Impact of operatoŕs experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry

Background: The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX. Methods: Prospective, multicenter, 'real-world' registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed ≤ 10 or > 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared. Results: 359 patients [mean age 75.5 (SD8.1), CHA2DS2-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the centeŕs previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed. Conclusions: The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operatoŕs experience with its previous device iteration or the number of Watchman FLX devices implanted

Material audiovisual para el mural "El Tiempo en Geología" de la Facultad de Ciencias Geológicas

La Geología abarca toda la historia del planeta, por lo que se hace inviable utilizar conceptos temporales de nuestra vida cotidiana. Por ello, se ha realizado un friso para el hall de la Facultad y para presentarlo, se ha realizado un vídeo explicativo del mismo

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Fusion of WorldView-2 and LiDAR data to map fuel types in the Canary Islands

Wildland fires are one of the factors causing the deepest disturbances on the natural environment and severely threatening many ecosystems, as well as economic welfare and public health. Having accurate and up-to-date fuel type maps is essential to properly manage wildland fire risk areas. This research aims to assess the viability of combining Geographic Object-Based Image Analysis (GEOBIA) and the fusion of a WorldView-2 (WV2) image and low density Light Detection and Ranging (LiDAR) data in order to produce fuel type maps within an area of complex orography and vegetation distribution located in the island of Tenerife (Spain). Independent GEOBIAs were applied to four datasets to create four fuel type maps according to the Prometheus classification. The following fusion methods were compared: Image Stack (IS), Principal Component Analysis (PCA) and Minimum Noise Fraction (MNF), as well as the WV2 image alone. Accuracy assessment of the maps was conducted by comparison against the fuel types assessed in the field. Besides global agreement, disagreement measures due to allocation and quantity were estimated, both globally and by fuel type. This made it possible to better understand the nature of disagreements linked to each map. The global agreement of the obtained maps varied from 76.23% to 85.43%. Maps obtained through data fusion reached a significantly higher global agreement than the map derived from the WV2 image alone. By integrating LiDAR information with the GEOBIAs, global agreement improvements by over 10% were attained in all cases. No significant differences in global agreement were found among the three classifications performed on WV2 and LiDAR fusion data (IS, PCA, MNF). These study's findings show the validity of the combined use of GEOBIA, high-spatial resolution multispectral data and low density LiDAR data in order to generate fuel type maps in the Canary Islands.We thank Alejandro Lorenzo-Gil for preprocessing the LiDAR data and Laia Núñez for her assistance in the field. Thanks to Mar Brito for editing the manuscript and improving the use of English. LiDAR data were ceded by GRAFCAN. We wish to thank the peer reviewers for their valuable comments and suggestions. This work has been funded by the Ministerio de Economía y Competitividad CGL2013-48202-C2 project. The research of L. A. Arroyo was supported by the JAE-Doc Program (Junta para la Ampliación de Estudios), financed by the Spanish National Research Council (CSIC) and the European Social Fund (ESF

Fusion of WorldView-2 and LiDAR Data to Map Fuel Types in the Canary Islands

Wildland fires are one of the factors causing the deepest disturbances on the natural environment and severely threatening many ecosystems, as well as economic welfare and public health. Having accurate and up-to-date fuel type maps is essential to properly manage wildland fire risk areas. This research aims to assess the viability of combining Geographic Object-Based Image Analysis (GEOBIA) and the fusion of a WorldView-2 (WV2) image and low density Light Detection and Ranging (LiDAR) data in order to produce fuel type maps within an area of complex orography and vegetation distribution located in the island of Tenerife (Spain). Independent GEOBIAs were applied to four datasets to create four fuel type maps according to the Prometheus classification. The following fusion methods were compared: Image Stack (IS), Principal Component Analysis (PCA) and Minimum Noise Fraction (MNF), as well as the WV2 image alone. Accuracy assessment of the maps was conducted by comparison against the fuel types assessed in the field. Besides global agreement, disagreement measures due to allocation and quantity were estimated, both globally and by fuel type. This made it possible to better understand the nature of disagreements linked to each map. The global agreement of the obtained maps varied from 76.23% to 85.43%. Maps obtained through data fusion reached a significantly higher global agreement than the map derived from the WV2 image alone. By integrating LiDAR information with the GEOBIAs, global agreement improvements by over 10% were attained in all cases. No significant differences in global agreement were found among the three classifications performed on WV2 and LiDAR fusion data (IS, PCA, MNF). These study’s findings show the validity of the combined use of GEOBIA, high-spatial resolution multispectral data and low density LiDAR data in order to generate fuel type maps in the Canary Islands

Protocolos de indicación farmacéutica y criterios de derivación al médico en síntomas menores

La actuación del farmacéutico, ante un paciente con síntomas o trastornos banales, que acude a la farmacia buscando la asesoría o el consejo de este profesional, se ha definido como indicación farmacéutica, la cúal se concibe como el acto profesional por el que el farmacéutico se responsabiliza de la selección de un medicamento que no necesita receta médica, con el objetivo de aliviar o resolver un problema de salud a instancias del paciente, o su derivación al médico cuando dicho problema necesite de su actuación. En este contexto, los objetivos del farmacéutico son, en primer lugar valorar si el problema de salud por el que consulta el paciente es un síntoma o trastorno banal, en segundo lugar indicar al paciente la opción más adecuada para resolver su problema de salud, incluyendo la derivación al médico, la indicación de un medicamento sin receta médica o de medidas no farmacológicas. Por último, proporcionar la información necesaria al paciente y protegerlo frente a la posible aparición de resultados negativos asociados a la medicación detectando y corrigiendo sus causas prevenibles.Grupo de Fármacos de la semFYC (Sociedad Española de Medicina en Famlia y Comunitaria)Fundación AbbottSociedad Española de Farmacia Comunitaria (SEFAC

Trascendencia clínica del embarazo en el síndrome de Brugada.

Little is known about the risks and outcomes of pregnancy in women with Brugada syndrome. We therefore evaluated pregnancy outcomes and the influence of pregnancy in patients with Brugada syndrome.JOURNAL ARTICLEinfo:eu-repo/semantics/publishe