Manual de simulación clínica en especialidades médicas

Manual sobre técnicas y modos de simulación clínica en diversas especialidades médicas.La enseñanza y formación en medicina necesita el uso de la simulación. Existen evidencias de su uso desde hace cientos de años, pero, en los últimos años se ha incrementado y diseminado. La simulación clínica está validada científicamente en múltiples contextos médicos y de otras áreas profesionales de la salud. Y es considerada de gran importancia como proceso de entrenamiento y de mejora de las competencias y adquisición de habilidades médicas en campos que incluye desde la historia clínica, comunicación con el paciente, exploración, diagnóstico terapéutica médica-farmacológica y quirúrgica y seguridad al tratar al paciente. Hoy en día, para muchas técnicas y situaciones clínicas es inaceptable llegar junto a los pacientes sin un dominio adquirido en simulación. La simulación puede ocurrir sin el uso de recursos adicionales, solo las personas, o utilizando pocos o muchos recursos de baja hasta alta tecnología y se puede adaptar a los recursos disponibles, abarcando todas las áreas de conocimiento, y dentro de ellas competencias técnicas o actitudes, solas o en conjunto. El uso racional y basado en evidencia de la simulación es de la mayor importancia por la necesidad de una mayor efectividad y eficiencia en la transformación de los profesionales de la salud para que puedan mejorar su capacidad de atender a los pacientes. La simulación es también una buena herramienta de evaluación de competencias y habilidades en Medicina y otras disciplinas de las Ciencias de la Salud Este manual incluye técnicas y modos de simulación clínica en diversas especialidades médicas, útiles, para quien busque un manual práctico y actualizado.Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Terapias Avanzadas en Patología Cardiovascular Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Investigación Biomédica Quirón Salu

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

A comparative economic feasibility study of photovoltaic heat pump systems for industrial space heating and cooling

The use of photovoltaic (PV) systems for powering heat pumps (HP) leads to an economic, energy efficient and environmentally friendly alternative for heating and cooling generation. A technical solution developed by the authors permits stand-alone configurations to operate without batteries, mitigating up to 75% of the solar power fluctuations resulting from cloud-passing. Once its technical feasibility has been demonstrated, the economic potential of this innovative solution should be assessed (avoiding a battery system is a significant advantage). This paper presents a comparative economic assessment of this autonomous (AU) solution and a self-consumption (SC) solution, that would substitute a grid-powered HP system for the space heating and cooling of two livestock farms located in Spain. Results show that PV-HP systems are economically feasible regardless of the technical solution: the Profitability Index (PI) is in the 2.23–2.97 €/€ range, the Internal Rate of Return (IRR) is in the 8.1–10.9% range, the Payback Period (PBP) is in the 9.2–11 years range and the savings in terms of the Levelized Cost of Energy (LCOE) are in the 57–70% range. The AU solution offers a higher economic profitability, because it permits larger savings in the electricity bill. The SC solution presents lower LCOEs because of its greater electricity production

Potential of the three-terminal heterojunction bipolar transistor solar cell for space applications

Multi-Terminal multi-junction solar cells (MJSC) offer higher efficiency potential than series connected (two-Terminal) ones. In addition, for terrestrial applications, the efficiency of multi-Terminal solar cells is less sensitive to solar spectral variations than the two-Terminal series-connected one. In space, generally, cells are always illuminated with AM0 spectrum and no impact is expected from spectral variations. Still, in space, the multi-Terminal approach offers some advantages in comparison with the series-connected architecture approach derived from a higher end of life (EOL) efficiency. In this work we review the potential of multi-Terminal solar cells for achieving extended EOL efficiencies with emphasis in the potential of the three-Terminal heterojunction bipolar transistor solar cell, a novel multi-Terminal MJSC architecture with a simplified structure not requiring, for example, tunnel junctions

Potential of the three-terminal heterojunction bipolar transistor solar cell for space applications

Multi-Terminal multi-junction solar cells (MJSC) offer higher efficiency potential than series connected (two-Terminal) ones. In addition, for terrestrial applications, the efficiency of multi-Terminal solar cells is less sensitive to solar spectral variations than the two-Terminal series-connected one. In space, generally, cells are always illuminated with AM0 spectrum and no impact is expected from spectral variations. Still, in space, the multi-Terminal approach offers some advantages in comparison with the series-connected architecture approach derived from a higher end of life (EOL) efficiency. In this work we review the potential of multi-Terminal solar cells for achieving extended EOL efficiencies with emphasis in the potential of the three-Terminal heterojunction bipolar transistor solar cell, a novel multi-Terminal MJSC architecture with a simplified structure not requiring, for example, tunnel junctions

AMADEUS: Next Generation Materials and Solid State Devices for Ultra High Temperature Energy Storage and Conversion

Starting in January 2017, AMADEUS (www.amadeus-project.eu) is the first project funded by the European Commission to research on a new generation of materials and solid state devices for ultra-high temperature energy storage and conversion. By exploring storage temperatures well beyond 1000 ºC the project aims at breaking the mark of ~ 600ºC rarely exceeded by current state of the art thermal energy storage (TES) systems. AMADEUS Project, through a collaborative research between seven European partners, aims to develop a novel concept of latent heat thermal energy storage (LHTES) systems with unprecedented high energy density. One of the main objectives of the project is to create new PCMs (phase change materials) with latent heat in the range of 1000-2000 kWh/m3, an order of magnitude greater than that of typical salt-based PCMs used in concentrated solar power (CSP), along with developing advanced thermal insulation, PCM casing designs, and novel solid-state heat to power conversion technologies able to operate at temperatures in the range of 1000-2000 ºC

Células solares de banda intermedia

Las células solares de banda intermedia se inventaron en España. Constituyen una propuesta para aumentar la eficiencia de las células solares por encima del límite de Shockley y Queisser para células de un solo gap. El número de ideas para llevarlas a la práctica (desde la utilización de puntos cuánticos a la implantación selectiva de impurezas) se ha ido expandiendo a medida que nuestra comprensión ha ido aumentando. En este artículo repasamos el concepto de célula solar de banda intermedia y algunas de estas ideas para llevarla a la práctica

Ernaehrung zwischen Konflikt und Tausch

Erst seit gut einem Jahrzehnt hat sich eine spezifische Ernaehrungssoziologie im akademischen Betrieb etabliert. In diesem Zeitraum hat sich in dem Spannungsfeld von 'Naturthema Ernaehrung' vs. 'Kulturthema Essen' eine faecheruebergreifende Debatte entfaltet, die der Vielzahl der speziellen Soziologien nicht lediglich eine neue Sparte hinzufuegte, sondern die sich dem Verhaeltnis von Gesellschaft und Ernaehrung grundsaetzlich naehert. Als biologisches und gesellschaftliches Fundamentalproblem laesst sich Ernaehrung mit fast allen Grundbegriffen der Soziologie in Verbindung bringen: Macht, Herrschaft, Gewalt bieten sich ebenso an wie Risiko, Rolle und Sozialisation. Die Autoren thematisieren den Aspekt Konflikt und Tausch, um die auch in der Anthropologie, Ethnologie und Soziologie gleichermassen bewaehrten Kategorien fuer das Thema fruchtbar zu machen. (ICA)Available from UuStB Koeln(38)-20000106159 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols