The Need for Unification and Harmonization in a Maritime Licensing Standard for Recreational Craft

The objective of this document is to make clear the importance of simplifying the transit of pleasure boats and their skippers safely in the European territory with the foreseeable improvement of the functioning of the internal market. In many European countries recreational skippers are required to have specific training and experience in order to demonstrate their maritime competence. These licenses for navigation allow a recreational vessel to be skippered in each national territory. One of the main objectives of these qualifications is to reduce the number of accidents in recreational boating. Generally speaking, in the European Union, as regards the requirements for the management of pleasure craft, both private and professional, the requirements are very different depending on the member state

A atividade de desmantelamento de navios nas águas da Baía de Cádis

This paper reviews existing levels of heavy metals and other compounds which are toxic for human health and the environment in the waters of the Bay of Cadiz. It addresses the impact of the ship-dismantling activity by analysing and discussing the data provided by the Andalusian Regional Government’s Sampling Network, stressing some of the compounds which are susceptible of being present at the time of the breaking up of a ship or vessel. We have compared the available official information with other studies of reference in the area, in addition with those related to the world’s largest ship-breaking facilities. Compared to baseline studies, the results for pollutant concentrations in the study area do not show significant indexes, which suggests it is necessary to carry out in-depth studies in the proposed area. Finally, we make a series of recommendations about the needs and sustainability priorities in the ship-recycling industry.El presente documento revisa los niveles existentes de metales pesados y otros compuestos tóxicos para la salud y el medio ambiente en las aguas de la bahía de Cádiz. En el mismo, se aborda el impacto de la actividad del desguace de buques mediante el estudio de los datos aportados por la Red de muestreo de la Junta de Andalucía y una discusión de los mismos, haciendo hincapié en algunos de los compuestos que son susceptibles de estar presentes en el momento del desmantelamiento de un buque o embarcación. La información oficial disponible es analizada y comparada con otros estudios de referencia en el área, además de los relacionados con las grandes instalaciones mundiales. En comparación con los estudios de referencia, los resultados de concentraciones de contaminantes en el área de estudio no muestran unos índices significativos, lo cual nos hace pensar sobre la necesidad de realizar estudios de mayor profundidad en el área propuesta. Por último, el estudio propone una serie de recomendaciones sobre las necesidades y las prioridades de la sostenibilidad en el reciclado de buques.O presente trabalho analisa os níveis existentes de metais pesados e outros compostos tóxicos para a saúde e o ambiente nas águas da baía de Cádis. No mesmo, aborda-se o impacto da ativada de desmantelamento de navios através do estudo e discussão dos dados fornecidos pela rede de amostragem da Junta da Andaluzia, focando em alguns compostos que são suscetíveis de estar presentes no momento do desmantelamento de um navio ou embarcação. A informação oficial disponível é analisada e comparada com outros estudos de referência na área, para além dos relacionados com grandes estaleiros mundiais. Em comparação com os estudos de referência, os resultados de concentrações de contaminantes na área em estudo não apresentam índices significativos, o que leva a refletir na necessidade da realização de estudos mais aprofundados sobre esta temática. Por último, o estudo propõe uma série de recomendações sobre as necessidades e as prioridades da sustentabilidade na reciclagem de navios

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

The Ro-Ro terminals and SSS

Este Trabajo profundiza en la forma de cómo se desarrollan los intercambios de mercancías en las terminales portuarias y de los factores que los determinan. El papel que juegan las terminales especializadas en el Transporte Marítimo de Corta Distancia (TMCD), las cuales establecen relaciones entre los diferentes modos de transporte tanto a nivel regional como mundial. Las terminales TMCD tienen una gran importancia en el sistema, elemento sobre el cual se articula los intercambios entre los sistemas marítimo y terrestre. El diseño, la gestión y su relación con los diferentes actores, requiere de los mejores medios disponibles para obtener unos resultados satisfactorios, en lo referente al coste de las operaciones y al servicio prestado a los usuarios, muy por encima de los niveles tradicionales y, con los cuales poder ser una alternativa al transporte por carreteraGrado en Ingeniería Náutica y Transporte Marítim

El perfeccionamiento de aptitudes del alumnado: la integración entre grados

La incorporación en el mercado laboral de los alumnos que finalizan sus estudios universitarios, se ha visto obstaculizada en las últimas décadas por la creciente necesidad de introducir contenidos prácticos educativos más efectivos que los empleados en los modelos tradicionales hasta el momento aplicados. Tras la introducción de estos nuevos contenidos, es estimulante para el alumnado el poder comparar el nivel del mercado laboral con el contenido educativo recibido a lo largo de su formación

Didáctica de la Música Comtemporánea en los Conservatorios de Música

Resumen basado en el de la publicaciónSe incluye archivo con anexosLa formación en arte moderno, muy particularmente en música, resulta muy compleja tanto a nivel primario como secundario. La enseñanza musical se canaliza a través de enseñanzas de régimen general y de régimen especial, formación cultural y formación técnica. Pero en ningún caso la propia legislación apuesta por los valores actuales, sino por la tradición, obviando en buena medida la evolución acaecida en música en los últimos cien años y sus aportaciones. Las principales causas de esta desatención podrían relacionarse con la eficiencia y con la innovación. La actividad docente – en última instancia – viene determinada por el cumplimiento de unas programaciones de amplios contenidos, que requieren una atención muy continuada y que dificultan la ampliación de dichos contenidos con el mismo tiempo de atención. Además, la innovación en contenidos requiere innovación en metodología, así como ampliación de recursos y conocimientos. Aplicar la innovación en términos de eficiencia, requiere del docente un esfuerzo verdaderamente extraordinario de puesta al día en conocimiento de estilos, repertorio, material didáctico (normalmente de difícil acceso, y principalmente editados en el extranjero), grabaciones… y saber adecuarlo a las circunstancias. El proyecto de innovación “Didáctica de la música contemporánea en los conservatorios de música” realizado en el Conservatorio Profesional de Música, C.P.M. “Marcos Redondo" de Ciudad Real, pretende paliar ese déficit de formación en los profesores, que termina por incidir en los alumnos. El hecho de tratarse de un proyecto de innovación supone un incentivo importante para la actividad docente individual, así como para priorizar esta cuestión a nivel de Centro.Consejería de Educación, Cultura y Deportes de Castilla-La ManchaCastilla La ManchaES

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study.

Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P  In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19