Alarm compliance in healthcare: Design considerations for actionable alarms (in intensive care units)

Intensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called "alarm fatigue" and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation

Hidrodinámica de los acuíferos karsticos de las sierras de Urbión y Neila (Burgos)

On the northern slopes of the Urbión and Neila Ridges there is a karstic system of Jurassic limestones and dolomites in a monoclinal arrangement, bounded above and below, respectively, by the impermeable series of the Keuper and Weald. Recharge is by infiltration of rain and meiting snow as well as from the outflow of numerous streams. Discharge flows towards the springs of the young Rivers Najerilla (198 l/s) and Arlanza (500 l/s). An interesting point is an underground transfer at Urbión of 14 hm3/yr from the basin of the Ebro to that of the Duero. According to water-tracing tests, during low flow periods, the average water velocity in the aquifers is between 27 and 38 m/h, and 160 rn/h near the outlet. A simulation in 1990-1991 of the hydrographs of the springs using a rainfall runoff model provided a detailed hydrological balance in which the importance of upstream turbulent flow was evident. The net recharge of precipitation was 42-43 %, though this varied considerably with the seasons.En la vertiente septentrional de las Sierras de Urbión y Neila se presenta un desarrollado aparato kárstico constituido por calizas y dolomías del Jurásico, dispuestas monoclinalmente, y limitadas por arriba y por abajo por las series impermeables del Keuper y del Weald, respectivamente. La recarga se efectúa a través de la infiltración de las precipitaciones de lluvia y nieve, así como por las pérdidas de los arroyos en los numerosos sumideros existentes. La descarga se verifica hacia los manantiales de los nacimientos de los ríos Najerilla (198 l/s) y Arlanza (500 l/s). Un aspecto significativo es la existencia de un trasvase subterráneo en Urbión de 14 hm3/a de la Cuenca del Ebro a la del Duero. Según las pruebas con trazadores realizadas se obtienen unas velocidades medias en los acuíferos y en aguas bajas o estiaje de 27-38 m/h, y de 160 rn/h en las proximidades de los exutorios. La simulación de los hidrogramas de los manantiales con un modelo de precipitación-escorrentía durante 1990- 199 1 ha permitido establecer un detallado balance hidrológico, donde se constata la importancia del régimen turbulento en aguas altas; el rango de recarga media de la precipitación se establece en el 42-43 % aunque es muy variable según las estaciones del año

Duration and cost variability of construction activities: an empirical study

The unique nature of construction projects can mean that construction activities often suffer from duration and cost variability. Because this variability is unplanned, it can present a problem when attempting to complete a project on time and on budget. Various factors causing this variability have been identified in the literature, but they predominantly refer to the nature and/or context of the whole project rather than specific activities. In this paper, the order of magnitude of and correlation between activity duration and cost variability is analyzed in 101 construction projects with over 5,000 activities. To do this, the first four moments (mean, standard deviation, skewness, and kurtosis) of actual versus planned duration and cost (log) ratios are analyzed by project, phase of execution, and activity type. Results suggest that, contrary to common wisdom, construction activities do not end late on average. Instead, the large variability in the activity duration is the major factor causing significant project delays and cost overruns. The values of average activity duration and cost variability gathered in this study will also serve as a reference for construction managers to improve future construction planning and project simulation studies with more realistic data

¿Puede considerarse diferente la calidad de la proteína y grasa de la leche de Cabra y vaca?

