Modelado de procesos y desarrollo de sistemas software: integración entre UML y EPC.

Los objetivos de UML (Unified Modeling Language – Lenguaje Unificado de Modelado) y de la EPC (Event-driven Process Chain - Cadena de Procesos guiada por Eventos), están bien diferenciados: mientras que UML se enfoca al diseño de sistemas de información (SI), las EPCs se emplean para el modelado de procesos de negocios (BPM) dentro de la metodología ARIS. No obstante, es evidente la relación entre ambas técnicas: por una parte, un correcto diseño de SI debe basarse en los requisitos definidos por el modelo de procesos de negocio. Por otra parte, las mejoras de los procesos existentes a menudo deben llevarse a cabo mediante el desarrollo o modificación de los SI que soportan dichos procesos. En esta comunicación se analizan las posibilidades de integración de ambas técnicas de modelad

Experiencias en la aplicación de Modelado de Procesos de Negocio (BPM) en el sector sanitario

VIII Congreso de Ingeniería de Organización Leganés, 9 y 10 de septiembre de 2004Esta comunicación se deriva de las experiencias obtenidas mediante la participación de los autores en un proyecto de rediseño y reingeniería de procesos de un conjunto de servicios de salud implantados en distintos hospitales nacionales. Una de las primeras fases del proyecto consistió en el modelado del conjunto de procesos actuales (modelos as-is) para su posterior análisis mediante simulación y la obtención de modelos que representen los procesos objetivo (modelos to-be). En esta comunicación se describe la metodología empleada en el proyecto y se realiza una discusión de las ventajas y limitaciones de la aplicación del modelado de procesos en el sector de la salud. Palabras clave: modelado de procesos de negocio, simulación, sanidad, telemedicinaMinisterio de Sanidad y Consumo G03/11

Clinical Factors Associated with Reinfection versus Relapse in Infective Endocarditis: Prospective Cohort Study

We aimed to identify clinical factors associated with recurrent infective endocarditis (IE) episodes. The clinical characteristics of 2816 consecutive patients with definite IE (January 2008?2018) were compared according to the development of a second episode of IE. A total of 2152 out of 2282 (94.3%) patients, who were discharged alive and followed-up for at least the first year, presented a single episode of IE, whereas 130 patients (5.7%) presented a recurrence; 70 cases (53.8%) were due to other microorganisms (reinfection), and 60 cases (46.2%) were due to the same microorganism causing the first episode. Thirty-eight patients (29.2%), whose recurrence was due to the same microorganism, were diagnosed during the first 6 months of follow-up and were considered relapses. Relapses were associated with nosocomial endocarditis (OR: 2.67 (95% CI: 1.37?5.29)), enterococci (OR: 3.01 (95% CI: 1.51?6.01)), persistent bacteremia (OR: 2.37 (95% CI: 1.05?5.36)), and surgical treatment (OR: 0.23 (0.1?0.53)). On the other hand, episodes of reinfection were more common in patients with chronic liver disease (OR: 3.1 (95% CI: 1.65?5.83)) and prosthetic endocarditis (OR: 1.71 (95% CI: 1.04?2.82)). The clinical factors associated with reinfection and relapse in patients with IE appear to be different. A better understanding of these factors would allow the development of more effective therapeutic strategies

Effect of the type of surgical indication on mortality in patients with infective endocarditis who are rejected for surgical intervention

AIM: To evaluate the effect of the type of surgical indication on mortality in infective endocarditis (IE) patients who are rejected for surgery. METHODS AND RESULTS: From January 2008 to December 2016, 2714 patients with definite left-sided IE were attended in the participating hospitals. One thousand six hundred and fifty-three patients (60.9%) presented surgical indications. Five hundred and thirty-eight patients (32.5%) presented surgical indications but received medical treatment alone. The indications for surgery in these patients were uncontrolled infection (366 patients, 68%), heart failure (168 patients, 31.3%) and prevention of embolism (148 patients, 27.6%). One hundred and thirty patients (24.2%) presented more than one indication. The mortality during hospital admission was 60% (323 patients). The in-hospital mortality of patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 75.6%, 61.4% and 54.7%, respectively (p?<?0.001). Surgical indications due to heart failure (OR: 3.24; CI 95%: 1.99-5.9) or uncontrolled infection (OR: 1.83; CI 95%: 1.04-3.18) were independently associated with a fatal outcome during hospital admission. Mortality during the first year was 75.4%. The mortality during the first year in patients whose indication for surgery was heart failure, uncontrolled infection or risk of embolism was 85.9%, 76.7% and 72.7%, respectively (p?=?0.016). Surgical indication due to heart failure (OR: 3.03; CI 95%: 1.53-5.98) were independently associated with fatal outcome during the first year. CONCLUSIONS: The type of surgical indication is associated with mortality in IE patients who are rejected for surgical intervention

El Gorrión Serrano (Xenospiza baileyi): síntesis sobre la historia natural, estudios científicos y acciones para la conservación de un ave micro endémica de México en peligro de extinción

