[Impacto de la covid-19 en el estrés, la ansiedad y la depresión en personas con Trastorno Obsesivo Compulsivo: una revisión sistemática.] / Impact of covid-19 on stress, anxiety and depression in people with Obsessive-Compulsive Disorder: a systematic review.

OBJECTIVE: The population's mental health has been compromised by a global pandemic, especially in patients with obsessive-compulsive disorder. The objective of this study was to evaluate the levels of stress, anxiety and depression in patients with obsessive-compulsive disorder during COVID-19 pandemic. METHODS: A systematic review was carried out following the PRISMA format in the electronic databases Pubmed, Scopus, Web of Science, Dialnet and Medline between the months of January and May 2023. Method quality was assessed based on the critical evaluation tools for studies of the Joanna Briggs Institute (JBI). RESULTS: A total of twelve studies were included in this review. The mental health of the population has been compromised by the COVID-19 pandemic, with patients with obsessive-compulsive disorder being especially affected. Although there was a wide variability of results, it was observed that the level of stress and anxiety increased during the pandemic. CONCLUSIONS: The mental health of patients with obsessive-compulsive disorder, especially washing machine patients, is compromised in times of pandemic, presenting medium-high levels of stress, anxiety and depression.

OBJETIVO: La salud mental de la población se ha visto comprometida ante una situación de pandemia mundial, especialmente en pacientes con Trastorno Obsesivo Compulsivo (TOC). El objetivo de este estudio fue evaluar los niveles de estrés, ansiedad y depresión en pacientes con TOC durante la pandemia de la COVID-19. METODOS: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicas Pubmed, Scopus, Web of Science, Dialnet y Medline entre los meses de enero y mayo de 2023. A partir de las herramientas de evaluación crítica para estudios del Joanna Briggs Institute (JBI) se evaluó la calidad metodológica. RESULTADOS: Un total de doce estudios fueron incluidos en esta revisión. La salud mental de la población se vio comprometida ante la pandemia de la COVID-19, siendo especialmente afectados los pacientes con TOC. Aunque existió una amplia variabilidad de resultados, se observó que el nivel de estrés y ansiedad aumentó durante la pandemia. CONCLUSIONES: La salud mental de los pacientes con TOC, especialmente los que tienen TOC de limpieza, se ve comprometida en tiempos de pandemia, presentando niveles medios-altos de estrés, ansiedad y depresión.

Effects of hydrogeochemistry on the microbial ecology of terrestrial hot springs.

Temperature, pH, and hydrochemistry of terrestrial hot springs play a critical role in shaping thermal microbial communities. However, the interactions of biotic and abiotic factors at this terrestrial-aquatic interface are still not well understood on a global scale, and the question of how underground events influence microbial communities remains open. To answer this, 11 new samples obtained from the El Tatio geothermal field were analyzed by 16S rRNA amplicon sequencing (V4 region), along with 191 samples from previous publications obtained from the Taupo Volcanic Zone, the Yellowstone Plateau Volcanic Field, and the Eastern Tibetan Plateau, with their temperature, pH, and major ion concentration. Microbial alpha diversity was lower in acid-sulfate waters, and no significant correlations were found with temperature. However, moderate correlations were observed between chemical parameters such as pH (mostly constrained to temperatures below 70°C), SO4 2- and abundances of members of the phyla Armatimonadota, Deinococcota, Chloroflexota, Campilobacterota, and Thermoplasmatota. pH and SO4 2- gradients were explained by phase separation of sulfur-rich hydrothermal fluids and oxidation of reduced sulfur in the steam phase, which were identified as key processes shaping these communities. Ordination and permutational analysis of variance showed that temperature, pH, and major element hydrochemistry explain only 24% of the microbial community structure. Therefore, most of the variance remained unexplained, suggesting that other environmental or biotic factors are also involved and highlighting the environmental complexity of the ecosystem and its great potential to test niche theory ecological associated questions. IMPORTANCE This is the first approach to investigate whether geothermal processes could have an influence on the ecology of thermal microbial communities on a global scale. In addition to temperature and pH, microbial communities are structured by sulfate concentrations, which depends on the tectono-magmatic settings (such as the depth of magmatic chambers) and the local settings (such as the availability of a confining layer separating NaCl waters from steam after phase separation) and the possibility of mixing with more diluted fluids. Comparison of microbial communities from different geothermal areas by homogeneous sequence processing showed that no significant geographic distance decay was detected on the microbial communities according to Bray-Curtis, Jaccard, unweighted, and weighted Unifrac similarity/dissimilarity indices. Instead, an ancient potential divergence in the same taxonomic groups is suggested between globally distant thermal zones.

