Concordancia entre ecoscopia realizada por médicos no cardiológos y ecocardiografía convencional

Introduction: Focused cardiac ultrasound has been proposed as a useful approach for improving clinical decision making, as well as to be able to rapidly identify the ultrasound signs of a specific list of potential diagnoses. Objective: To evaluate a training program for physicians with no experience in cardiac ultrasound with the aim performing focused cardiac ultrasound using a portable device (echoscopy). Materials and methods: The results obtained from echoscopy performed by the physicians that received training were compared with those obtained with conventional cardiac ultrasound carried out by expert cardiologists. A total of 5 non-cardiologist doctors, including 1 medical student, 2 Internal Medicine residents, and 2 from Intensive Medicine, took part in a four-week training course given by a Level III Cardiology specialist. The course included: First week: Theory and basis of cardiac ultrasound (3 hours daily) Second week: Theory of acquiring images. Normal and abnormal findings (50 studies). Third week: handling of the echoscope (50 studies). Fourth week: Data collection. The study included patients scheduled for conventional cardiac ultrasound in the Non-Invasive Methods Laboratory. Two examinations were carried out on each patient. The first consisted of an echoscopy performed by a doctor that had received the training, and the second consisted of a cardiac ultrasound carried out by an expert cardiologist. The ultrasound parameters evaluated were: left ventricular ejection fraction, right ventricular dysfunction, left atrial enlargement, pulmonary hypertension, cardiac valve disease, and pericardial effusion. The results found in echoscopy versus cardiac ultrasound were compared using concordance analysis (Kappa Index). Results: The following results were obtained on the 221 studies performed: moderate agreement in left ventricular ejection fraction (? = 0.541, p less than .000), right ventricular function (? = 0.403, p less than .001), left atrial enlargement (? = 0.413, p less than .001), mitral valve and tricuspid valve disease (? = 0.437, p less than .001 and (? = 0.466, P less than .001, respectively). There was weak agreement with aortic valve disease. Pericardiac effusion and the presence of pulmonary hypertension had a poor and week agreement, respectively. Conclusions: With a limited training period, the participants with no previous experience in ultrasound techniques and using echoscopy achieved a moderate agreement in the majority of measurements when compared with conventional cardiac ultrasound performed by experts in the technique. A study with a larger number of participants is required in order to determine the ideal training period to obtain results comparable with cardiac ultrasound. © 201

Recent results in nuclear astrophysics at the n_TOF facility at CERN

The neutron time of flight (n_TOF) facility at CERN is a spallation source characterized by a white neutron spectrum. The innovative features of the facility, in the two experimental areas, (20 m and 185 m), allow for an accurate determination of the neutron cross section for radioactive samples or for isotopes with small neutron capture cross section, of interest for Nuclear Astrophysics. The recent results obtained at n_TOF facility are presented

Addressing the Location Problem of a Perishables Redistribution Center in the Middle of Europe

This work aims to contribute to the debate on practical utilization of different location models for consolidation, redistribution, and repackaging centers in a supply chain to optimize shipments, thereby reducing food loss and waste, within the framework of quality of customer service improvement. The scenario in question is the creation of a redistribution center for highly perishable products (fruits and vegetables) from southeast Spain—the leading European supplier—for customers throughout Europe. It is estimated that 10% of exports (more than 530,000 metric tons) from this area are returned by customers due to minor defects. These products cannot be reused and are therefore wasted. Regarding the methodology, comparisons were made between the p-median, gravity p-median, and p-center models. Scenarios of change in demand and randomness in distances were also tested. In addition, the modelling used included the cost and time within a multicriteria optimization framework to assess the possibility of a transport mode change. It was observed, for example, that the gravity p-median model proved useful for perishable products and the logistics strategy chosen. Furthermore, the p-median model displayed strong robustness against long-term changes in demand and random distances. In general, it was demonstrated that this strategy would successfully reduce the response time and distance of shipment from the distribution center to the customers and thereby improve sustainability of the service, reducing the waste related to direct shipments. Furthermore, this research also demonstrated the difficulty of using intermodality in this context, mainly due to transit time, which would undoubtedly increase the waste generate