La conservación enfocada en especies endémicas es prioritaria dada su alta vulnerabilidad. Para lograrla resulta imprescindible conocer la historia natural de las especies. El Gorrión Serrano (Xenospiza baileyi), catalogado en peligro de extinción, es una de las aves endémicas más vulnerables de México (valor de vulnerabilidad máximo = 20). Su estudio ha sido intermitente y la información asociada a su historia natural se encuentra dispersa, no publicada o es de difícil acceso. En este trabajo se sistematizó, examinó y actualizó el conocimiento relacionado con la historia natural de X. baileyi. Se compilaron estudios sobre esta especie para identificar vacíos en torno a su investigación. Se lograron integrar aspectos de la historia natural de X. baileyi relacionados con su taxonomía, descripción, distribución, hábitat, demografía, dispersión, territorialidad, alimentación, interacciones ecológicas, perchas, vocalizaciones, ciclo reproductivo, cortejo, nido, huevos, pollos y amenazas. Además, se incluyó información nueva resultante de actividades de monitoreo comunitario sobre esta especie, lo cual permitió denotar la importancia de la inclusión comunitaria para el manejo y conservación de la especie y su hábitat. Esta información resulta fundamental para optimizar su estudio y orientar las acciones urgentes en torno a su conservación.The conservation of endemic species deserves priority attention given their high vulnerability. Information about the natural history of species is essential for achieving conservation goals. The Sierra Madre Sparrow (Xenospiza baileyi) is an endangered species that is considered to be one of the most vulnerable endemic birds of Mexico (maximum vulnerability value = 20). Its study has been intermittent and the information about its natural history is disperse, unpublished, or difficult to access. This work systematized, evaluated, and updated the knowledge regarding the natural history, taxonomy, description, distribution, habitat, demography, dispersion, territoriality, feeding behavior, ecological interactions, perches, vocalizations, breeding cycle, courtship displays, nest, eggs, nestlings, and threats to the conservation of X. baileyi. In addition, we included novel information generated through community-based monitoring activities, which also highlighted the relevance of including local communities for managing and conserving the species and its habitat. This information is key for optimizing research and guiding urgent conservation actions on the species

Trends in the prevalence and distribution of HTLV-1 and HTLV-2 infections in Spain

<p>Abstract</p> <p>Background</p> <p>Although most HTLV infections in Spain have been found in native intravenous drug users carrying HTLV-2, the large immigration flows from Latin America and Sub-Saharan Africa in recent years may have changed the prevalence and distribution of HTLV-1 and HTLV-2 infections, and hypothetically open the opportunity for introducing HTLV-3 or HTLV-4 in Spain. To assess the current seroprevalence of HTLV infection in Spain a national multicenter, cross-sectional, study was conducted in June 2009.</p> <p>Results</p> <p>A total of 6,460 consecutive outpatients attending 16 hospitals were examined. Overall, 12% were immigrants, and their main origin was Latin America (4.9%), Africa (3.6%) and other European countries (2.8%). Nine individuals were seroreactive for HTLV antibodies (overall prevalence, 0.14%). Evidence of HTLV-1 infection was confirmed by Western blot in 4 subjects (prevalence 0.06%) while HTLV-2 infection was found in 5 (prevalence 0.08%). Infection with HTLV types 1, 2, 3 and 4 was discarded by Western blot and specific PCR assays in another two specimens initially reactive in the enzyme immunoassay. All but one HTLV-1 cases were Latin-Americans while all persons with HTLV-2 infection were native Spaniards.</p> <p>Conclusions</p> <p>The overall prevalence of HTLV infections in Spain remains low, with no evidence of HTLV-3 or HTLV-4 infections so far.</p

Ruxolitinib in refractory acute and chronic graft-versus-host disease : a multicenter survey study

Graft-versus-host disease is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. First-line treatment is based on the use of high doses of corticosteroids. Unfortunately, second-line treatment for both acute and chronic graft-versus-host disease, remains a challenge. Ruxolitinib has been shown as an effective and safe treatment option for these patients. Seventy-nine patients received ruxolitinib and were evaluated in this retrospective and multicenter study. Twenty-three patients received ruxolitinib for refractory acute graft-versus-host disease after a median of 3 (range 1-5) previous lines of therapy. Overall response rate was 69.5% (16/23) which was obtained after a median of 2 weeks of treatment, and 21.7% (5/23) reached complete remission. Fifty-six patients were evaluated for refractory chronic graft-versus-host disease. The median number of previous lines of therapy was 3 (range 1-10). Overall response rate was 57.1% (32/56) with 3.5% (2/56) obtaining complete remission after a median of 4 weeks. Tapering of corticosteroids was possible in both acute (17/23, 73%) and chronic graft-versus-host disease (32/56, 57.1%) groups. Overall survival was 47% (CI: 23-67%) at 6 months for patients with aGVHD (62 vs 28% in responders vs non-responders) and 81% (CI: 63-89%) at 1 year for patients with cGVHD (83 vs 76% in responders vs non-responders). Ruxolitinib in the real life setting is an effective and safe treatment option for GVHD, with an ORR of 69.5% and 57.1% for refractory acute and chronic graft-versus-host disease, respectively, in heavily pretreated patients

Pasados y presente. Estudios para el profesor Ricardo García Cárcel

Ricardo García Cárcel (Requena, 1948) estudió Historia en Valencia bajo el magisterio de Joan Reglà, con quien formó parte del primer profesorado de historia moderna en la Universidad Autónoma de Barcelona. En esta universidad, desde hace prácticamente cincuenta años, ha desarrollado una extraordinaria labor docente y de investigación marcada por un sagaz instinto histórico, que le ha convertido en pionero de casi todo lo que ha estudiado: las Germanías, la historia de la Cataluña moderna, la Inquisición, las culturas del Siglo de Oro, la Leyenda Negra, Felipe II, Felipe V, Austrias y Borbones, la guerra de la Independencia, la historia cultural, los mitos de la historia de España... Muy pocos tienen su capacidad para reflexionar, ordenar, analizar, conceptualizar y proponer una visión amplia y llena de matices sobre el pasado y las interpretaciones historiográficas. A su laboriosidad inimitable se añade una dedicación sin límites en el asesoramiento de alumnos e investigadores e impulsando revistas, dosieres, seminarios o publicaciones colectivas. Una mínima correspondencia a su generosidad lo constituye este volumen a manera de ineludible agradecimiento