic tests. A systematic review was performed to identify existing evidence. We also addressed the challenges associated with implementing the Rapid Assessment Tool in the IPP process.
Results
Systematic reviews identifying evidence on the clinical validity and utility of omics technologies provided a foundation for the subsequent evaluation of two technologies in development, once the clinical trials had finished. An analysis of scientific evidence, together with the compilation of information provided by industry, was conducted through a questionnaire and clinical data derived from the company’s studies. The analysis of clinical and diagnostic validity was not conclusive. We delivered the final assessment report to support decision-making in the public health system of Andalusia.
Conclusions
Both assessed technologies presented a high degree of innovation, but different challenges and issues were identified during the application of the Rapid Assessment Tool for Omics Technologies. Further improvement in IPP procedures for innovative technologies in Andalusia, including integration of our methodological approach at the start the IPP process, could facilitate the acquisition of cutting-edge technologies in collaboration with public entities.
Personalized precision medicine (PPM) is an innovative approach to disease diagnosis, prognosis, and treatment of individual or group characteristics using diverse data sources. While omics technologies are integral to PPM, they pose challenges. Therefore, developing an appropriate methodology to assess these technologies is crucial for patient safety, resource efficiency, and clinical decision-making within the Spanish National Health System.
Methods
This health technology assessment (HTA) methodology procedure was developed by combining three different approaches: a systematic review (SR); a survey targeting experts in omics technology, ranging from basic science researchers to clinicians, and patient associations; and, finally, a consensus method (RAND Appropriateness Method [RAM]).
Results
Through data extraction and evidence synthesis of the 38 studies included in SR, 30 existing frameworks for evaluating omics technologies were identified, as well as the elements needed to assess these technologies, leading to the first version of the framework. Two surveys were performed to integrate the perspectives of omics technology experts and patients. Subsequently, this framework version was further developed by a RAM consensus panel of experts from HTA agencies to ensure a rigorous evaluation of gathered data. The final framework was categorized into 94 elements divided into sections, categories, domains, and subdomains.
Conclusions
A methodological guide, including the assessment framework, was developed for the Spanish HTA network. The framework is divided into several sections addressing evidence-gathering, provision models, organizational elements, economic evaluation, and ethical and social implications. Compared to other available frameworks, our proposal included aspects such as bioinformatics, technological maturity level, and the patient perspective with the personal utility domain.
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
Methods
Participants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
Results
COVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
Conclusions
COVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
Antequera in southern Spain is widely recognised as an outstanding example of the European megalithic phenomenon. One of its most remarkable features is the evident relationship between conspicuous natural formations and human-built monuments. Here, the authors report the results of their investigation of a tomb newly discovered at the site of Piedras Blancas at the foot of La Peña de los Enamorados, a limestone massif that dominates the Antequera plain. Excavation and multidisciplinary study, including geological, architectural and archaeoastronomical investigations, have revealed a complex funerary monument that is part natural, part built, part hypogeum, part megalith. The results emphasise the centrality of La Peña in the Neolithic worldview and encourage wider investigation of prehistoric place-making.
In contrast with optimistic shōnen protagonists, some Japanese popular franchises focus on characters that deal with psychological traumas and despondency. These young protagonists are saddled with responsibilities such as the survival of humankind. They carry out their assumed duties regardless of their mental instability. Even as reversals of fortune keep piling up, they press forward as if they had no other option. They will go as far as to sacrifice themselves for a world they reject. This chapter analyzes these works and explores the reasons why these nihilists with stamina have gained so much traction in the last decades.
Introduction: From zero to (loath) hero
In his study of the ecosystem of Weekly Shōnen Jump, one of the most influential weekly manga magazines since its advent in 1968 and especially since the 1980s, Bryan Hikari Hartzheim argues that although it has become a highly sophisticated publication in terms of production routines adapted to new forms of content consumption, its foundational motto “Friendship, Effort, Victory” continues to be the driving force behind the drafts that circulate at Shueisha offices (2019, 5). This seems logical considering the stable demand for the demographic genre shōnen (manga for boys) since the consolidation of the manga and anime markets in the 1970s. So much so that shōnen is the main culprit for the widespread identification of both Japanese comics and animation with the stories of self-improvement, positive values and happy endings that have dominated the market up to now.
Shōnen stories starring young action heroes have been distributed all over the world, and their sway has been acknowledged by successive Japanese administrations, which have co-opted the genre for cultural diplomacy actions. One of the most memorable moments of such diplomacy on a global scale came at the Rio 2016 Olympics closing ceremony with the brief presentation of the Tokyo 2020 Olympics (postponed to 2021 because of the COVID-19 pandemic). The inclusion of well-known figures such as Doraemon and supokon stars (a paradigmatic shōnen sub-genre) such as Tsubasa Oozora in the presentation sequence of the Japanese capital alongside athletes and Prime Minister Abe Shinzō is evidence of the extreme popularity of these heroes and their affinity with the Olympic creed: “[T]he most important thing in life is not the triumph but the struggle.