Education knowledge transfer: Report on in-school placements needs and possibilities of the technologies

The WP2 of the EKT project aimed at describing how in-school placement (ISP) is organised and developed in the initial teacher education in the countries participating in the EKT project (Austria, England, Ireland, Portugal and Spain). In order to achieve this goal, two main pr ocedures were developed: 1. The characterization of national ISP systems, based on the analysis of institutional documentation (legislation, tools, guides, regulations, protocols, reports...) identified and described by the EKT academic teams in each country 2. The identification of the perspectives and conceptions of academic and school mentors involved in ISP, working either Higher Education Institutions (HEI) where Initial Teacher Education (ITE) is developed or at the schools where ISP takes place. For this sake, a questionnaire was designed and applied to a sample of 347 mentors from the different countries involved in the project. The analysis of the different ITE systems enabled the identification of many common features. In fact, all the countries have ITE systems that involve the HEI and nursery/primary/ secondary schools where ISP takes place. In most situations, ITE involves consecutive programmes (at graduation and post-graduation levels). And despite some variation in the length of these consecutive programmes (6 + 3/4 semesters or 8 + 2/3 semesters), the extension of the whole ITE process is less variable, the same happening with the global number of ECTS units involved in any ITE process regardless of the country. In some countries (e.g., Spain), and concerning, mainly but not exclusively, nursery and primary school teachers’ preparation, ITE may take place at the graduation level. It is also worth mentioning the case of England, where two different teacher training paths can be found: HEI routes and School-led postgraduate (consecutive) routes that involve different kinds of programmes: • School-centred initial teacher training (SCITT) programmes (no salaried); • School Direct Training programmes (non-salaried); • School Direct Training programmes (salaried); • Teach First (salaried); • Postgraduate Teaching; Apprenticeship (PGTA) (salaried). No matter the country, ITE processes imply in-school placement. The characteristics of these placements may vary according not only to the features of each national educational system but also to the respective ITE programmes and the school level training refers to. In general ISP is developed under agreements established between HEI where ITE programmes are developed and schools where ISP takes place and involves both HEI teachers and school teachers as mentors. The selection of these school mentors varies from country to country as well as the role they play and their participation in the students´ evaluation. There also seems to be some variation regarding the tasks, the number of hours involved and the kind of materials students have to produce and deliver as a result of their practices during ISP. Despite this variation, it is possible to recognize that there is, in most cases, a concern with the promotion of a reflection on the practice by the use of adequate practices and instruments, such as the construction of portfolios that make possible a critical attitude towards the teaching activities developed. Report on in-school placements needs and possibilities of the technologies Página 5 1. Executive summary The questionnaire enabled the identification of academic and school mentors’ perspectives and conceptions about ISP and focused on different aspects involved in the process, such as: • The relevance of different internship activities and the degree of collaboration between academic and school mentors in their development. • The responsibility for the definition of the curricular framework of isp. • The aspects included in isp guides. • The relation between the student teacher and the mentors and the kind of activities they are involved in during the whole isp process. • The structure of student teachers’ final report or dissertation; the aspects focused on mentors’ observation and supervision during isp. • The structure and content of the Portfolio of in-school placement teaching practice. Due to the diversity of approaches in the countries involved in the study, the design of the questionnaire took into account the complexity of the ISP process and the multiplicity of aspects involved in the process by offering the respondents rather long lists of the items they should express their position about. As far as the relevance of the activities involved in ISP, all the items were valued above 3,10 in a scale that varied from 1 (nothing) to 5 (very much), regardless of the group (country), what may be seen as the recognition of the diversity and complexity of ISP. Despite the existing significant statistical differences, it is possible to say that there are some items, whose relevance is recognized (generally rated above 4), namely those related to the definition of standards and procedures and those concerning classroom observation, feedback, student-teacher evaluation, and collaborative work involving students and mentors. Collaboration between academic and school mentors throughout the ISP process and regarding the different activities involved is highly valued although the comparison of data regarding the degree of real cooperation and the data regarding the degree of cooperation that should exist suggests the necessity of its enhancement. Regardless of the country, the definition of the curricular framework of ISP depends mainly on the HEI, either the HEI coordinator or their mentors. In-school placement guides tend to include several items, but mentors responding to the questionnaire highlight those related to the definition of the different roles involved and to the teaching practices and their assessment. The planning of activities integrated into the school activity emerges as the most important aspect of the relationship between the student teacher and the mentors. Before the placement, activities concerning class teaching planning and the selection of materials and other resources seem to be the most frequent activities involving mentors, either from HEI or schools and student teachers. During the in-school placement, the most frequent activities involving mentors and student teachers concern not only teaching planning and materials selection but also teaching activities; pupils’ assessment is also highlighted as a frequent activity that involves school mentors and student teachers. Activities developed after the placement are valued in the questionnaire; the most highlighted regard pupils´ assessment and the production of students´ progress reports. The model for the student teacher’s final report or dissertation includes not only the monitoring procedures during its preparation and presentation but also writing rules and procedures, as well as guidelines and rules for the use of data collected by the trainee, the extent/ length of the report and formatting standards and references. The structure and content of this report dissertation are defined at the HEI level