Impacto de la COVID-19 en el estrés, la ansiedad y la depresión en personas con Trastorno Obsesivo Compulsivo: una revisión sistemática / mpact of COVID-19 on stress, anxiety and depression in people with Obsessive-Compulsive Disorder: a systematic review

Fundamentos: La salud mental de la población se ha visto comprometida ante una situación de pandemia mundial, especialmente en pacientes con Trastorno Obsesivo Compulsivo (TOC). El objetivo de este estudio fue evaluar los niveles de estrés, ansiedady depresión en pacientes con TOC durante la pandemia de la COVID-19. Métodos: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicasPubmed, Scopus,Web of Science, Dialnet yMedline entre los meses de enero y mayo de 2023. A partir de las herramientas de evaluación crítica paraestudios del Joanna Briggs Institute (JBI) se evaluó la calidad metodológica. Resultados: Un total de doce estudios fueron incluidos en esta revisión. La salud mental de la población se vio comprometidaante la pandemia de la COVID-19, siendo especialmente afectados los pacientes con TOC. Aunque existió una amplia variabilidad deresultados, se observó que el nivel de estrés y ansiedad aumentó durante la pandemia. Conclusiones: La salud mental de los pacientes con TOC, especialmente los que tienen TOC de limpieza, se ve comprometidaen tiempos de pandemia, presentando niveles medios-altos de estrés, ansiedad y depresión.(AU)

Bacground: The population’s mental health has been compromised by a global pandemic, especially in patients with obsessive-compulsive disorder. The objective of this study was to evaluate the levels of stress, anxiety and depression in patients withobsessive-compulsive disorder during COVID-19 pandemic. Methods: A systematic review was carried out following the PRISMA format in the electronic databases Pubmed, Scopus, Web ofScience, Dialnet and Medline between the months of January and May 2023. Method quality was assessed based on the critical evaluationtools for studies of the Joanna Briggs Institute (JBI). Results: A total of twelve studies were included in this review. The mental health of the population has been compromised by theCOVID-19 pandemic, with patients with obsessive-compulsive disorder being especially affected. Although there was a wide variabilityof results, it was observed that the level of stress and anxiety increased during the pandemic. Conclusions: The mental health of patients with obsessive-compulsive disorder, especiallywashing machine patients, is com-promised in times of pandemic, presenting medium-high levels of stress, anxiety and depression.(AU)

Longitudinal and bidirectional associations between posttraumatic stress disorder and emotional support among disaster-affected men and women.

Research has demonstrated a negative association between social support and symptoms of posttraumatic stress disorder (PTSD). This has been interpreted as a protective influence of social support against the development of posttraumatic stress symptoms (PTSS). Research on the opposite association is more limited, but findings suggest that PTSS have a negative impact on social support. There is conflicting evidence that these effects are moderated by gender. Few studies have assessed both associations and gender moderation in a postdisaster context. We examined the longitudinal and bidirectional effects of emotional support and PTSS and whether gender moderates these effects among U.S. survivors of the 2017-2018 season. Participants (N = 1,347) were assessed at four time points over 1 year. Bidirectional effects were assessed using cross-lagged, autoregressive analyses with the combined sample (Model 1) and grouped by gender (Model 2) to assess gender moderation. The results supported small bidirectional negative effects of social support and PTSS on one another from one assessment point (e.g. Wave 1) to the subsequent point (e.g., Wave 2) for all waves, ßs = -.07-.15, p < .001-p = .040. Multigroup analyses suggested the effects were not significantly different by gender. Overall, the results suggest that social support and PTSS may mutually diminish one another. Such effects may result in a positive or negative cascade wherein high PTSS may lead to lower social support and, therefore, even higher PTSS and vice versa. These findings support the importance of including social support in interventions to promote PTSS prevention and recovery.

Type III interferon drives thymic B cell activation and regulatory T cell generation.

