8 research outputs found
Nomadism and intermittent ubiquity in âoff the gridâ Shuar people
Media ecology suggests that the anyone, anywhere, anytime slogan of the ubiquitous society characterizes our times. A priori, mobile technology in the âdigital ecosystemâ fits this circumstance. However, if we delocalize to a remote area, this initial assumption changes. Results of a case study analyzing the use and appropriation of mobile phones in the indigenous Amazon Shuar communities show a different reality that could be labeled âintermittent ubiquityâ. How does the delocalization facilitated by mobile telephones affect a remote area? How do Ecuadorian Shuars appropriate digital mobile technology? How does technological novelty become apparent in a context that is currently âoff the gridâ? These questions drive our interest in examining the three premises of the ubiquitous society slogan in this specific contex
El derecho a la comunicaciĂłn desde la etnia y el gĂ©nero: acceso y participaciĂłn indĂgena en el sur de Ecuador
Prevention of ventilator-associated pneumonia: the multimodal approach of the spanish ICU pneumonia zero program.
Objectives:
The âPneumonia Zeroâ project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU.
Design:
Prospective, interventional, and multicenter study.
Setting:
A total of 181 ICUs throughout Spain.
Patients:
All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012.
Intervention:
Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (AprilâJune 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status.
Measurements and Main Results:
The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42â11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22â5.84) after 19â21 months of participation.
Conclusions:
Implementation of the bundle measures included in the âPneumonia Zeroâ project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation
Nomadism and intermittent ubiquity in âoff the gridâ Shuar people
Media ecology suggests that the anyone, anywhere, anytime slogan of the ubiquitous society characterizes our times. A priori, mobile technology in the âdigital ecosystemâ fits this circumstance. However, if we delocalize to a remote area, this initial assumption changes. Results of a case study analyzing the use and appropriation of mobile phones in the indigenous Amazon Shuar communities show a different reality that could be labeled âintermittent ubiquityâ. How does the delocalization facilitated by mobile telephones affect a remote area? How do Ecuadorian Shuars appropriate digital mobile technology? How does technological novelty become apparent in a context that is currently âoff the gridâ? These questions drive our interest in examining the three premises of the ubiquitous society slogan in this specific contex
Linguistic adaptation and validation of the Spanish version of the Memorial Pain Assessment Card (MPAC)
Prevention of ventilator-associated pneumonia: the multimodal approach of the spanish ICU pneumonia zero program.
Objectives:
The âPneumonia Zeroâ project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU.
Design:
Prospective, interventional, and multicenter study.
Setting:
A total of 181 ICUs throughout Spain.
Patients:
All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012.
Intervention:
Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (AprilâJune 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status.
Measurements and Main Results:
The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42â11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22â5.84) after 19â21 months of participation.
Conclusions:
Implementation of the bundle measures included in the âPneumonia Zeroâ project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation
Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP
Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19
BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old