Clinical experience of cefiderocol

Infections by antibiotic-resistant microorganisms could be considered a "stealth pandemic" that we fight daily in most hospitals. Some estimates suggest that today 700,000 deaths per year can be attributed to antimicrobial resistance. By the year 2050, it is estimated that this will increase to ten million deaths per year as a result of infections by multidrug-resistant microorganisms. In this context, the availability of antimicrobial therapy that is effective against these pathogens is essential to be able to "save the lives" of our patients. Cefiderocol, a new cephalosporin with a different mechanism of action, will be an essential treatment in many infections caused by resistant aerobic gram-negative bacteria. Cefiderocol has been used to treat patients with complicated urinary tract infections (cUTI); hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HAP); in patients with sepsis and bacteremia, some without an identified primary focus of infection

Conexión entre el neuromarketing y las emociones en el proceso de la toma de decisiones

Las emociones desempeñan un papel muy importante en la toma de decisiones de los consumidores y afectan tanto la elección del producto como la valoración que hacemos del mismo. También influyen en nuestra memoria, atención y capacidad de recordar detalles de un producto cuando nos sentimos emocionados por él. Por lo tanto, las decisiones de compra a menudo son impulsivas e irracionales, influenciadas por las emociones que transmiten las marcas. El neuromarketing se utiliza para medir y analizar estas respuestas emocionales y diseñar estrategias publicitarias más efectivas y persuasivas. En este contexto, este trabajo de fin de grado investiga cómo las emociones influyen en la toma de decisiones de los consumidores, y se destacará la importancia del neuromarketing como herramienta para comprender y aprovechar la conexión emocional entre el consumidor y la marca. El análisis empírico de esta investigación se basa cómo se utiliza la emoción en campañas publicitarias dependiendo del público objetivo de la marca.Grado en Publicidad y Relaciones Pública

Turismo y aversión al riesgo en la era COVID: el comportamiento del turista en los portales de reserva online

Este trabajo fin de grado investiga cómo la pandemia del COVID-19 ha afectado al comportamiento de los turistas en los portales de reserva online. La pandemia ha producido un escenario de incertidumbre en la toma de decisiones, donde la aversión al riesgo toma mayor importancia. Examinamos qué factores influyen en la toma de decisiones de los usuarios de reservas online antes y después del COVID. Relacionamos esos factores con los diferentes sesgos psicológicos que afectan a las personas en su toma de decisiones de inversión y analizamos en qué forma su patrón de comportamiento determinado por la aversión al riesgo puede variar según diferentes características personales, tales como el género, la edad, el nivel económico y el nivel educativo. El análisis empírico de nuestra investigación se basa en una encuesta online respondida por una muestra de 144 individuos. Nuestros resultados revelan que, durante la pandemia, los turistas valoran más las medidas de higiene y limpieza y las políticas de cancelación flexibles, lo que sugiere la relevancia de la aversión al riesgo en sus decisiones.Grado en Turism

Impacto de la implementación de sistemas de gestión de la calidad en la mejora de la atención sanitaria.

RESUMEN: En las últimas décadas se han introducido progresivamente en las organizaciones sanitarias de todo el mundo diferentes modelos de gestión de la calidad asistencial. Entre los más utilizados se encuentran los modelos de acreditación sanitaria, la certificación según las normas ISO o el modelo europeo de excelencia EFQM. Estos modelos pueden ser complementarios entre sí y actualmente la mayoría de los centros sanitarios los usan conjuntamente. El reto está en evaluar su efectividad y su impacto en la mejora de los resultados asistenciales y en la satisfacción de los pacientes. En los últimos años, diversos estudios de investigación multicéntricos llevados a cabo en hospitales de la Unión Europea han encontrado una asociación positiva entre la gestión de la calidad y la efectividad clínica, junto con un efecto también positivo de los sistemas de calidad basados en modelos de acreditación y certificación ISO sobre los resultados asistenciales.ABSTRACT: In recent decades they have been progressively introduced in healthcare organizations worldwide different management models of care quality. Among the most used are the models of health accreditation, certification according to ISO or EFQM European model of excellence. These models can be complementary to each other and currently in most health centers use them together. The challenge is to assess their effectiveness and impact in improving outcomes of care and patient satisfaction. In recent years, studies of multicenter research conducted in hospitals in the European Union have found a positive association between quality management and clinical effectiveness, with a positive effect of quality systems based on models of accreditation and ISO certification of the results of care