The activation of thymic B cells is critical for their licensing as antigen presenting cells and resulting ability to mediate T cell central tolerance. The processes leading to licensing are still not fully understood. By comparing thymic B cells to activated Peyer's patch B cells at steady state, we found that thymic B cell activation starts during the neonatal period and is characterized by TCR/CD40-dependent activation, followed by immunoglobulin class switch recombination (CSR) without forming germinal centers. Transcriptional analysis also demonstrated a strong interferon signature, which was not apparent in the periphery. Thymic B cell activation and CSR were primarily dependent on type III IFN signaling, and loss of type III IFN receptor in thymic B cells resulted in reduced thymocyte regulatory T cell (Treg) development. Finally, from TCR deep sequencing, we estimate that licensed B cells induce development of a substantial fraction of the Treg cell repertoire. Together, these findings reveal the importance of steady-state type III IFN in generating licensed thymic B cells that induce T cell tolerance to activated B cells.

Global phylogenomic novelty of the Cas1 gene from hot spring microbial communities.

The Cas1 protein is essential for the functioning of CRISPR-Cas adaptive systems. However, despite the high prevalence of CRISPR-Cas systems in thermophilic microorganisms, few studies have investigated the occurrence and diversity of Cas1 across hot spring microbial communities. Phylogenomic analysis of 2,150 Cas1 sequences recovered from 48 metagenomes representing hot springs (42-80°C, pH 6-9) from three continents, revealed similar ecological diversity of Cas1 and 16S rRNA associated with geographic location. Furthermore, phylogenetic analysis of the Cas1 sequences exposed a broad taxonomic distribution in thermophilic bacteria, with new clades of Cas1 homologs branching at the root of the tree or at the root of known clades harboring reference Cas1 types. Additionally, a new family of casposases was identified from hot springs, which further completes the evolutionary landscape of the Cas1 superfamily. This ecological study contributes new Cas1 sequences from known and novel locations worldwide, mainly focusing on under-sampled hot spring microbial mat taxa. Results herein show that circumneutral hot springs are environments harboring high diversity and novelty related to adaptive immunity systems.

Reduced T Cell Priming in Microbially Experienced "Dirty" Mice Results from Limited IL-27 Production by XCR1+ Dendritic Cells.

Successful vaccination strategies offer the potential for lifelong immunity against infectious diseases and cancer. There has been increased attention regarding the limited translation of some preclinical findings generated using specific pathogen-free (SPF) laboratory mice to humans. One potential reason for the difference between preclinical and clinical findings lies in maturation status of the immune system at the time of challenge. In this study, we used a "dirty" mouse model, where SPF laboratory mice were cohoused (CoH) with pet store mice to permit microbe transfer and immune system maturation, to investigate the priming of a naive T cell response after vaccination with a peptide subunit mixed with polyinosinic-polycytidylic acid and agonistic anti-CD40 mAb. Although this vaccination platform induced robust antitumor immunity in SPF mice, it failed to do so in microbially experienced CoH mice. Subsequent investigation revealed that despite similar numbers of Ag-specific naive CD4 and CD8 T cell precursors, the expansion, differentiation, and recall responses of these CD4 and CD8 T cell populations in CoH mice were significantly reduced compared with SPF mice after vaccination. Evaluation of the dendritic cell compartment revealed reduced IL-27p28 expression by XCR1+ dendritic cells from CoH mice after vaccination, correlating with reduced T cell expansion. Importantly, administration of recombinant IL-27:EBI3 complex to CoH mice shortly after vaccination significantly boosted Ag-specific CD8 and CD4 T cell expansion, further implicating the defect to be T cell extrinsic. Collectively, our data show the potential limitation of exclusive use of SPF mice when testing vaccine efficacy.

An OGT-STAT5 Axis in Regulatory T Cells Controls Energy and Iron Metabolism.

The immunosuppressive regulatory T (Treg) cells exert emerging effects on adipose tissue homeostasis and systemic metabolism. However, the metabolic regulation and effector mechanisms of Treg cells in coping with obesogenic insults are not fully understood. We have previously established an indispensable role of the O-linked N-Acetylglucosamine (O-GlcNAc) signaling in maintaining Treg cell identity and promoting Treg suppressor function, via STAT5 O-GlcNAcylation and activation. Here, we investigate the O-GlcNAc transferase (OGT)-STAT5 axis in driving the immunomodulatory function of Treg cells for metabolic homeostasis. Treg cell-specific OGT deficiency renders mice more vulnerable to high-fat diet (HFD)-induced adiposity and insulin resistance. Conversely, constitutive STAT5 activation in Treg cells confers protection against adipose tissue expansion and impaired glucose and insulin metabolism upon HFD feeding, in part by suppressing adipose lipid uptake and redistributing systemic iron storage. Treg cell function can be augmented by targeting the OGT-STAT5 axis to combat obesity and related metabolic disorders.