Peer reviewe

Anticoncepción poscoital. Características de la demanda

ObjetivoConocer el perfil de las mujeres que demandan anticoncepción poscoital (APC).DiseñoDescriptivo transversal. Emplazamiento. Centro de Orientación Familiar (COF), Área 4 del Instituto Madrileño de Salud. Madrid.ParticipantesTodas las mujeres que acudieron en el año 2000 para requerir APC (n = 404).MedicionesSe realizó una encuesta con variables sociodemográficas relacionadas con la APC y con la vida sexual.ResultadosLa edad media fue de 23,9 años (límites, 14–49); el 9,9% era menor de edad. La media de coitos al mes era de 6,7, el número de años de relaciones sexuales era de 4,9 y el primer coito se produjo, de media, a los 18 años. El 90,9% afirmaba tener pareja estable. Tenía estudios secundarios o universitarios un 75%. El 55,7% manifestaba no haber recibido información sobre anticonceptivos. El 19,5% utilizó APC en otra ocasión. El 6,5% había tenido alguna interrupción voluntaria de embarazo y de éstas, el 36% había utilizado APC anteriormente. Los motivos de consulta fueron: rotura de preservativo (69,3%), preservativo retenido (16,9%) y coito sin protección (12%). El 7% tuvo otros coitos de riesgo en el mismo ciclo. Un 33,2% las remitía su equipo de atención primaria, acudió por conocidos el 19% y desde servicios de urgencias el 16%. Conocía el COF un 26,1%. En el 12,2% no se prescribió APC por mínimo riesgo de embarazo. Realizaron la valoración una enfermera (52,6%), médicos residentes (34,4%) y una ginecóloga (13%).ConclusionesFalta información sobre métodos anticonceptivos. La mayoría de las pacientes son derivadas por otros servicios sanitarios.ObjectiveDefine the profile of the women that ask for emergency contraception (EC).DesignTransversal descriptive investigation.SettingFamiliar Planning Center of 4th Area of Instituto Madrileño de Salud. in Madrid. Participants. All the women that went in the year 2000 requiring EC (n=404).MeasurementsWas carried out a survey with sociodemographic variables, related with the EC and with the sexual life.ResultsThe average age was of 23.9 years (age range 14 to 49) were inquired, 9.9 were under 18. They had an average of 6.7 intercourses per month, the first intercourse when they were 18 years old on average, and 4.9 years of sexual relationships. 90.9% stated to have a couple. 75% were graduated from high school or university, and 55.7% said they had never received information about contraceptives. For 19.5% this was not the first time they asked for EC. 6.5% had interrupted on purpose pregnancy and 36% of them had used EC before. The reasons to demand EC were: condom break (69.3%), held condom (16.9%) and intercourse without any protection (12%). 7% acknowledged other risky intercourses during the same period. 33.2% had been sent by a General Practitioner, 26.1% knew the center, 19% were sent by acquaintances and 16% from Emergency Services. EC was not prescribed in 12.2% of the cases because of minimum risk to pregnancy. The evaluation was made by a nurse (52.6%), by a doctor (34.4%) and by a gynecologist (13%).ConclusionsThere is a lack of information about contraceptive methods. Most of the patients are sent from other sanitary services

Huellas de Pterosaurios en el grupo Oncala (Soria, España). Pteraichnus palaciei-saenzi, nov. icnosp.

Several ptesoraur tracksites have been found in the northern area of Soria, Spain, among which Barranco de Valdelavilla (Valdelavilla) stands out due to the great amount of tracks, and Los Tormos (Santa Cruz de Yanguas) because of the occurrence of trackways. This group of tracks is attributable to the ichnogenus Pteraichnus, and the existence of a new ichnospecies has been verified (Pteraichnus palaciei-saenzi). To this moment, only sporadic tracks from these flying reptiles have been found in the other localities and this poor fossil trackway record cannot be attributed to a specific ichnospecies. These findings together with the trackway found in Los Tormos (Santa Cruz de Yanguas), described by Moratalla (1993) and Lockley et al. (1995), and digit impressions of these animals found at Río Ventosa and Valdehuérteles (Fuentes y Meijide, 1996) confirm the generalized presence of these animals in the Oncala Formation, more specifically at subunits IV-b of the Huérteles Aloformation and at the base of V-b of the Valdeprado Aloformation. This can be explained on the basis of environmental conditions in this area at that time -a muddy plain covered at one point by lakes with a more or less long life- being appropriate for these reptiles, who are always associated to coastal or aquatic terrestrial environments, to live and develop.En la zona Norte de Soria se han descubierto numerosos yacimientos de huellas de pterosaurios, destacando el del Barranco de Valdelavilla (Valdelavilla) por la cuantía de las mismas y el de Los Tormos (Santa Cruz de Yanguas) por la presencia de rastros. El conjunto de huellas pertenece al icnogénero Pteraichnus, habiéndose constatado la presencia de una nueva icnoespecie (Pteraichnus palaciei-saenzi). En el resto de las localidades sólo se han encontrado, por ahora, esporádicas huellas de estos reptiles voladores, no permitiendo la escasez del registro icnológico la asignación a una icnoespecie concreta. Estos hallazgos, junto con el rastro ubicado también en los Tormos (Santa Cruz de Yanguas), descrito por Moratalla (1993) y Lockley et al. (1995), y la localización de falanges de estos animales en Río Ventosa y Valdehuérteles (Fuentes y Meijide, 1996), confirman la presencia generalizada de estos animales en el Grupo Oncala y más concretamente en las subunidades IV-b de la Aloformación Huérteles y en la base de la V-b de la Aloformación Valdeprado. Tal circunstancia se puede explicar sobre la base de la existencia, en aquellos tiempos, de unas condiciones medioambientales propicias para la vida y el desarrollo de estos reptiles, asociadas siempre con ambientes litorales o terrestres acuáticos, como es el que presentaba esta zona (llanura fangosa, cubierta, en algunos momentos, por lagos de vida más o menos larga)

