Desenvolupament d’un model d'arbres de decisió per optimitzar el control de la freqüència de la fibril·lació auricular en els serveis d'urgències hospitalàries

a fibril.lació auricular associa un gran impacte sanitari i encara que les guies estableixen la importància del control de freqüència com a pilar del maneig, existeix una baixa taxa d’adherència a les recomanacions en els serveis d’urgències. Amb l’objectiu d’augmentar l’eficàcia del tractament en pacients amb fibril.lació auricular s’ha desenvolupat, arran d’un extens estudi multicèntric, un model basat en arbres de decisió que permeti conèixer els factors pronòstics predictius dels resultats del tractament i, d’aquesta manera, proposar recomanacions categòriques que ajudin a la presa de decisions ràpides en els serveis d’urgències. Així, per exemple, s’ha comprovat que en els homes amb fibril·lació auricular superior a 48 hores i en els quals s'utilitza digoxina, s'obtenen pitjors resultats en el control de freqüència i en l'alleujament dels símptomes. Implementar estratègies per a un òptim control de freqüència en aquests pacients són àrees de millora de la qualitat assistencial a urgències.La fibrilación auricular asocia un gran impacto sanitario y aunque las guías establecen la importancia del control de frecuencia como pilar del manejo, existe una baja tasa de adherencia a las recomendaciones en los servicios de urgencias. Con el objetivo de aumentar la eficacia del tratamiento en pacientes con fibrilación auricular se ha desarrollado, a raíz de un extenso estudio multicentrico, un modelo basado en árboles de decisión que permita conocer los factores pronósticos predictivos de los resultados del tratamiento y, de este modo, proponer recomendaciones categóricas que ayuden a la toma de decisiones rápidas en los servicios de urgencias. Así, por ejemplo, se ha comprobado que en los hombres con fibrilación auricular superior a 48 horas y en los cuales se utiliza digoxina, se obtienen peores resultados en el control de frecuencia y en el alivio de los síntomas. Implementar estrategias para un óptimo control de frecuencia en estos pacientes son áreas de mejora de la calidad asistencial a urgencias.Atrial fibrillation is associated with big impact on health. Although guidelines establish the importance of rate control as a base in the management, low rate of recommendations adherence exists in the emergency department. In order to improve the effectiveness in the treatment of patients with atrial fibrillation, based on an extensive multicenter study, a decision trees model has been developed that allows for recognising prognostic predictive factors of treatment results and, in this way, propose categorical recommendations that assists quick decisions-making in emergency departments. Thus, it was found that men with atrial fibrillation >48 hours in which digoxin is used, the worst results in rate control and symptom relief were obtained. Implement strategies for optimal rate control in these patients are areas of improving the quality of care in emergency departments

STUDY OF PUBLIC SERVICE INTERPRETING AND TRANSLATING PRACTICE IN HEALTHCARE SETTINGS IN THE METROPOLITAN AREA OF BARCELONA

Este trabajo pretende observar cómo están organizados los servicios de traducción e interpretación en los servicios públicos (TISSPP) del ámbito sanitario en la provincia de Barcelona. Para ello, realizamos una observación indirecta detallada mediante entrevistas semi-estructuradas tanto a profesionales de la salud, como al personal encargado de gestionar dichos servicios.Los resultados obtenidos permiten describir en qué consisten los servicios de TISSPP de los centros estudiados, cuál es el perfil de sus usuarios, el de sus prestatarios y el de los profesionales de la salud que los utilizan. Asimismo, se relata cómo se ejerce la práctica de la TISSPP y cuál es la evaluación que ésta recibe.This paper aims to describe the organization of Public Service Interpreting and Translating (PSIT) in healthcare settings in Barcelona. In doing so, a detailed indirect observation process using semi-structured interviews has been conducted. Both healthcare professionals and staff in charge of PSIT services were interviewed.The results obtained allowed to describe the PSIT services provided in the studied centers, the profile of its users and its providers, as well as the profile of the healthcare staff. Moreover, the paper focuses in describing how the service of PSIT is being carried and how it is being assessed

Estudio de la práctica de la interpretación en los servicios públicos en el ámbito sanitario en el área metropolitana de Barcelona