Compliance with the clinical laboratory quality protocol in public primary healthcare centres.

The clinical and economic relevance of the clinical laboratories procedures in Andalusia (Spain) have led the Regional Department of Health to focus attention on their improvement. A unified laboratory protocol was implemented that consisted of the unification of criteria in the handling and processing of samples, and report of results. The objective of this study is to describe the degree of compliance with the clinical laboratory protocol in the preanalytical phase, which includes the analytical request and up to the delivery in the laboratory, as well as the influencing factors. Cross-sectional descriptive study with a sample of 214 healthcare professionals involved in the preanalytical phase of laboratory procedures in primary care. A self-reported questionnaire with 11 items was used for data collection. Each item was assessed separately with a scale from 0 to 10. A 5 points score was considered as the cutoff point. Descriptive analysis was conducted and Mann-Whitney U test was used to determine differences between subgroups. Internal consistency of the questionnaire was considered. The best rated item was verifying the correspondence between the request form and identity of the patient. Each item scored from 3 to 10, and the mean for each item ranged from 6.40 (standard deviation = 3.06) to 8.57 (standard deviation = 2.00). Values above or equal to 8 were obtained, for 63.6% of them. Statistically significant differences between accredited and nonaccredited centres were found. Differences were not noteworthy regarding centres with a teaching activity or those without it. All the items were measured separately. The compliance with the protocol was adequate among primary healthcare professionals, who have a strategic position in the sample collection and its transport during the preanalytical phase. Being so, standardisation should be a priority to reduce errors and improve clinical safety and results.

Type 2 cytokines in the thymus activate Sirpα+ dendritic cells to promote clonal deletion.

The thymus contains a diversity of dendritic cells (DCs) that exist in defined locations and have different antigen-processing and -presenting features. This suggests that they play nonredundant roles in mediating thymocyte selection. In an effort to eliminate SIRPα+ classic DC2 subsets, we discovered that a substantial proportion expresses the surface lectin, CD301b, in the thymus. These cells resemble the CD301b+ type 2 immune response promoting DCs that are present in the skin-draining lymph nodes. Transcriptional and phenotypic comparison to other DC subsets in the thymus revealed that thymic CD301b+ cDCs represent an activated state that exhibits enhanced antigen processing and presentation. Furthermore, a CD301b+ cDC2 subset demonstrated a type 2 cytokine signature and required steady-state interleukin-4 receptor signaling. Selective ablation of CD301b+ cDC2 subsets impaired clonal deletion without affecting regulatory T cells (Treg cells). The T cell receptor α repertoire sequencing confirmed that a cDC2 subset promotes deletion of conventional T cells with minimal effect on Treg cell selection. Together, these findings suggest that cytokine-induced activation of DCs in the thymus substantially enforces central tolerance.

Epithelial STAT6 O-GlcNAcylation drives a concerted anti-helminth alarmin response dependent on tuft cell hyperplasia and Gasdermin C.

The epithelium is an integral component of mucosal barrier and host immunity. Following helminth infection, the intestinal epithelial cells secrete "alarmin" cytokines, such as interleukin-25 (IL-25) and IL-33, to initiate the type 2 immune responses for helminth expulsion and tolerance. However, it is unknown how helminth infection and the resulting cytokine milieu drive epithelial remodeling and orchestrate alarmin secretion. Here, we report that epithelial O-linked N-Acetylglucosamine (O-GlcNAc) protein modification was induced upon helminth infections. By modifying and activating the transcription factor STAT6, O-GlcNAc transferase promoted the transcription of lineage-defining Pou2f3 in tuft cell differentiation and IL-25 production. Meanwhile, STAT6 O-GlcNAcylation activated the expression of Gsdmc family genes. The membrane pore formed by GSDMC facilitated the unconventional secretion of IL-33. GSDMC-mediated IL-33 secretion was indispensable for effective anti-helminth immunity and contributed to induced intestinal inflammation. Protein O-GlcNAcylation can be harnessed for future treatment of type 2 inflammation-associated human diseases.

