Utilidad de la exploración física para el diagnóstico de neumonía infantil adquirida en la comunidad en un centro de atención primaria

ObjetivoDeterminar la utilidad diagnóstica de tres signos clínicos (fiebre, tos, estertores crepitantes) para el diagnóstico de neumonía en niños; evaluar la concordancia en la interpretación de la radiografía de tórax por dos radiólogosDiseñoEstudio de pruebas diagnósticasEmplazamientoAtención primariaMaterialTrescientas cincuenta historias clínicas de niños a los que se practicó una radiografía de tórax urgente para diagnosticar neumonía entre el 1 de enero de 1996 y el 30 de junio de 1999Mediciones principalesa) Prevalencia de neumonía en toda la muestra y en dos subgrupos de edad: igual o inferior a 5 años y superior a 5 años; b) cocientes de probabilidad positivo y negativo e intervalos de confianza del 95% (IC del 95%). Se consideró la radiografía de tórax como estándar de referencia, y c) concordancia interradiólogos-índice kappa (?)ResultadosLa prevalencia de neumonía en toda la muestra fue del 22,9% (IC del 95%, 18,5-27,3); en los niños de 5 años de edad o menores fue del 20,4% (IC del 95%, 15,6- 25,2), y en los mayores de 5 años, del 31,3% (IC del 95%, 21,1-41,4). Los signos estudiados sólo tuvieron alguna utilidad para confirmar el diagnóstico en mayores de 5 años: el cociente de probabilidad positivo fue de 3,52 (IC del 95%, 1,28-9,69) y los radiólogos coincidieron en el diagnóstico en el 93,1% de las radiografías de tórax (k=0,8; IC del 95%, 0,77-0,83)ConclusionesEn este estudio no se constató la presencia de un subconjunto de signos clínicos que aseguren de forma inequívoca el diagnóstico de neumonía en niñosObjectiveTo determine the diagnostic usefulness of three clinical signs (temperature, cough, crepitant stertor) for diagnosing pneumonia in children.To evaluate the agreement of two radiologists in evaluating thoracic x-rays (TXR)DesignStudy of diagnostic testsSettingPrimary careParticipants350 clinical histories of children who had an urgent TXR to diagnosis pneumonia between 1st January 1996 and 30th June 1999Main measurementsa) Prevalence of pneumonia in the entire sample and two age-based sub-groups: aged 5 years and under, and over 5; b) positive probability quotients (PQ+) and negative ones (PQ-) and 95% confidence intervals (95% CI). The TXR was seen as the reference standard, and c) kappa index (?) for inter-radiologist concordanceResultsPrevalence: the entire sample, 22.9% (95% CI, 18.5-27.3); children aged 5 or less, 20.4% (95% CI, 15.6-25.2); aged over 5, 31.3% (95% CI, 21.1-41.4). The signs studied were only of any use in confirming the diagnosis in children over 5: PQ+ was 3.52 (1.28-9.69). Radiologists coincided in their diagnosis in 93.1% of the TXR (k=0.8; 95% CI, 0.77-0.83)ConclusionsThis study did not prove that there was a sub-grouping of clinical signs which confirmed unmistakeably the diagnosis of pneumonia in childre

Conductance and application of organic molecule pairs as nanofuses

We propose that a pair of organic molecules can mimic the behavior of a macroscopic fuse at nanoscale, one component of the pair being the on state and the other the off state. For this task wemake use of density-functional theory to calculate the physical properties of selected molecules, which have also been synthesized by our team. By this means we obtain the transmission spectra and the current of the proposed devices, which allows us to compare the behavior of the on and off states.Of particular interest is the on/off switch ratios, defined as the current ratios of the on and off structures at the corresponding bias voltage. In a first stage, we examine the best linker between the device and the electrode for high on/off switch ratios. Once this is determined, we test the influence of the electron richness of the system to provide a high on/off switch ratio. The entire analysis is also supported by the molecular projected self-consistent Hamiltonian, which provides a good way of understanding the molecular behavior. All the calculations support that interesting on/off switch ratios of two orders of magnitude could be obtained with these prototypical nanofusesWe thank the Regional Government of Andalucía for financial support (Projects No. P06-FQM-01726 and No. P09-FQM-04571), the “Centro de Supercomputación de la Universidad de Granada,” and the “Centro de Computación Científica-UAM” for computation time. The authors are also grateful to the Spanish Secretaría de Estado de Universidades e Investigación, Ministerio de Educación y Ciencia, for financial support within research projects TEC2007-66812 and TEC2010-16211. N.F. thanks the Regional Government of Andalucía for her research contract, and LAC thanks the University of Granada for his research contrac

Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review

Aim: The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. Methods: MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. Results: Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. Conclusion: According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors

Evaluating the extent and impact of the extreme Storm Gloria on Posidonia oceanica seagrass meadows

Extreme storms can trigger abrupt and often lasting changes in ecosystems by affecting foundational (habitat-forming) species. While the frequency and intensity of extreme events are projected to increase under climate change, its impacts on seagrass ecosystems remain poorly documented. In January 2020, the Spanish Mediterranean coast was hit by Storm Gloria, one of the most devastating recent climate events in terms of intensity and duration. We conducted rapid surveys of 42 Posidonia oceanica meadows across the region to evaluate the extent and type of impact (burial, unburial and uprooting). We investigated the significance of oceanographic (wave impact model), geomorphological (latitude, depth, exposure), and structural (patchiness) factors in predicting impact extent and intensity. The predominant impact of Storm Gloria was shoot unburial. More than half of the surveyed sites revealed recent unburial, with up to 40 cm of sediment removed, affecting over 50 % of the meadow. Burial, although less extensive, was still significant, with 10–80 % of meadow cover being buried under 7 cm of sediment, which is considered a survival threshold for P. oceanica. In addition, we observed evident signs of recently dead matte in some meadows and large amounts of detached drifting shoots on the sea bottom or accumulated as debris on the beaches. Crucially, exposed and patchy meadows were much more vulnerable to the overall impact than sheltered or continuous meadows. Given how slow P. oceanica is able to recover after disturbances, we state that it could take from decades to centuries for it to recoup its losses. Seagrass ecosystems play a vital role as coastal ecological infrastructure. Protecting vulnerable meadows from anthropogenic fragmentation is crucial for ensuring the resilience of these ecosystems in the face of the climate crisis.This study was funded by the CSIC project “Effects of storm Gloria on the western Mediterranean meadows (202030E052) and “Storms of change: as phenomena extreme weather alters Mediterranean coastal ecosystems, their services and their perception by society" (PID2020-113745RB-I00), state program of I+D+I Oriented to the Challenges of the Society and within the framework of the activities of the Spanish Government through the "Maria de Maeztu Centre of Excellence” accreditation to IMEDEA (CSIC-UIB) (CEX2021-001198). We want to thank the SPAS (Society of Fishing and Underwater Activities of Mataró) and the Mataró City Council, which has financed 25 years of the Alguer de Mataró project

A heterotrimetallic Ir(III), Au(III) and Pt(II) complex incorporating cyclometallating bi- and tridentate ligands : simultaneous emission from different luminescent metal centres leads to broad-band light emission

Di- and tri-nuclear metal complexes incorporating gold(III), iridium(III) and platinum(II) units linked via a 1,3,5-triethynylbenzene core are reported, together with the corresponding mononuclear complexes as models. The gold(III) and platinum(II) units comprise tridentate, cyclometallating, C^N^C and N^N^C-coordinating ligands, respectively, with the Ar–C[triple bond, length as m-dash]C– directly bound to the metal at the fourth coordination site. The iridium moiety is an Ir(ppy)2(acac) unit bound to the triethynylbenzene through a phenyl substituent at the 3-position of the acac ligand. The multinuclear compounds are prepared, using a modular synthetic strategy, from the monometallic complexes. All of the compounds are luminescent in solution at room temperature, and their photophysical properties were studied. The triplet excited state energies of the mononuclear complexes lie in the order Au > Ir > Pt. Consistent with this order, energy transfer from Au to Ir and from Au to Pt is observed, leading to quenching of the Au emission in the gold-containing multinuclear complexes. Energy transfer from Ir to Pt occurs at a rate that only partially quenches the Ir-based emission. As a result, the dinuclear Ir–Pt and trinuclear Au–Ir–Pt complexes display broad emission across most of the visible region of the spectrum

Asymmetric synthesis of substituted 1-aminocyclopropane-1-carboxylic acids via diketopiperazine methodology

Diketopiperazinespirocyclopropane 12 is prepared in > 98% d.e. via the conjugate addition of a phosphorus ylide to (6S)-N,N'-bis(p-methoxybenzyl)-3-methylenepiperazine-2,5-dione 2. Deprotection and hydrolysis of adduct 12 and subsequent peptide coupling demonstrate the applicability of this methodology to the asymmetric synthesis of 1-aminocyclopropane-1-carboxylic acids for incorporation into novel peptides. A model for the high level of diastereofacial selectivity observed in the cyclopropanation reaction is presented. A highly selective asymmetric approach (> 98% d.e.) to (S)-[2,2-(2)H2]-1-aminocyclopropane-1-carboxylic acid 29 is also reported via a deuterated sulfur ylide addition to acceptor 2

Teacher training and strategies to develop intra and interpersonal intelligence in classroom

The education system needs constant adaptations. Teachers and students complain often about the low motivation and the low utility of the competences developed in class. Socio-emotional component requires special attention in young people, so it is necessary educational system serves this demand. Scientific evidence about the benefits of emotional intelligence in the academic performance and well-being of the student is increasingly greater, as well as training needs of teachers. This article shows a educational model based on emotional intelligence starting with teacher training due to their influence in climate classroom