To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms.
Design:
An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used.
Setting:
Spanish older adults with metabolic syndrome (MetS).
Participants:
A total of 6625 adults aged 55–75 years from the PREDIMED-Plus study with overweight or obesity and MetS.
Results:
Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)).
Conclusions:
According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.
The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (Pfor trend = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (β (95 %) CI = −0·67 z-score (–1·17, −0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time.
Globally, rock art is one of the most widely distributed manifestations of past human activity. Previous research, however, has tended to focus on the art rather than artists. Understanding which members of society participated in creating such art is crucial to interpreting its social implications and that of the sites at which it is found. This article presents the first application of a method—palaeodermatoglyphics—for the estimation of the sex and age of two later prehistoric individuals who left their fingerprints at the Los Machos rockshelter in southern Iberia. The method has the potential to illuminate the complex socio-cultural dimensions of rock art sites worldwide.
This paper examines how monuments with ‘local’ idiosyncrasies are key in processes of place-making and how, through persistence, such places can engage in supra-local and even ‘global’ dynamics. Departing from a detailed revision of its context, materiality and iconography, we show how a remarkable Iberian ‘warrior’ stela brings together the geo-strategic potential of a unique site, located literally between the Mediterranean and the Atlantic worlds, the century-long dialogue between shared and local identities and the power of connectivity of inexorable global processes. Previous approaches to Iberian late prehistoric stelae have had problems in developing bottom-up, theoretically informed and empirically sound approaches to their simultaneously local and supra-local character. The remarkable site of Almargen provides the opportunity to explore this issue. Located in Lands of Antequera (Málaga), a region with a strong tradition of landscape-making through monuments going back to the Late Neolithic, the Almargen ‘warrior’ stela serves us to explore the notion of ‘glocalization’, which embodies persistent local engagements with material culture, sites and landscapes on the one hand, and their connections with wider regional and even ‘global’ worlds on the other.
A remarkable stela from Montoro, southern Spain, is unique in its morphology, epigraphic traits and landscape context. A programme of chemical characterisation, digital imaging, and geo-lithological and epigraphic analyses were conducted to determine its age and significance, and the results were integrated with data from archaeological investigations of the surrounding area. This multi-faceted approach allowed the stela to be interpreted within the context of early interactions between literate Mediterranean societies of the Late Bronze Age and Iron Age and non-literate Iberian societies. A key outcome of this research is a wider understanding of the complex patterns in the use and perception of early scripts.
Nerja Cave is a karstic cavity used by humans from Late Paleolithic to post-Chalcolithic times. Remains of molluscan foods in the uppermost Pleistocene and Holocene sediments were studied with cluster analysis and principal components analysis, in bothQ and R modes. The results from cluster analysis distinguished interval groups mainly in accordance with chronology and distinguished assemblages of species mainly according to habitat. Significant changes in the shellfish diet through time were revealed. In the Late Magdalenian, most molluscs consumed consisted of pulmonate gastropods and species from sandy sea bottoms. The Epipaleolithic diet was more varied and included species from rocky shorelines. From the Neolithic onward most molluscs consumed were from rocky shorelines. From the principal components analysis inQ mode, the first factor reflected mainly changes in the predominant capture environment, probably because of major paleogeographic changes. The second factor may reflect selective capture along rocky coastlines during certain times. The third factor correlated well with the sea-surface temperature curve in the western Mediterranean (Alboran Sea) during the late Quaternary.
New data and a review of historiographic information from Neolithic sites of the Malaga and Algarve coasts (southern Iberian Peninsula) and from the Maghreb (North Africa) reveal the existence of a Neolithic settlement at least from 7.5 cal ka BP. The agricultural and pastoralist food producing economy of that population rapidly replaced the coastal economies of the Mesolithic populations. The timing of this population and economic turnover coincided with major changes in the continental and marine ecosystems, including upwelling intensity, sea-level changes and increased aridity in the Sahara and along the Iberian coast. These changes likely impacted the subsistence strategies of the Mesolithic populations along the Iberian seascapes and resulted in abandonments manifested as sedimentary hiatuses in some areas during the Mesolithic–Neolithic transition. The rapid expansion and area of dispersal of the early Neolithic traits suggest the use of marine technology. Different evidences for a Maghrebian origin for the first colonists have been summarized. The recognition of an early North-African Neolithic influence in Southern Iberia and the Maghreb is vital for understanding the appearance and development of the Neolithic in Western Europe. Our review suggests links between climate change, resource allocation, and population turnover.