Adverse events reported after administration of BNT162b2 and mRNA-1273 COVID-19 vaccines among hospital workers: a cross-sectional survey-based study in a Spanish hospital.

BACKGROUND: The World Health Organization declared COVID-19 a pandemic in March 2020. The first vaccine became available in December, with practically no post-marketing data. METHODS: An analytical cross-sectional survey-based study was conducted in a third-level hospital in Spain between March and April 2021 to describe the difference in adverse events with the BNT162b2 and mRNA-1273 COVID-19 vaccines. The participants were hospital workers who completed a survey voluntarily at least 14 days after the last vaccine. The STROBE checklist was followed. RESULTS: One thousand two hundred and forty-nine respondents completed the survey; 48% (599) received mRNA-1273 and 52% (650) BNT162b2. Fourteen thousand four hundred and two adverse reactions were recorded, 6896 local (3939 with mRNA-1273 and 2957 with BNT162b2 (6.6 vs 4.4 reactions per patient)) and 7506 systemic (4460 with mRNA-1273 and 3046 with BNT162b2 (7.4 vs 4.7 per patient)). Local reactions were more frequent after the first dose, while systemic reactions were higher after the second, for both vaccines and in a higher percentage with mRNA-1273 compared to BNT162b2 (p-value<0.05). CONCLUSIONS: Licensed mRNA vaccines were highly safe when administered under post-marketing conditions among working-age adults. The main adverse events were mild, although they occurred in most patients, especially after the mRNA-1273 vaccine.

Unveiling Ecological and Genetic Novelty within Lytic and Lysogenic Viral Communities of Hot Spring Phototrophic Microbial Mats.

Viruses exert diverse ecosystem impacts by controlling their host community through lytic predator-prey dynamics. However, the mechanisms by which lysogenic viruses influence their host-microbial community are less clear. In hot springs, lysogeny is considered an active lifestyle, yet it has not been systematically studied in all habitats, with phototrophic microbial mats (PMMs) being particularly not studied. We carried out viral metagenomics following in situ mitomycin C induction experiments in PMMs from Porcelana hot spring (Northern Patagonia, Chile). The compositional changes of viral communities at two different sites were analyzed at the genomic and gene levels. Furthermore, the presence of integrated prophage sequences in environmental metagenome-assembled genomes from published Porcelana PMM metagenomes was analyzed. Our results suggest that virus-specific replicative cycles (lytic and lysogenic) were associated with specific host taxa with different metabolic capacities. One of the most abundant lytic viral groups corresponded to cyanophages, which would infect the cyanobacteria Fischerella, the most active and dominant primary producer in thermophilic PMMs. Likewise, lysogenic viruses were related exclusively to chemoheterotrophic bacteria from the phyla Proteobacteria, Firmicutes, and Actinobacteria. These temperate viruses possess accessory genes to sense or control stress-related processes in their hosts, such as sporulation and biofilm formation. Taken together, these observations suggest a nexus between the ecological role of the host (metabolism) and the type of viral lifestyle in thermophilic PMMs. This has direct implications in viral ecology, where the lysogenic-lytic switch is determined by nutrient abundance and microbial density but also by the metabolism type that prevails in the host community. IMPORTANCE Hot springs harbor microbial communities dominated by a limited variety of microorganisms and, as such, have become a model for studying community ecology and understanding how biotic and abiotic interactions shape their structure. Viruses in hot springs are shown to be ubiquitous, numerous, and active components of these communities. However, lytic and lysogenic viral communities of thermophilic phototrophic microbial mats (PMMs) remain largely unexplored. In this work, we use the power of viral metagenomics to reveal changes in the viral community following a mitomycin C induction experiment in PMMs. The importance of our research is that it will improve our understanding of viral lifestyles in PMMs via exploring the differences in the composition of natural and induced viral communities at the genome and gene levels. This novel information will contribute to deciphering which biotic and abiotic factors may control the transitions between lytic and lysogenic cycles in these extreme environments.

Taxonomic Novelty and Distinctive Genomic Features of Hot Spring Cyanobacteria.