Validation of the spanish version of the multiple sclerosis international quality of life (musiqol) questionnaire

<p>Abstract</p> <p>Background</p> <p>The Multiple Sclerosis International Quality Of Life (MusiQoL) questionnaire, a 31-item, multidimensional, self-administrated questionnaire that is available in 14 languages including Spanish, has been validated using a large international sample. We investigated the validity and reliability of the Spanish version of MusiQoL in Spain.</p> <p>Methods</p> <p>Consecutive patients with different types and severities of multiple sclerosis (MS) were recruited from 22 centres across Spain. All patients completed the MusiQoL questionnaire, the 36-Item Short Form (SF-36) health survey, and a symptoms checklist at baseline and 21 days later. External validity, internal consistency, reliability and reproducibility were tested.</p> <p>Results</p> <p>A total of 224 Spanish patients were evaluated. Dimensions of MusiQoL generally demonstrated a high internal consistency (Cronbach's alpha: 0.70-0.92 for all but two MusiQoL domain scores). External validity testing revealed that the MusiQoL index score correlated significantly with all SF-36 dimension scores (Pearson's correlation: 0.46-0.76), reproducibility was satisfactory (intraclass correlation coefficient: 0.60-0.91), acceptability was high, and the time taken to complete the 31-item questionnaire was reasonable (mean [standard deviation]: 9.8 [11.8] minutes).</p> <p>Conclusions</p> <p>The Spanish version of the MusiQoL questionnaire appears to be a valid and reliable instrument for measuring quality of life in patients with MS in Spain and constitutes a useful instrument to measure health-related quality of life in the clinical setting.</p

II Jornadas de la Sociedad Española para la Conservación y Estudio de Los Mamíferos (SECEM) Soria 7-9 diciembre 1995

