Sistemas de clasificación de pacientes en centros de media y larga estancia: evolución y perspectivas de futuro

ResumenLa atención de media y larga estancia es un sector cada vez más importante de la prestación de cuidados sanitarios. La utilización de sistemas de clasificación de pacientes se contempla cada vez más como un elemento necesario tanto en la planificación como en la gestión de servicios en el sector de atención a enfermos crónicos y geriátricos.Aunque mucho menos conocidos, los sistemas de clasificación de pacientes han tenido en el sector de la atención de media y larga estancia un desarrollo mucho más rico y precoz que en el sector hospitalario. De este modo, puede verse la evolución desde clasificaciones basadas exclusivamente en la valoración de la capacidad funcional de los residentes, hacia clasificaciones que incluyen progresivamente variables de complejidad asistencial, hasta sistemas elaborados como la clasificación RUG-III.Los sistemas de clasificación de pacientes se utilizaron inicialmente como instrumentos para soportar los sistemas de financiación de los centros de media y larga estancia basándose en las características de paciente. Posteriormente, sus aplicaciones se han ido extendiendo hacia otros objetivos relacionados con la gestión de los centros, la evaluación de la calidad asistencial, la determinación de niveles de dotación de personal, el control del acceso a la atención y la formulación de políticas gubernamentales. En España, la única experiencia de utilización de un sistema de clasificación de pacientes es la del Programa Vida Als Anys en Cataluña, que desde 1990 utiliza una clasificación para la financiación de los centros acogidos al mismo.SummaryThe importance of long term care sector is increasingly growing. Actually, the use of patient classification systems is a useful tool for the planning and management of health services for chronic and geriatric patients.Despite being much less known, patient classification systems have had a richer and earlier development in the long term care sector than in the acute care sector. Thus, one could see the evolution from classifications based on the assessment of functional dependency to classifications progressively including variables corresponding to clinical complexity, and finally to complex systems such as RUG-III.Patient classification systems were first utilised as tools for the financing of long term centres, based on the patients' characteristics. Later, their applications have spread out to objectives related to the management of centres, assessment of quality of care, staff allocation level, control of access and national policies. In Spain, the only experience in the use of a patient classification system is the one used by the Catalan Health Care Administration which uses a classification for the financing of their centres

Materias primas para la fabricación de clinker de cemento portland en el área de Madrid.

En Madrid y su area de influencia se ha incrementado la demanda de materiales de construcción, como consecuencia del espectacular desarrollo de las obras de infraestructura y de la edificación. Los problemas derivados del impacto ambiental y la futura expansión y/o renovación de las plantas de fabricación de cemento portland, aconsejan una investigación en el area, de las materias primas para la fabricación de clinker. Los materiales aflorantes en la cuenca Terciaria sobre la que se asienta Madrid, han sido divididos en tres unidades estratigráficas, con importantes diferencias litológicas. La Unidad Superior, presenta un volumen de mas de 1500 Mt de calizas de buena calidad para ser usadas como componente principal . La Unidad Inferior o Salina, esta formada localmente por sedimentos lutítico-arcillosos, que pueden ser usados en función de su naturaleza mineralógica y química, como un buen componente secundario. Estos materiales constituyen la materia prima para la fabricación de cerámica basta, por lo que en algunas zonas ambos tipos de uso deben de coexistir. Los yesos detríticos y primarios de la Unidad Intermedia, pueden ser usados como componente regulador de fraguado. Los modelos de dosificación elaborados muestran que no es necesaria la adición de un tercer componente al crudo del portland, para obtener una composición química adecuada

Development and evaluation of a multiplex test for the detection of atypical bacterial DNA in community-acquired pneumonia during childhood

AbstractAn incorrect or late diagnosis can lead to an increase in the morbidity and mortality caused by pneumonia, and the availability of a rapid and accurate microbiological test to verify the aetiology is imperative. This study evaluated a molecular test for the identification of the bacterial cause of atypical community-acquired pneumonia (ACAP). Fifty-four children with pneumonia were studied using bacteriological cultures, Mycoplasma pneumoniae, Coxiella burnetii, Chlamydophila pneumoniae and Legionella spp. serology, and Streptococcus pneumoniae and Legionella antigens. Simultaneously, the presence of bacterial and fungal DNA was tested for in respiratory secretion samples using the Vircell SL kit, including multiplex PCR and amplicon detection by means of line blots. There were 14 cases of ACAP caused by M. pneumoniae, with positive kit results for 13 of them, and two cases of Q-fever, with negative kit results for Coxiella burnetii. The test was negative in the remaining 38 cases (one staphylococcal pneumonia, 20 Streptococcus pneumoniae pneumonias, and 17 probable viral pneumonias). The sensitivity of the test for the detection of M. pneumoniae was 92.8% and the specificity was 100%. The Vircell SL kit allows detection of M. pneumoniae DNA in respiratory secretion samples from children with ACAP