Este trabajo pretende observar cómo están organizados los servicios de traducción e interpretación en los servicios públicos (TISSPP) del ámbito sanitario en la provincia de Barcelona. Para ello, realizamos una observación indirecta detallada mediante entrevistas semi-estructuradas tanto a profesionales de la salud, como al personal encargado de gestionar dichos servicios. Los resultados obtenidos permiten describir en qué consisten los servicios de TISSPP de los centros estudiados, cuál es el perfil sus usuarios, el de sus prestatarios y el de los profesionales de la salud que los utilizan. Asimismo, se relata cómo se ejerce la práctica de la TISSPP y cuál es la evaluación que ésta recibeThis paper aims to describe the organization of Public Service Interpreting and Translating (PSIT) in healthcare settings in Barcelona. In doing so, a detailed indirect observation process using semi-structured interviews has been conducted. Both healthcare professionals and staff in charge of PSIT services were interviewed. The results obtained allowed to describe the PSIT services provided in the studied centers, the profile of its users and its providers, as well as the profile of the healthcare staff. Moreover, the paper focuses in describing how the service of PSIT is being carried and how it is being assesse

Eficacia y posible posicionamiento del tezepelumab para tratar el asma grave

Phenotype; Thymic stromal lymphopoietin; Uncontrolled asthmaFenotip; Limfopoetina estromal tímica; Asma no controladaFenotipo; Linfopoyetina estromal tímica; Asma no controladaThe excellent results for monoclonal antibodies in the treatment of severe uncontrolled asthma (SUCA) represent a milestone in current treatment of asthmatic disorders. Remaining, however, are several subsidiary areas for improvement in which new biologics are expected to make a decisive contribution. These biologics include tezepelumab, a monoclonal antibody that blocks thymic stromal lymphopoietin (TSLP). TSLP is an epithelial-release cytokine (alarmin) that plays a key role in initiating both the innate (group 2 innate lymphoid cell (ILC) pathway) and the acquired (T helper 2 (Th2) pathway) immune responses by activating the type 2 (T2) asthma inflammatory pathway through both. It is also thought that it may additionally intervene in the neutrophilic non-T2 inflammatory pathway (via interaction with ILC3 and interleukin-17). Six clinical trials that included 2187 patients with uncontrolled asthma, with 2 or more exacerbations in the previous year, on medium/high-dose inhaled corticosteroids and at least 1 other controller, have demonstrated – irrespective of T2 endotype (and possibly also non-T2 endotype) – the efficacy and safety of tezepelumab, as it significantly reduces exacerbations (61.7%–66%) and bronchial hyperresponsiveness, and improves lung function, disease control, and quality of life. Tezepelumab could be indicated for the treatment of patients with, independently of the T2 phenotype (eosinophilic and non-eosinophilic), and may even be the only biologic available for treatment of non-T2 SUCA.Los excelentes resultados de los anticuerpos monoclonales en el tratamiento del asma grave no controlada (AGNC) constituyen un hito en el tratamiento actual de los trastornos asmáticos. Sin embargo, aún quedan varios aspectos complementarios susceptibles de mejorar para los que se esperan contribuciones decisivas de los nuevos biofármacos, entre los cuales se encuentra el tezepelumab, un anticuerpo monoclonal que bloquea la linfopoyetina estromal tímica (TSLP). La TSLP es una citocina de liberación epitelial (alarmina) que desempeña una función clave en el inicio de las respuestas inmunitarias tanto innata (vía de las células linfocíticas innatas [ILC] del grupo 2) como adaptativa (vía de los linfocitos T cooperadores 2 [Th2]), activando la vía inflamatoria del asma del tipo 2 (T2) mediante ambas. También se cree que puede intervenir en la vía inflamatoria neutrofílica con T2 baja (mediante la interacción con los ILC3 y la interleucina 17). En seis ensayos clínicos que incluyeron a 2.187 pacientes con asma no controlada, dos o más exacerbaciones en el año anterior, a tratamiento con corticosteroides inhalados en dosis medias o altas y con un mínimo de un tratamiento preventivo adicional, se ha demostrado la eficacia y seguridad del tezepelumab sin importar el endotipo T2 (y posiblemente tampoco el endotipo no T2), ya que reduce significativamente las exacerbaciones (61,7-66%) y la hiperreactividad bronquial y mejora la función pulmonar, el control de la enfermedad y la calidad de vida. El tezepelumab puede estar indicado para tratar a pacientes con asma grave, independientemente del fenotipo T2 (eosinofílico y no eosinofílico), y tal vez sea incluso el único biofármaco existente para el tratamiento del AGNC no T2.This article was funded by the Barcelona Respiratory Network (BRN) who did not participate in the articles selected or writing of the manuscript