The specific aim of this study was to analyze the psychometric properties of the English version of the Health-Related Quality of Life for Drug Abusers Test (HRQoLDA Test) applying the Rasch model, and emphasizing fit between empirical data and theoretical Rasch model assumptions; item(s) category probability curve; and precision in terms of information function. In this study, the authors present the results of the translation and adaptation of the original Spanish version to English, as applied to a sample of substance users in Australia. The authors evaluated 121 adults recruited from inpatient and outpatient treatment facilities in Sydney, Australia. The Rating Scale Model was used in the psychometric analysis of the English version of the HRQoLDA Test. The items and persons revealed a fit between the reported data and the model. It was also demonstrated that respondents did not discriminate among the five response categories, which led to a reduction to three response categories. The adaptation of the TECVASP to the English language, renamed the HRQoLDA test, as developed with an Australian sample revealed adequate psychometric properties.
Sexual harassment is among the most serious forms of gender violence, and what all violent acts have in common are the many myths associated with them. Three studies were conducted to adapt a Spanish version of the Illinois Sexual Harassment Myth Acceptance (ISHMA) scale, which assesses myths about sexual harassment. The first study aimed to, for the first time, present psychometric data on the Spanish version of the ISHMA. The participants were 339 college students. After adapting the items and measuring their content validity, we examined the test’s dimensional structure, statistically analyzed the items, and determined the instrument’s reliability (α = .91 for the total scale and between .77 and .84 for the different dimensions). Study 2 involved 326 adult participants from the general population and its objective was to evaluate the scale’s dimensional structure through confirmatory factor analysis (χ2143 = 244.860, p < .001; GFI = .952; CFI = .958; RMSEA = .034 [.026 – .041]). The third study was conducted in order to measure convergent validity in both students and adults from the general population. Differences by gender were found in all dimensions being the females’ means higher than males (Cohen´s d between .38 and .62). Our findings suggest the Spanish version of the ISHMA is a useful instrument to study myths about sexual harassment.
To study the effectiveness of safety devices intended to prevent percutaneous injuries.
Design.
Quasi-experimental trial with before-and-after intervention evaluation.
Setting.
A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002.
Methods.
In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour “hands-on” training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006).
Results.
We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P = .002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P = .007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was €0.558 (US$0,753) per patient in the emergency department and €0.636 (US$0,858) per patient-day in the hospital wards.
Conclusion.
Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.
An experimental and numerical study has been performed to improve the understanding of the air/liquid interaction in an air-blasted breaking water sheet. This research is focused in the near field close to the exit slit, because it is in this region where instabilities develop and grow, leading to the sheet breakup. In the experiments, several relevant parameters were measured including the sheet oscillation frequency and wavelength, as well as the droplet size distribution and the amplification growth rate. The flow was also investigated using linear instability theory. In the context of existing papers on instability analysis, the numerical part of this work presents two unique features. First, the air boundary layer is taken into account, and the effects of air and liquid viscosity are revealed. Second, the equations are solved for the same parameter values as those in the experiments, enabling a direct comparison between calculations and measurements; although qualitatively the behaviour of the measured variables is properly described, quantitative agreement is not satisfactory. Limitations of the instability analysis in describing this problem are discussed. From all the collected data, it is confirmed that the oscillation frequency strongly depends on the air speed due to the near-nozzle air/water interaction. The wave propagates with accelerating interface velocity which in our study ranges between the velocity of the water and twice that value, depending on the air velocity. For a fixed water velocity, the oscillation frequency varies linearly with the air velocity. This behaviour can only be explained if the air boundary layer is considered.
Nicholas Georgescu-Roegen (1971) pointed out in his seminal book, The Entropy Law and the Economic Process, that “… the science of thermodynamics began as a physics of economic value and, basically, can still be regarded as such. The Entropy Law itself emerges as the most economic in nature of all natural laws… the economic process and the Entropy Law is only an aspect of a more general fact, namely, that this law is the basis of the economy of life at all levels…”
Might the justification of thermoeconomics be said in better words?
Since Georgescu-Roegen wrote about the entropic nature of the economic process, no significant effort was made until the 1980s to advance and fertilize thermodynamics with ideas taken from economics. At that time most thermodynamicists were polishing theoretical thermodynamics or studying the thermodynamics of irreversible processes.
But the Second Law tells us more than about thermal engines and heat flows at different temperatures. One feels that the most basic questions about life, death, fate, being and nonbeing, and behavior are in some way related to Second Law. Nothing can be done without the irrevocable expenditure of natural resources, and the amount of natural resources needed to produce something is its thermodynamic cost. All the production processes are irreversible, and what we irreversibly do is destroy natural resources.
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