Decoupled supercapacitive electrolyzer for membrane-free water splitting

Green hydrogen production via water splitting is vital for decarbonization of hard-to-abate industries. Its integration with renewable energy sources remains to be a challenge, due to the susceptibility to hazardous gas mixture during electrolysis. Here, we report a hybrid membrane-free cell based on earth-abundant materials for decoupled hydrogen production in either acidic or alkaline medium. The design combines the electrocatalytic reactions of an electrolyzer with a capacitive storage mechanism, leading to spatial/temporal separation of hydrogen and oxygen gases. An energy efficiency of 69% lower heating value (48 kWh/kg) at 10 mA/cm2 (5 cm–by–5 cm cell) was achieved using cobalt-iron phosphide bifunctional catalyst with 99% faradaic efficiency at 100 mA/cm2. Stable operation over 20 hours in alkaline medium shows no apparent electrode degradation. Moreover, the cell voltage breakdown reveals that substantial improvements can be achieved by tunning the activity of the bifunctional catalyst and improving the electrodes conductivity. The cell design offers increased flexibility and robustness for hydrogen production.E.A.T.-C. would like to thank the National Research and Development Agency of Chile (ANID) for the doctoral scholarship “Beca Chile” 2018-72190682. M.G.-R. and L.M.S.-M. would like to thank Campus Iberus for Erasmus+ KA103 scholarship and Facultad de Ciencias of University of Alicante for the internship scholarship. J.D. would like to acknowledge partial financing from Vinnova (diary no. 2021-02313) and Åforsk (ref. no. 21-105)

Intrinsic noise-induced phase transitions: beyond the noise interpretation

We discuss intrinsic noise effects in stochastic multiplicative-noise partial differential equations, which are qualitatively independent of the noise interpretation (Ito vs. Stratonovich), in particular in the context of noise-induced ordering phase transitions. We study a model which, contrary to all cases known so far, exhibits such ordering transitions when the noise is interpreted not only according to Stratonovich, but also to Ito. The main feature of this model is the absence of a linear instability at the transition point. The dynamical properties of the resulting noise-induced growth processes are studied and compared in the two interpretations and with a reference Ginzburg-Landau type model. A detailed discussion of new numerical algorithms used in both interpretations is also presented.Comment: 9 pages, 8 figures, to be published in Phys. Rev.

Neurobiology of social attachments

Many types of social attachments can be observed in nature. We discuss the neurobiology of two types (1) intraspecific (with a partner) and (2) parental (with the offspring). Stimuli related to copulation facilitate the first, whereas pregnancy, parturition and lactation facilitate the second. Both types develop as consequence of cohabitation. These events seem to stimulate similar neural pathways that increase (1) social recognition, (2) motivation, reward; and (3) decrease fear/anxiety. Subregions of the amygdala and cortex facilitate social recognition and also disinhibition to decrease rejection responses. The interrelationship between MeA, BNST, LS may mediate the activation of NAcc via the mPOA to increase motivation and reward. Cortical areas such as the ACC discriminate between stimuli. The interaction between OT and D2-type receptors in NAcc shell facilitates intraspecific attachment, but D1-type appears to facilitate parental attachment. This difference may be important for maternal females to direct their attention, motivation and expression of attachment toward the appropriate target.Cuerpo Académico UV-CA-28 Neurociencias. Grant SEP-CONACYT (167773) to GACA

Noise-Driven Mechanism for Pattern Formation

We extend the mechanism for noise-induced phase transitions proposed by Ibanes et al. [Phys. Rev. Lett. 87, 020601-1 (2001)] to pattern formation phenomena. In contrast with known mechanisms for pure noise-induced pattern formation, this mechanism is not driven by a short-time instability amplified by collective effects. The phenomenon is analyzed by means of a modulated mean field approximation and numerical simulations