How to define the therapeutic limits

With the advance of technological progress and the increase in life expectancy, it is nowadays mandatory to define what is the therapeutic limit. Every day each physician must take therapeutic decisions on the basis of his scientific knowledge, but also of his own conscience and sense of limits. They can not avoid to consider the global risk of death, disability and morbidity in more advanced age, especially in the field of cardiology and cardiac surgery. In these subjects, both fit that frail, is necessary not only an evaluation for adequate risk assessment, but also a multidimensional assessment performed with advanced tools. The resilience of the subject, ability for which some patients considered out of therapy demonstrate the ability to adapt and overcome critical phases, must also be weighed. Where and what is the therapeutic limit should be evaluated individually with humility, competence and capacity for dialogue with other disciplines in a work team that respects the individual professionalism. In recent years, much has changed in the cardiology/cardiac surgery approach in old people. With the development of less or minimal invasive new techniques, there are no more insurmountable limits that can be connected only to the chronological age of the patients

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Scientific school calendar 2023 (English)

El proyecto “Calendario Científico Escolar 2023” ha consistido en la elaboración de un calendario dirigido al alumnado de educación primaria y secundaria obligatoria. Cada día se ha recogido un aniversario científico o tecnológico como, por ejemplo, nacimientos de personas de estos ámbitos o conmemoraciones de hallazgos destacables. Además, el calendario se acompaña de una guía didáctica con orientaciones para el aprovechamiento educativo transversal del calendario en las clases, incluyendo actividades adaptadas a cada rango de edad y al alumnado con necesidades especiales. Se trata de la cuarta edición de este proyecto de divulgación científica.Proyecto FCT-21-17253 de la Fundación Española para la Ciencia y la Tecnología (FECYT); Agencia Estatal de Investigación (España); Ministerio de Ciencia e Innovación; Consejo Superior de Investigaciones Científicas; Universidad de León; Delegación del CSIC en Castilla y León; Instituto de Ganadería de Montaña (IGM, CSIC-ULE); Casa de la Ciència de Valencia (CSIC); Cátedra de Cultura Científica de la Universidad del País Vasco/ Euskal Herriko Unibertsitatea (UPV/EHU); People Help; University of California-Davis; Academia de la Llingua Asturiana; Federación Española de Esperanto; Teagasc; PuraVida Software; Universidad de Zaragoza; Casa Árabe; CSIC Delegació a Catalunya; CCULT.org; Museo Didáctico e Interactivo de Ciencias de la Vega Baja del Segura (MUDIC VBS-CV); Universidad Miguel Hernández; Unidade de Divulgación Científica e Cultural - Universidade da Coruña; Asociación Cultural Nogará ReligadaMujeres con Ciencia; Asociaţia Secular-Umanistă din România; Instituto Geológico y Minero de España (IGME); Centro de Biología Molecular Severo Ochoa (CSIC-UAM); Asociación Española para el Avance de la Ciencia (AEAC); Centro de Investigación del Cáncer (CIC, CSIC-USAL); Discapacitodos; Universitat de les Illes Balears (UIB); Comisión Mujeres y Ciencia de la Sociedad Geológica de España; Institut d’Investigació en Intel.ligéncia Artificial (IIIA-CSIC); Centre for Research in Agricultural Genomics (GRAG, CSIC-UAB-ICREA); Escuela de Estudios Hispano-americanos (CSIC); Institut Botànic de Barcelona (IIB, CSIC-Ajuntament Barcelona); Institut de Ciència de Materials de Barcelona (ICMAB, CSIC); Institut de Ciències del Mar (ICM, CSIC); PRISMA – Asociación para la diversidad afectivo-sexual y de género en ciencia, tecnología e innovación; Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA, CSIC); Círculo Escéptico; Civiencia; Universidad Autónoma de Madrid; Escuela de Estudios Árabes (CSIC); Evento Ciencia; Europa Laica; Universidad de Oviedo; Institut de Microelectrònica de Barcelona - Centre Nacional de Microelectrònica (IMB-CNM, CSIC); Centre d'Estudis Avançats de Blanes (CEAB, CSIC).Peer reviewe

Scienca lerneja kalendaro 2023 (esperanto)

El proyecto “Calendario Científico Escolar 2023” ha consistido en la elaboración de un calendario dirigido al alumnado de educación primaria y secundaria obligatoria. Cada día se ha recogido un aniversario científico o tecnológico como, por ejemplo, nacimientos de personas de estos ámbitos o conmemoraciones de hallazgos destacables. Además, el calendario se acompaña de una guía didáctica con orientaciones para el aprovechamiento educativo transversal del calendario en las clases, incluyendo actividades adaptadas a cada rango de edad y al alumnado con necesidades especiales. Se trata de la cuarta edición de este proyecto de divulgación científica.Proyecto FCT-21-17253 de la Fundación Española para la Ciencia y la Tecnología (FECYT); Agencia Estatal de Investigación (España); Ministerio de Ciencia e Innovación; Consejo Superior de Investigaciones Científicas; Universidad de León; Delegación del CSIC en Castilla y León; Instituto de Ganadería de Montaña (IGM, CSIC-ULE); Casa de la Ciència de Valencia (CSIC); Cátedra de Cultura Científica de la Universidad del País Vasco/ Euskal Herriko Unibertsitatea (UPV/EHU); People Help; University of California-Davis; Academia de la Llingua Asturiana; Federación Española de Esperanto; Teagasc; PuraVida Software; Universidad de Zaragoza; Casa Árabe; CSIC Delegació a Catalunya; CCULT.org; Museo Didáctico e Interactivo de Ciencias de la Vega Baja del Segura (MUDIC VBS-CV); Universidad Miguel Hernández; Unidade de Divulgación Científica e Cultural - Universidade da Coruña; Asociación Cultural Nogará Religada.Mujeres con Ciencia; Asociaţia Secular-Umanistă din România; Instituto Geológico y Minero de España (IGME); Centro de Biología Molecular Severo Ochoa (CSIC-UAM); Asociación Española para el Avance de la Ciencia (AEAC); Centro de Investigación del Cáncer (CIC, CSIC-USAL); Discapacitodos; Universitat de les Illes Balears (UIB); Comisión Mujeres y Ciencia de la Sociedad Geológica de España; Institut d’Investigació en Intel.ligéncia Artificial (IIIA-CSIC); Centre for Research in Agricultural Genomics (GRAG, CSIC-UAB-ICREA); Escuela de Estudios Hispano-americanos (CSIC); Institut Botànic de Barcelona (IIB, CSIC-Ajuntament Barcelona); Institut de Ciència de Materials de Barcelona (ICMAB, CSIC); Institut de Ciències del Mar (ICM, CSIC); PRISMA – Asociación para la diversidad afectivo-sexual y de género en ciencia, tecnología e innovación; Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA, CSIC); Círculo Escéptico; Civiencia; Universidad Autónoma de Madrid; Escuela de Estudios Árabes (CSIC); Evento Ciencia; Europa Laica; Universidad de Oviedo; Institut de Microelectrònica de Barcelona - Centre Nacional de Microelectrònica (IMB-CNM, CSIC); Centre d'Estudis Avançats de Blanes (CEAB, CSIC).Peer reviewe