Bartonella Endocarditis in Spain: Case Reports of 21 Cases

Endocarditis por Bartonella; Endocarditis infecciosaBartonella endocarditis; Infective endocarditisEndocarditis per Bartonella; Endocarditis infecciosaBlood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the “Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)”cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment

Screening pulmonary arteriovenous malformations in a large cohort of Spanish patients with hemorrhagic hereditary telangiectasia

39 p.-1 fig.-7 tab.Background and objectives Because of the serious nature of potential complications, screening for pulmonary arteriovenous malformations is required in patients with hereditary hemorrhagic telangiectasia. The aim of this study was to evaluate the utility of contrast echocardiography and compare the performance of two contrast agents: agitated saline and Gelofusine.Material and methods Two hundred and five patients screened for PAVMs using TTCE and computed tomography (CT) performed with an interval of less than 180 days. Contrast echocardiography studies were graded on a 4-point semiquantitative scale based on the amount of microbubbles seen in left heart chambers.Results Positive TTCE findings were seen in 137 (66.8%) patients, whereas CT confirmed PAVMs in 59 (43.1%). Two of 67 grade 1 patients; 18 of 42 grade 2; 17 of 22 grade 3 and all grade 4 had PAVMs on CT. Embolotherapy was feasible in 38.9% patients in grade 2 and 82.3% and 95.2% in grades 3–4. No patients in grade 1 were embolized. The mean cardiac cycle in which bubbles were first seen in the left heart in patients without and with PAVMs on CT was 6.1 and 3.9 (p < 0.0001). Compared to saline, Gelofusine produced an overall increase in grade.Conclusions No grade 1 patients had treatable PAVMs. There is a need for improvement in the selection of patients for CT in grade 2, where less than half have PAVMs on CT. The cardiac cycle may help to differentiate between patients with and without PAVMs. Gelofusine was not better than saline for PAVM screening.This study has been supported by grants from Instituto de Salud Carlos III (ISCIII; PI11/0246 to JAP), FEDER (to JAP), Ministerio de Economía y Competitividad of Spain (SAF2011-23475 to LMB and SAF2013-43421-R to CB), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER; ISCIIICB06/ 07/0038 to CB).Peer reviewe

Combined method of flow-reduced dump load for frequency control of an autonomous micro-hydropower in AC microgrids

Nowadays, microgrids (MGs) play a crucial role in modern power systems due to possibility of integrating renewable energies into grid-connected or islanded power systems. The Load Frequency Control (LFC) is an issue of paramount importance to ensure MGs reliable and safe operation. Specifically, in AC MGs, primary frequency control of each energy source can be guaranteed in order to integrate other energy sources. This paper proposes a micro-hydro frequency control scheme, combining the control of a reduced dump load and the nozzle flow control of Pelton turbines operating in autonomous regime. Some works have reported the integration of dump load and flow control methods, but they did not reduce the dump load value and adjust the nozzle flow linearly to the power value demanded by users, causing the inefficient use of water. Simulation results were obtained in Matlab®/Simulink® using models obtained from previous research and proven by means of experimental studies. The simulation of the proposed scheme shows that the frequency control in this plant is done in correspondence with the Cuban NC62-04 norm of power energy quality. In addition, it is possible to increase energy efficiency by reducing the value of the resistive dump load by up to 7.5% in a case study. The validation result shows a 60% reduction of overshoot and settling time of frequency temporal behavior of the autonomous micro-hydro.Peer ReviewedPostprint (published version

Mannose-binding lectin gene variants and infections in patients receiving autologous stem cell transplantation

BACKGROUND: Serious infections are common in patients undergoing autologous stem cell transplantation (ASCT) mainly because of the effects of immunosuppression. The innate immune system plays an important role in the defense against different infections. Mannose binding lectin (MBL) is a central molecule of the innate immune system. There are several promoter polymorphisms and structural variants of the MBL2 gene that encodes for this protein. These variants produce low levels of MBL and have been associated with an increased risk for infections. METHODS: Prospective cohort study. The incidence, severity of infections and mortality in 72 consecutive patients with hematologic diseases who underwent ASCT between February 2006 and June 2008 in a tertiary referral center were analyzed according to their MBL2 genotype. INNO-LiPA MBL2 was used for MBL2 gene amplification and genotyping. Relative risks (RR) (IC95%) as measure of association were calculated. Multivariate analysis was performed using logistic regression. RESULTS: A statistically significant higher number of fungal infections was found in patients with MBL2 variants causing low MBL levels (21.1%versus1.9%, p=0.016). In this MBL2 variant group infection was more frequently the cause of mortality than in the MBL2 wild-type group (p=0.05). Although not statistically significant, there was a higher incidence of major infections in the MBL2 variant group as well as a higher number of infections caused by gram-positive bacteria. CONCLUSIONS: Low-producer MBL2 genotypes were associated with an increased number of fungal infections in ASCT patients, which would suggest that MBL has a protective role against such infections. ASCT patients with MBL2 variant genotypes are more likely to die as a result of an infection

