Uso de cuestionarios digitales en el aula y realización de seminarios en la unidad de cuidados intensivos como innovaciones docentes en Ingeniería Biomédica

La Ingeniería Biomédica proporciona una herramienta esencial para la formación de nuevos profesionales capaces de diseñar y gestionar la próxima generación de dispositivos médicos. La interacción de los futuros ingenieros e ingenieras y los profesionales de la medicina es importante para lograr un correcto aprendizaje de los alumnos y asegurar la adecuada atención a los pacientes. Los problemas más frecuentes detectados por los profesores y profesoras del Grado han sido la baja asistencia y la falta de interés de los alumnos y alumnas por no encontrar un enfoque práctico a los conocimientos adquiridos. Con el objetivo de mejorar esta situación, se introdujeron dos nuevas herramientas docentes en el módulo de Fisiología del Grado de Ingeniería Biomédica: la resolución de cuestionarios digitales en las clases y la realización de seminarios docentes en la unidad de cuidados intensivos del Hospital General Universitario Santa Lucía. La realización de los cuestionarios mejoró significativamente los resultados académicos de aquellos alumnos y alumnas que completaron como mínimo el 50% de los mismos, así como la asistencia a clase, alcanzándose un 73% del total de alumnos matriculados. La eficacia del seminario se evaluó mediante encuestas anónimas y opiniones de texto libre. Todos los/as estudiantes encuestados se mostraron satisfechos (6%) o muy satisfechos (94%) con esta actividad. En resumen, el uso de estas nuevas metodologías aumentó las calificaciones, la asistencia a clase y la motivación de los alumnos y alumnas, mejorando la adquisición de conocimientos, el desarrollo de habilidades comunicativas y su capacidad crítica.Por último, agradecer a los anteriores comités organizadores del CASEIB por su amabilidad al permitirnos usar sus guías de estilo como referencia para la realización de este documento

Uso de cuestionarios digitales en el aula y realización de seminarios en la unidad de cuidados intensivos como innovaciones docentes en Ingeniería Biomédica

La Ingeniería Biomédica proporciona una herramienta esencial para la formación de nuevos profesionales capaces de diseñar y gestionar la próxima generación de dispositivos médicos. La interacción de los futuros ingenieros e ingenieras y los profesionales de la medicina es importante para lograr un correcto aprendizaje de los alumnos y asegurar la adecuada atención a los pacientes. Los problemas más frecuentes detectados por los profesores y profesoras del Grado han sido la baja asistencia y la falta de interés de los alumnos y alumnas por no encontrar un enfoque práctico a los conocimientos adquiridos. Con el objetivo de mejorar esta situación, se introdujeron dos nuevas herramientas docentes en el módulo de Fisiología del Grado de Ingeniería Biomédica: la resolución de cuestionarios digitales en las clases y la realización de seminarios docentes en la unidad de cuidados intensivos del Hospital General Universitario Santa Lucía. La realización de los cuestionarios mejoró significativamente los resultados académicos de aquellos alumnos y alumnas que completaron como mínimo el 50% de los mismos, así como la asistencia a clase, alcanzándose un 73% del total de alumnos matriculados. La eficacia del seminario se evaluó mediante encuestas anónimas y opiniones de texto libre. Todos los/as estudiantes encuestados se mostraron satisfechos (6%) o muy satisfechos (94%) con esta actividad. En resumen, el uso de estas nuevas metodologías aumentó las calificaciones, la asistencia a clase y la motivación de los alumnos y alumnas, mejorando la adquisición de conocimientos, el desarrollo de habilidades comunicativas y su capacidad crítica.Por último, agradecer a los anteriores comités organizadores del CASEIB por su amabilidad al permitirnos usar sus guías de estilo como referencia para la realización de este documento

The association of germline variants with chronic lymphocytic leukemia outcome suggests the implication of novel genes and pathways in clinical evolution

Background Chronic Lymphocytic Leukemia (CLL) is the most frequent lymphoproliferative disorder in western countries and is characterized by a remarkable clinical heterogeneity. During the last decade, multiple genomic studies have identified a myriad of somatic events driving CLL proliferation and aggressivity. Nevertheless, and despite the mounting evidence of inherited risk for CLL development, the existence of germline variants associated with clinical outcomes has not been addressed in depth. Methods Exome sequencing data from control leukocytes of CLL patients involved in the International Cancer Genome Consortium (ICGC) was used for genotyping. Cox regression was used to detect variants associated with clinical outcomes. Gene and pathways level associations were also calculated. Results Single nucleotide polymorphisms in PPP4R2 and MAP3K4 were associated with earlier treatment need. A gene-level analysis evidenced a significant association of RIPK3 with both treatment need and survival. Furthermore, germline variability in pathways such as apoptosis, cell-cycle, pentose phosphate, GNα13 and Nitric oxide was associated with overall survival. Conclusion Our results support the existence of inherited conditionants of CLL evolution and points towards genes and pathways that may results useful as biomarkers of disease outcome. More research is needed to validate these findings.S

COSMO: Corrientes Marinas y Seguridad en el Medio Marino

Ejercicio internacional de salvamento y lucha contra la contaminación marina "Polex 24-17" organizado por la Dirección General de Marina Mercante y Salvamento Marítimo del 14 al 16 de junio de 2017 en SantanderDisponer en tiempo real de información sobre las corrientes oceánicas es clave para algunos de los servicios encomendados a la Sociedad de Salvamento y Seguridad Marítima y al Cuerpo Nacional de Policía (CNP). Un alto porcentaje de las emergencias de búsqueda de personas y náufragos, y de los incidentes de contaminación gestionados por Salvamento Marítimo, tienen lugar en zonas cercanas a la costa. Asimismo, el 71% de los casos de restos humanos no identificados (CSI) acontecidos en España durante el período 1968-2015 se da en zonas costeras. El proyecto COSMO busca mejorar la eficacia de las operaciones de búsqueda y de predicción de derivas, y mejorar la proporción de identificaciones positivas acelerando la resolución de casos de recuperación de restos humanosProyecto cofinanciado por el Ministerio de Economía Industria y Competitividad y Fondos FEDER de la UE (COSMO-CTM2016-79474-R, UE)Peer Reviewe