Several cyanobacterial species are dominant primary producers in hot spring microbial mats. To date, hot spring cyanobacterial taxonomy, as well as the evolution of their genomic adaptations to high temperatures, are poorly understood, with genomic information currently available for only a few dominant genera, including Fischerella and Synechococcus. To address this knowledge gap, the present study expands the genomic landscape of hot spring cyanobacteria and traces the phylum-wide genomic consequences of evolution in high temperature environments. From 21 globally distributed hot spring metagenomes, with temperatures between 32 and 75°C, 57 medium- and high-quality cyanobacterial metagenome-assembled genomes were recovered, representing taxonomic novelty for 1 order, 3 families, 15 genera and 36 species. Comparative genomics of 93 hot spring genomes (including the 57 metagenome-assembled genomes) and 66 non-thermal genomes, showed that the former have smaller genomes and a higher GC content, as well as shorter proteins that are more hydrophilic and basic, when compared to the non-thermal genomes. Additionally, the core accessory orthogroups from the hot spring genomes of some genera had a greater abundance of functional categories, such as inorganic ion metabolism, translation and post-translational modifications. Moreover, hot spring genomes showed increased abundances of inorganic ion transport and amino acid metabolism, as well as less replication and transcription functions in the protein coding sequences. Furthermore, they showed a higher dependence on the CRISPR-Cas defense system against exogenous nucleic acids, and a reduction in secondary metabolism biosynthetic gene clusters. This suggests differences in the cyanobacterial response to environment-specific microbial communities. This phylum-wide study provides new insights into cyanobacterial genomic adaptations to a specific niche where they are dominant, which could be essential to trace bacterial evolution pathways in a warmer world, such as the current global warming scenario.

Intestinal CD8αα IELs derived from two distinct thymic precursors have staggered ontogeny.

CD8αα intraepithelial lymphocytes (IELs) are abundant T cells that protect the gut epithelium. Their thymic precursors (IELps) include PD-1+ type A and Tbet+ type B populations, which differ in their antigen-receptor specificities. To better understand CD8αα IEL ontogeny, we performed "time-stamp" fate mapping experiments and observed that it seeds the intestine predominantly during a narrow time window in early life. Adoptively transferred IELps parked better in the intestines of young mice than in adults. In young mice, both type A and type B IELps had an S1PR1+ and α4ß7+ emigration- and mucosal-homing competent phenotype, while this was restricted to type A IELps in adults. Only CD8αα IELs established in early life were enriched in cells bearing type B IELp TCR usage. Together, our results suggest that the young intestine facilitates CD8αα IEL establishment and that early IELs are distinct from IELs established after this initial wave. These data provide novel insight into the ontogeny of CD8αα IELs.

[Applicability of decision aids in emergency departments: an exploratory review]. / Aplicabilidad de las herramientas de ayuda a la toma de decisiones compartidas en los servicios de Urgencias: una revisión exploratoria.

BACKGROUND: Decision aid tools (DAT) have been widely used in chronic diseases, but there are few studies on their usefulness in emergency departments. The objective of this study was to analyse the applicability of DAT in emergency services. METHODS: An exploratory review was conducted. Between January 1, 2012 and August 1, 2019, searches of randomised and controlled clinical trials, systematic reviews and other secondary studies where DAT are used to assist patients of any age in emergency services were conducted. The databases used were: Pubmed, Embase, Web Of Science, Cuiden, Patient Decision Aids Research Group IPDAS Collaboration, Cochrane, Centres for Reviews and Dissemination, National Guideline Clearinghouse, Guidelines International Network. Two reviewers analysed and selected the studies. RESULTS: Twelve studies of moderate-low quality were included. The patients in the intervention group (IG) were more aware of their illness (M=3.6 vs 3 correct answers and M=4.2 vs 3.6), and more involved in the decisions (score in OPTION: 26.6 vs 7 and 18.3 vs 7). The conflict was reduced in the IG regarding those imaging tests in the TBI (traumatic brain injury; M=14.8 vs 19.2). In the IG, admittance to perform effort tests was reduced in low-risk chest pain (58% vs 77%; CI95%=6%-31%, 37% vs 52%; p<0.001). When DAT were used in children with diarrhoea or vomiting, in 80% of the cases the decision was to use oral rehydration against 61% in the control group (CG, p=0.001). CONCLUSIONS: DAT in emergency services improve patient's knowledge about the disease and their participation in care. More studies are needed to develop DAT in emergency services.