Evaluating seawater quality objectives: Application to the Andalusian littoral

The University of Cadiz (southern Spain) and the Andalusian Environmental Agency (AMA) have signed an agreement to draw up a proposal of quality objectives for Andalusian littoral waters in accordance with the classification of zones approved in the Andalusian Littoral Waters Quality Objectives Regulations (Decree 14/1996, 01-16-1996, BOJA no. 19, 02-08-1996). The present paper reviews different regulations (European Union, Spain and the United States) concerning seawater quality criteria and presents the quality criteria proposed by the University of Cadiz.La Universidad de Cádiz y la Agencia de Medio Ambiente Andaluza (AMA) han desarrollado un convenio cuya finalidad es la realización de una propuesta de objetivos de calidad para las aguas litorales andaluzas según la clasificación de zonas establecida en el Decreto 14/1996, por el que se aprueba el Reglamento de Calidad de las Aguas Litorales Andaluzas (BOJA n.° 19 de 8 de febrero de 1996). En este trabajo se hace una revisión de la normativa referente a los objetivos de calidad de las aguas marinas en la Unión Europea, España y Estados Unidos. Además, se recoge la propuesta de objetivos de calidad de aguas litorales realizada por la Universidad de Cádiz.Instituto Español de Oceanografí

Una variedad blanca (Vitis vinifera L.) de alto interés comercial, y en vías de extinción. Sinonimias y homonimias

Comunicación presentada al X Congreso Nacional de Ciencias Hortícolas, celebrado en Pontevedra en mayo de 2003.Peer reviewe

Mycobacterial aminoglycoside acetyltransferases: a little of drug resistance, and a lot of other roles

Aminoglycoside acetyltransferases are important determinants of resistance to aminoglycoside antibiotics in most bacterial genera. In mycobacteria, however, aminoglycoside acetyltransferases contribute only partially to aminoglycoside susceptibility since they are related with low level resistance to these antibiotics (while high level aminoglycoside resistance is due to mutations in the ribosome). Instead, aminoglycoside acetyltransferases contribute to other bacterial functions, and this can explain its widespread presence along species of genus Mycobacterium. This review is focused on two mycobacterial aminoglycoside acetyltransferase enzymes. First, the aminoglycoside 2'-N-acetyltransferase [AAC(2')], which was identified as a determinant of weak aminoglycoside resistance in M. fortuitum, and later found to be widespread in most mycobacterial species; AAC(2') enzymes have been associated with resistance to cell wall degradative enzymes, and bactericidal mode of action of aminoglycosides. Second, the Eis aminoglycoside acetyltransferase, which was identified originally as a virulence determinant in M. tuberculosis (enhanced intracellular survival); Eis protein in fact controls production of pro-inflammatory cytokines and other pathways. The relation of Eis with aminoglycoside susceptibility was found after the years, and reaches clinical significance only in M. tuberculosis isolates resistant to the second-line drug kanamycin. Given the role of AAC(2') and Eis proteins in mycobacterial biology, inhibitory molecules have been identified, more abundantly in case of Eis. In conclusion, AAC(2') and Eis have evolved from a marginal role as potential drug resistance mechanisms into a promising future as drug targets

Probing H2 autoionizing states with femto and attosecond laser pulses.

ABSTRACT: We show the relevance that molecular autoionizing states display in some recent experiments related to the symmetry-breaking in molecular-frame photoelectron angular distributions in H2 when exposed to intense xuv femtosecond laser pulses, and others related to the electron (proton) localization when subject to attosecond pump-probe laser schemes. Our theoretical method solves the time-dependent Schr¨odinger equation with an spectral method that expands the wave function in terms of H2 correlated stationary vibronic states including all electronic and vibrational degrees of motion. Time-resolved asymmetric electron angular distributions are obtained at specific proton kinetic energies due to the delayed autoionization from H2 doubly excited states, which induces interferences between gerade (1s(sigma)g) and ungerade (2p(sigma)u) ionization channels. We also study photoionization of H2 exposed to a xuv attosecond pump pulse plus a time-delayed IR femtosecond probe pulse. Fast alternating asymmetries in the proton ejection (electron localization) are obtained as a function of the time delay between the pump and the probe pulses. Finally, we deal with the process of (xuv) two-photon double ionization of H2 under the assumption of having both sequential and non-sequential absorption processes