Atlas of surface currents in the Mediterranean and Canary-Iberian-Biscay waters

24 pages, 10 figures, 3 tablesSea surface currents probably are the most relevant essential ocean variable affecting diverse societal challenges concerning the marine environmental (as, for example, safe and efficient navigation, marine pollution and ecological connectivity). This work introduces a climatological Atlas (monthly resolution) of currents in the Mediterranean and Canary–Iberian–Biscay basins, based on today's state of the art reanalyses of the ocean circulation. The focus is on surface and subsurface reanalyses (here understood as z∼0.5 and z∼15 m, respectively) provided by the Copernicus Marine Environment Monitoring Service (CMEMS). The climatological values are computed from the median of the empirical probability density functions and the Atlas also includes the variance matrix and a bimodality index to have quantitative information on their variability. For both domains, the subsurface climatological fields are reasonably consistent with circulation schemes proposed in the previous literature but clearly improving the time and space resolution of the emerging patterns. For the Canary–Iberian–Biscay domain, the monthly climatological surface currents capture accurately the characteristic seasonal signal and its transition between a favourable and non-favourable upwelling regime. In the Mediterranean basin, differences between the near-surface and the 15 m velocity fields suggest a non-negligible role of winds over the variability of the uppermost ocean layer, specially in the Eastern Mediterranean basin. This is, up to our knowledge, the first time that such near-surface climatological patterns are computed. It has been found that, in general, the resulting patterns agree with surface drifter trajectories. In several regions, interannual variability foster bimodal and multimodal probability distributions. The Atlas has been conceived with the purpose of providing a first quantitative assessment on the surface circulation, thus being a complementary tool of real-time ocean forecasting systems. The Atlas is distributed following the FAIR principles and is accompanied with a digital version, with enhanced visualization capabilities for both research and assessmentThis is a contribution made with support of COSMO project funded by the Spanish Ministry of Economy, Industry and Competitiveness (Code: CTM2016-79474-R) and MEDOSMOSIS (Code: 6MED20_4.1_SP_005) funded by the INTERREG-MED program. S. González-Motos was under contract of COSMO project. The support of MEDOSMOSIS has been crucial to extend the work to the whole Mediterranean basin.The authors would like to thank the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)Peer reviewe

Atlas of currents and their variability in the mediterranean and canary-iberian-biscay waters

VI Expanding Ocean Frontiers Conference (EOF 2021), 5-7 July 2021The Canary-Iberian-Biscay and Mediterranean basins are of particular interest for the high anthropic pressure regarding the use of the marine space for navigation, fisheries, aquaculture, and tourism. Just a few numbers, approximately 16% of the global marine trade and 33% of the global oil transportation cross through the Mediterranean. Their neighbour ountries are the destination for 33% of all international tourism. Such accumulation of population is a challenging situation for managing the maritime space from many aspects that go from marine safety issues to ecosystems threats associated with eutrophication, fisheries exploitation, pollutants, and plastics discharges. In facing all these aspects, the information about the surface currents and their variability is of primary importance. The climatological atlases of ocean currents are of great interest to have a first approach on how the flow organization may affect the aforementioned issues as a complementary tool despite the most recent advances in operational oceanography. Still, the well-known pilot charts often used by sailors include currents atlas for routing and navigation. One may see climatology value as the most representative field value for a given location in a given season or month. The determination of the velocity fields from measurements is still a challenging topic of the Earth observation system [Isern-Fontanet et al. 2017]. Nevertheless, operational centres are able today to provide reanalyses of the ocean circulation over the last three decades. We present here an Atlas of monthly climatological currents for the waters in the Canary-Iberian-Biscay and Mediterranean basins built from the latest up-to-date reanalysis for such region [Martínez et al. 2021]. The advances in terms of data collection and time span facilitate the derivation of statistically robust but also representative high-resolution climatological atlas that may be used for operational purposes. The monthly climatological atlas includes surface and subsurfacecurrents and variance matrix at each grid point to provide quantitative information on the variability of currents. The climatological fields are computed using two different current velocity products for the Mediterranean (from altimetry measurements and MEDSEA reanalysis) and one product for the Atlantic domain only based on data (GLOBCURRENT project). Results unveiled important differences between surface (0-1 m.) and subsurface (15-16 m.) currents patterns in both the Atlantic and Mediterranean basin, a fact never discussed in dealing with typical ocean circulation schemes. The differences are significant in summer, in both the Mediterranean and Atlantic waters, showing the non-negligible role of winds [Gerin et al. 2009] even in the climatological value of the ocean currents. Figure 1 illustrates some qualitative examples with true independent data using drifters trajectories extracted from the COSMO database (http//cosmo.icm.csic.es/drifters/). Northern winds mould the east Mediterranean superficial currents in summer (see atlas currents and 4-meters CMOD drifters¿ trajectories in the left upper side of fig. 1). Left lower side of fig.1 shows the winter Atlas currents at the north east of the Iberian Peninsula together with the trajectories of drifters deployed in November 2006 the Cape of Finisterre [García-Ladona et al. 2015] and those deployed in December 2002 [García-Ladona et al. 2005]. Drifters from [Sotillo et al. 2008] also reflect the current towards the south in summer (right hand side of the figure

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society