OBJETIVO: Las herramientas de ayuda en la toma de decisiones (HATD) han sido muy utilizadas en las enfermedades crónicas, pero existen pocos estudios sobre su utilidad en los servicios de urgencias. El objetivo de este estudio fue analizar la utilización de las HATD en los servicios de urgencias. METODOS: Se realizó una revisión exploratoria. Se realizaron búsquedas de ensayos clínicos aleatorizados y controlados, revisiones sistemáticas y otros estudios secundar0ios donde se utilizaran las HATD para la asistencia a pacientes de cualquier edad en los servicios de urgencias, entre el 1 de enero de 2012 y el 1 de agosto de 2019. Dos revisores examinaron y seleccionaron los estudios. Se utilizaron las siguientes bases de datos: Pubmed, Embase, Web Of Science, Cuiden, Patient Decision Aids Research Group IPDAS Collaboration, Cochrane, Centres for Reviews and Dissemination, National Guideline Clearinghouse, Guidelines International Network. RESULTADOS: Se incluyeron doce estudios, de calidad metodológica moderada-baja. Los pacientes del Grupo de Intervención (GI) tenían mayor conocimiento de la enfermedad (M=3,6 frente a 3 preguntas correctas y M=4,2 frente a 3,6) y más implicación en las decisiones (puntuación en OPTION: 26,6 contra 7 y 18,3 contra 7). El conflicto se redujo en el GI en las decisiones sobre pruebas de imagen en el traumatismo craneoencefálico (TCE) (M=14,8 frente a 19,2). En el GI era menos frecuente el ingreso para realizar una prueba de esfuerzo en casos de dolor torácico de bajo riesgo (58% contra 77%; IC95%=6%-31%, y 37% contra 52%; p<0,001). Cuando se utilizaba una HATD en niños con diarrea o vómitos, en el 80% la decisión era seguir una rehidratación oral frente al 61% en el GC (p=0,001). CONCLUSIONES: Las HATD en los servicios de urgencias mejoran el conocimiento de los pacientes sobre la enfermedad y la participación en los cuidados. Se necesitan más estudios para desarrollar HATD en los servicios de urgencias.

A Descriptive Analysis of the Interactions During Clinical Supervision.

This study intends to analyze some skills trained during supervision. In it we describe sets of interactions (based on the American Psychological Association [APA], 2006; competency domains) happened between the supervisor and the supervisee during the supervision process. Interactions from twelve supervisor-supervisee dyads during asynchronous and direct, and individual and group supervision sessions were video recorded for this purpose. The recordings helped to determine, classify, and define behavioral response classes in each dyad's interactions. Percentages of time spent in each behavior class were computed. A reliability of 95% CI [0.91, 0.95] among observers was obtained. The behavior classes in which more time was spent were assessment, intervention, and conceptualization skills. Behavior classes in which less time was spent were related to emotional and interpersonal processes. These findings are discussed by linking the evidence-based theory on supervision with the time spent in each behavior class.

The lineage stability and suppressive program of regulatory T cells require protein O-GlcNAcylation.

Regulatory T (Treg) cells control self-tolerance, inflammatory responses and tissue homeostasis. In mature Treg cells, continued expression of FOXP3 maintains lineage identity, while T cell receptor (TCR) signaling and interleukin-2 (IL-2)/STAT5 activation support the suppressive effector function of Treg cells, but how these regulators synergize to control Treg cell homeostasis and function remains unclear. Here we show that TCR-activated posttranslational modification by O-linked N-Acetylglucosamine (O-GlcNAc) stabilizes FOXP3 and activates STAT5, thus integrating these critical signaling pathways. O-GlcNAc-deficient Treg cells develop normally but display modestly reduced FOXP3 expression, strongly impaired lineage stability and effector function, and ultimately fatal autoimmunity in mice. Moreover, deficiency in protein O-GlcNAcylation attenuates IL-2/STAT5 signaling, while overexpression of a constitutively active form of STAT5 partially ameliorates Treg cell dysfunction and systemic inflammation in O-GlcNAc deficient mice. Collectively, our data demonstrate that protein O-GlcNAcylation is essential for lineage stability and effector function in Treg cells.