Seguimiento de una reintroducción de corzo (Capreolus capreolus) en ambiente mediterráneo. Dispersión y área de campeoModelos de distribución de los insectívoros ern la Península IbéricaDieta anual del zorro, Vulpes vulpes, en dos hábitats del Parque Nacional de DoñanaDesarrollo juvenil del cráneo en las poblaciones ibéricas de gato montés, Felis silvestris Schreber, 1777Presencia y expansión del visón americano (Mustela vison) en las provincias de Teruel y Castellón (Este de España).Preferencias de hábitat invernal de la musaraña común (Crocidura russula) en un encinar fragmentado de la submeseta norteUso de cámaras automáticas para la recogida de información faunística.Dieta del lobo en dos zonas de Asturias (España) que difieren en carga ganadera.Consumo de frutos y dispersión de semillas de serbal (Sorbus aucuparia L.) por zorros y martas en la cordillera Cantábrica occidentalEvaluación de espermatozoides obtenidos postmorten en el ciervo.Frecuencia de aparición de diferentes restos de conejo en excrementos de lince y zorroAtlas preliminar de los mamíferos de Soria (España)Censo y distribución de la marmota alpina (Marmota marmota) en Navarra.Trampeo fotográfico del género Martes en el Parque Nacional de Aigüestortes i Estany de Sant Maurici (Lleida)Peer reviewe

Measurement of the Ge 70 (n,γ) cross section up to 300 keV at the CERN n-TOF facility

©2019 American Physical Society.Neutron capture data on intermediate mass nuclei are of key importance to nucleosynthesis in the weak component of the slow neutron capture processes, which occurs in massive stars. The (n,γ) cross section on Ge70, which is mainly produced in the s process, was measured at the neutron time-of-flight facility n-TOF at CERN. Resonance capture kernels were determined up to 40 keV neutron energy and average cross sections up to 300 keV. Stellar cross sections were calculated from kT=5 keV to kT=100 keV and are in very good agreement with a previous measurement by Walter and Beer (1985) and recent evaluations. Average cross sections are in agreement with Walter and Beer (1985) over most of the neutron energy range covered, while they are systematically smaller for neutron energies above 150 keV. We have calculated isotopic abundances produced in s-process environments in a 25 solar mass star for two initial metallicities (below solar and close to solar). While the low metallicity model reproduces best the solar system germanium isotopic abundances, the close to solar model shows a good global match to solar system abundances in the range of mass numbers A=60-80.Peer reviewedFinal Published versio

Prediction of poor outcome in clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Producción CientíficaClassification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options

Susceptibility to Aminoglycosides and Distribution of aph and aac(3)-XI Genes among Corynebacterium striatum Clinical Isolates

Corynebacterium striatum is an opportunistic pathogen, often multidrug-resistant, which has been associated with serious infections in humans. Aminoglycosides are second-line or complementary antibiotics used for the treatment of Corynebacterium infections. We investigated the susceptibility to six aminoglycosides and the molecular mechanisms involved in aminoglycoside resistance in a collection of 64 Corynebacterium striatum isolated in our laboratory during the period 2005?2009. Antimicrobial susceptibility was determined using E-test. The mechanisms of aminoglycoside resistance were investigated by PCR and sequencing. The 64 C. striatum were assessed for the possibility of clonal spreading by Pulsed-field Gel Electrophoresis (PFGE). Netilmicin and amikacin were active against the 64 C. striatum isolates (MICs90 = 0.38 and 0.5 mg/L, respectively). Twenty-seven of the 64 C. striatum strains showed a MIC90 for kanamycin > 256 mg/L, and 26 out the 27 were positive for the aph(3?)-Ic gene. Thirty-six out of our 64 C. striatum were streptomycin resistant, and 23 out of the 36 carried both the aph(3?)-Ib and aph(6)-Id genes. The gene aac(3)-XI encoding a new aminoglycoside 3-N acetyl transferase from C. striatum was present in 44 out of the 64 isolates, all of them showing MICs of gentamicin and tobramycin > 1 mg/L. CS4933, a C. striatum showing very low susceptibility to kanamycin and streptomycin, contains an aminoglycoside resistance region that includes the aph(3?)-Ic gene, and the tandem of genes aph(3?)-Ib and aph(6)-Id. Forty-six major PFGE types were identified among the 64 C. striatum isolates, indicating that they were mainly not clonal. Our results showed that the 64 clinical C. striatum were highly resistant to aminoglycosides and mostly unrelated