The poor accuracy of D-dimer for the diagnosis of prosthetic joint infection but its potential usefulness in early postoperative infections following revision arthroplasty for aseptic loosening

Background: D-dimer was introduced in 2018 as an alternative biomarker for C-reactive protein (CRP) in the diagnostic of prosthetic joint infection (PJI) criteria of the Musculoskeletal Infection Society. We assessed the accuracy of plasma D-dimer for the diagnosis of early, delayed, and late PJI according to Infectious Diseases Society of America (IDSA) criteria, and whether persistently high levels of D-dimer in cases of aseptic loosening (AL) may be predictive of subsequent implant-related infection. Methods: A prospective study of a consecutive series of 187 revision arthroplasties was performed at a single institution.Septic (n = 39) and aseptic revisions (n = 141) were classified based on IDSA criteria. Preoperative assessment of CRP, erythrocyte sedimentation rate (ESR) and D-dimer was performed. Receiver operating curves were used to determine maximum sensitivity and specificity of the biomarkers. The natural progress of D-dimer for AL cases was followed up either until the date of implant-related infection at any time during the first year or 1 year after revision in patients without failure. Clinical outcomes for those AL cases included infection-related failure that required a new surgery or need for antibiotic suppression. Results: Preoperative D-dimer level was significantly higher in PJI cases than in AL cases (p = 0.000). The optimal threshold of D-dimer for the diagnosis of PJI was 1167 ng/mL. For overall diagnosis of PJI, C-reactive protein (CRP) achieved the highest sensitivity (84.6%), followed by erythrocyte sedimentation rate (ESR) and D-dimer (82% and 71.8%, respectively). Plasma D-dimer sensitivity was lower for all PJI types. When combinations of 2 tests were studied, the combined use of ESR and CRP achieved the best accuracy for all types of PJI (76.9%). 4.25% of AL cases had implant failure due to implant-related infection during the first year after the index revision arthroplasty, only the cases with early failure maintained high D-dimer levels

Operational study of drone spraying application of phytosanitary products in vineyards

The use of drones in topics related to precision agriculture to improve the efficiency in the application of phytosanitary products to vineyards increases every day. Drones are especially productive in difficult orographic terrains, where other mechanical systems such as tractors cannot be used. This study shows the development and implementation of a methodology to determine key parameters to decide the suitability of a drone to a spraying task (i.e. spraying time for a certain parcel, number or tank refills required), taking into account the technical specifications of a certain commercial model. For the validation, the data of a vineyard belonging to the Rías Baixas appellation of origin (NW Spain) and the technical specifications of drones from three different manufacturers (i.e. DJI, Hylio and Yamaha) are used. Results show that the Hylio AD122 with a phytosanitary tank of 22 L provides the best performance, with a productivity around 6 minutes per hectare.La utilización de drones en tareas relacionadas con la agricultura de precisión para mejorar la eficiencia en la aplicación de productos fitosanitarios en viñedos es cada vez mayor. Los drones son especialmente eficientes en terrenos con orografía difícil, donde no se pueden emplear otros sistemas mecánicos como tractores. Este estudio muestra el desarrollo e implementación de una metodología para determinar parámetros clave que decidan la adecuación de un drone determinado a una tarea de fumigación (por ejemplo, el tiempo de fumigación para una cierta parcela o el número de tanques requeridos para dicha fumigación), teniendo en cuenta las especificaciones técnicas de un determinado modelo comercial. Para la validación de la metodología, se han utilizado los datos de un viñedo que pertenece a la denominación de origen Rías Baixas (Noroeste de Espala) y las características técnicas de tres fabricantes diferentes de drones (DJI, Hylio y Yamaha). Los resultados obtenidos muestran como el Hylio AD122 con un tanque de fitosanitario de 22 L provee el mejor rendimiento, con una productividad de aproximadamente 6 minutos por hectáre