Analysis of the population structure of Plasmodium falciparum-infected erythrocytes

Preprin

Pulmonary arterial wall disease in COPD and interstitial lung diseases candidates for lung transplantation

Malaltia pulmonar obstructiva crònica; Trasplantament de pulmó; Paret arterial pulmonarEnfermedad pulmonar obstructiva crónica; Trasplante de pulmón; Pared arterial pulmonarChronic obstructive pulmonary disease; Lung transplantation; Pulmonary arterial wallBackground Pulmonary hypertension (PH) associated with lung disease has the worst prognosis of all types of PH. Pulmonary arterial vasculopathy is an early event in the natural history of chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). The present study characterized the alterations in the structure and function of the pulmonary arterial (PA) wall of COPD and ILD candidates for lung transplantation (LTx). Methods A cohort of 73 patients, 63 pre-LTx (30 COPD, 33 ILD), and ten controls underwent simultaneous right heart catheterisation and intravascular ultrasound (IVUS). Total pulmonary resistance (TPR), capacitance (Cp), and the TPR-Cp relationship were assessed. PA stiffness and the relative area of wall thickness were estimated as pulse PA pressure/IVUS pulsatility and as [(external sectional area-intimal area)/external sectional area] × 100, respectively. Results Twenty-seven percent of patients had pulmonary arterial wedge pressure > 15 mmHg and were not analyzed. PA stiffness and the area of wall thickness were increased in comparison with controls, even in patients without PH (p < 0.05). ILD patients showed a significant higher PA stiffness, and lower Cp beyond mean PA pressure (mPAP) and lower area of wall thickness than COPD patients (p < 0.05). TPR-Cp relationship was shifted downward left for ILD patients. Conclusions Significant increase of PA stiffness and area of wall thickness were present even in patients without PH and can make the diagnosis of pulmonary vasculopathy at a preclinical stage in PH-lung disease candidates for LTx. ILD patients showed the worst PA stiffness and Cp with respect to COPD.Partially support by a grant of Boston Scientific Corporation, USA

TYC 2675-663-1: A newly discovered W UMa system in an active state

The recently discovered eclipsing binary system TYC 2675-663-1 is a X-ray source, and shows properties in the optical that are similar to the W UMa systems, but are somewhat unusual compared to what is seen in other contact binary systems. The goal of this work is to characterize its properties and investigate its nature by means of detailed photometric and spectroscopic observations. We have performed extensive V-band photometric measurements with the INTEGRAL satellite along with ground-based multi-band photometric observations, as well as high-resolution spectroscopic monitoring from which we have measured the radial velocities of the components. These data have been analysed to determine the stellar properties, including the absolute masses and radii. Additional low-resolution spectroscopy was obtained to investigate spectral features. From the measured eclipse timings we determine an orbital period for the binary of P=0.4223576+-0.0000009 days. The light-curve and spectroscopic analyses reveal the observations to be well represented by a model of an overcontact system composed of main-sequence F5 and G7 stars (temperature difference of nearly 1000 K), with the possible presence of a third star. Low-resolution optical spectroscopy reveals a complex H alpha emission, and other features that are not yet understood. The unusually large mass ratio of q=0.81+-0.05 places it in the rare "H" (high mass ratio) subclass of the W UMa systems, which are presumably on their way to coalescence.Comment: 12 pages in double column format. Accepted for publication in Astronomy and Astrophysic

Tracking the dynamics of skyglow with differential photometry using a digital camera with fisheye lens

Artificial skyglow is dynamic due to changing atmospheric conditions and the switching on and off of artificial lights throughout the night. Street lights as well as the ornamental illumination of historical sites and buildings are sometimes switched off at a certain time to save energy. Ornamental lights in particular are often directed upwards, and can therefore have a major contribution towards brightening of the night sky. Here we use differential photometry to investigate the change in night sky brightness and illuminance during an automated regular switch-off of ornamental light in the town of Balaguer and an organized switch-off of all public lights in the village of \`Ager, both near Montsec Astronomical Park in Spain. The sites were observed during two nights with clear and cloudy conditions using a DSLR camera and a fisheye lens. A time series of images makes it possible to track changes in lighting conditions and sky brightness simultaneously. During the clear night, the ornamental lights in Balaguer contribute over 20% of the skyglow at zenith at the observational site. Furthermore, we are able to track very small changes in the ground illuminance on a cloudy night near \`Ager.Comment: 17 pages, 13 figures, 1 tabl

Métodos y problemas interpretativos en los estudios de cerámica utilitaria: los materiales cerámicos y sus limitaciones en el yacimiento de Revenga, Burgos (s. VI-XI)

[spa] A lo largo de los últimos años las excavaciones arqueológicas llevadas a cabo en el yacimiento de Revenga (Comunero de Revenga, Burgos) han permitido recuperar algunos materiales cerámicos de cronologías tardoantiguas y altomedievales. Dado su estado de conservación muy precario, el carácter utilitario de este tipo de producciones y las dificultades que aún hoy existen en el estudio de la cerámica común altomedieval, dichos materiales plantean algunos problemas interpretativos que hemos intentado resolver a partir de una caracterización petrográfica de los mismos. Los resultados obtenidos aportan nuevos datos muy significativos para el conocimiento de las comunidades del Alto Arlanza, permiten precisar las distintas fases de ocupación del asentamiento de Revenga y abren nuevas perspectivas para la investigación futura.[eng] Archaeological fieldwork at the site of Revenga (Comunero de Revenga, Burgos) allowed discovering in recent years some late antique and early medieval pottery sherds. Given their precarious state of preservation, the utilitarian character of these products and the still existing lacks of knowledge in this domain, the materials found introduce some interpretative problems. We attempted to solve some of these throughout the petrographic characterization of these vessels. According to the results obtained new significant data contributing to the knowledge of peasant communities at the Upper Arlanza Basin are introduced, and a more precise occupation sequence at the site of Revenga is discussed, opening new perspectives for future research

Proximal pulmonary arterial wall disease in patients with persistent pulmonary hypertension after successful left-sided valve replacement according to the hemodynamic phenotype

Regression of pulmonary hypertension (PH) is often incomplete after successful left-sided valve replacement (LSVR). Proximal pulmonary arterial (PPA) wall disease can be involved in patients with persistent-PH after LSVR, affecting the right ventricular to pulmonary arterial (RV-PA) coupling. Fifteen patients underwent successful LSVR at least one year ago presenting PH by echo (> 50 mmHg). Prosthesis-patient mismatch and left ventricular dysfunction were discarded. All patients underwent hemodynamic and intravascular ultrasound (IVUS) study. We estimated PPA stiffness (elastic modulus [EM]) and the relative area wall thickness (AWT). Acute vasoreactivity was assessed by inhaled nitric oxide (iNO) testing. RV-PA coupling was estimated by the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure ratio. Patients were classified as isolated post-capillary PH (Ipc-PH; pulmonary vascular resistance [PVR] ≤ 3 WU and/or diastolic pulmonary gradient [DPG] 3 WU and DPG ≥ 7 mmHg). Both Ipc-PH and Cpc-PH showed a significant increase of EM and AWT. Despite normal PVR and DPG, Ipc-PH had a significant decrease in pulmonary arterial capacitance and RV-PA coupling impairment. Cpc-PH had worse PA stiffness and RV-PA coupling to Ipc-PH (P < 0.05). iNO decreased RV afterload, improving the cardiac index and stroke volume only in Cpc-PH (P < 0.05). Patients with persistent PH after successful LSVR have PPA wall disease and RV-PA coupling impairment beyond the hemodynamic phenotype. Cpc-PH is responsive to iNO, having the worse PA stiffness and RV-PA coupling. The PPA remodeling could be an early event in the natural history of PH associated with left heart disease