Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition

Background: Rapid and accurate interpretation of cardiac arrhythmias by nurses has been linked with safe practice and positive patient outcomes. Although training in electrocardiogram (ECG) rhythm recognition is part of most undergraduate nursing programmes, research continues to suggest that nurses and nursing students lack competence in recognising cardiac rhythms. In order to promote patient safety, nursing educators must develop valid and reliable assessment tools that allow the rigorous assessment of this competence before nursing students are allowed to practise without supervision. Aim: To develop and psychometrically evaluate a toolkit to holistically assess competence in ECG rhythm recognition. Methods: Following a convenience sampling technique, 293 nursing students from a nursing faculty in a Spanish university were recruited for the study. The following three instruments were developed and psychometrically tested: a knowledge assessment tool (ECG-KAT), a skills assessment tool (ECG-SAT) and a self-efficacy assessment tool (ECG-SES). Reliability and validity (content, criterion and construct) of these tools were meticulously examined. Results: A high Cronbach’s alpha coefficient demonstrated the excellent reliability of the instruments (ECG-KAT=0.89; ECG-SAT=0.93; ECG-SES=0.98). An excellent context validity index (S-CVI/Ave>0.94) and very good criterion validity were evidenced for all the tools. Regarding construct validity, principal component analysis revealed that all items comprising the instruments contributed to measure knowledge, skills or self-efficacy in ECG rhythm recognition. Moreover, known-groups analysis showed the tools’ ability to detect expected differences in competence between groups with different training experiences. Conclusion: The three-instrument toolkit developed showed excellent psychometric properties for measuring competence in ECG rhythm recognition

Osteoblastoma del sacro. A propósito de dos casos clínicos.

El osteoblastoma es un tumor óseo primitivo de frecuente localización en los elementos posteriores de la columna vertebral, aunque raro en el sacro. Se presentan dos osteoblastomas del sacro, con un seguimiento medio de ocho años, tratados mediante resección intralesional que, sin morbilidad, deparó un excelente resultado. El curetaje sería un procedimiento de resección válido en osteoblastomas sacros no agresivos, si bien obliga a un seguimiento prolongado del paciente para vigilar la posibilidad de recidivas locales.Osteoblastoma is a primary neoplasm of bone fre- quently located in the posterior elements of the spine, alt- hough rarely affecting the sacrum. Two cases in this location are reported, with a mean follow-up of eight years, treated with an intralesional resection that, without any morbidity, has provided an excellent result. Curettage should be a valid re- section procedure for nonagressive osteoblastomas of the sacrum, although it makes necessary a long follow-up in or- der to watch over the possibility of a local recurrence

Morteros de cemento mejorados con la adición de cenizas volantes carbonatadas provenientes de la incineración de residuos

This article presents the results of a research developing high performance cement mortars with the addition of municipal solid waste incineration fly ash (MSWIFA) stabilized as insoluble carbonates. The encapsulation of hazardous wastes in mortar matrixes has also been achieved. The ashes present high concentrations of chlorides, Zn and Pb. A stabilization process with NaHCO3 has been developed reducing 99% the content of chlorides. Developed mortars replace 10% per weight of the aggregates by treated MSWIFA. Physical/mechanical properties of these mortars have been studied. Presence of Zn, Pb, Cu and Cd has been also analyzed confirming that leaching of these heavy metal ions is mitigated. Conclusions prove better behavior of CAC and CSA mortars than those of CEM-I and CEM-II cement. Results are remarkable for the CAC mortars, improving reference strengths in more than 25%, which make them a fast-curing product suitable for the repair of structures or industrial pavements.Este artículo presenta los resultados del desarrollo de morteros mejorados con la incorporación de cenizas volantes de residuos sólidos urbanos inertizadas en forma de carbonatos. Además se consigue la encapsulación de un residuo peligroso. Las cenizas presentan una alta concentración de cloruros, Zn y Pb. Se ha desarrollado un proceso de estabilización con NaHCO3 reduciendo en un 99% el contenido de cloruros. Los morteros reemplazan un 10% en peso del árido por cenizas tratadas. Se han analizado sus propiedades físico/mecánicas y la presencia de Zn, Pb, Cu y Cd. Se demuestra un mejor comportamiento de los morteros de CAC y CSA que los de CEM-I y CEM-II y se mitiga el lixiviado de metales pesados. Los resultados son significativos en los morteros CAC al mejorar las resistencias de los de referencia en un 25%. Los morteros desarrollados son de curado rápido adecuados para la reparación de estructuras o soleras industriales

Nuestra experiencia con el minivástago femoral de disco a compresión y el cotilo Hedrocel (tantalio)

Durante los años 2000 a 2002 intervinimos 18 pacientes de artrosis o necrosis sintomática de cadera, con minivástago de fijación metafisiaria de Disco a Compresión (Sulzer) y cotilo monobloque de tantalio Hedrocel (Zimmer), con par de fricción alúmina-polietileno. La edad media de los pacientes fue de 46,7 años (rango 35-61), y el seguimiento medio de 42 meses. La valoración clínica se realizó con la escala de Merle D'Augbigné Postel obteniendo 38,8% de resultados excelentes, 22,2 de resultados buenos, 11,1% regulares y 27,4% malos (5 casos). Cuatro casos necesitaron reintervención por aflojamiento del tallo femoral. No hubo ningún fracaso del cotilo. La sustitución protésica de la cadera en los pacientes jóvenes requieren soluciones con la menor resección del hueso, pero este modelo de tallo femoral, no da un resultado satisfactorio, por lo que lo hemos abandonado.Between 2000 2002 we treated 18 patients with symptomatic osteoarthritis or osteonechrosis of hip, with uncemneted Thrust Plate Protesis (Sulzer) and tantalium acetabular componente Hedrocel (Zimmer), with ceramic-pol- yethylene pair. The average age of the patients was 46,7 years (range:35-61), and the average follow-up of 42 months. Clinical evaluation was done with Merle D'Augbigné Postel's scale obtaining 38,8 % of excellent results, 22,2 % of good results, 11,1 % fair and 27,4 % poor (5 cases). Four cases needed re-operation for loosening of the femoral stem. There was no failure of the acetabular component. The hip artrhroplasty in the young patients need solutions with the minor resection of bone, but this model of femoral stem does not give a satisfactory result, therefore we have abandoned it

Deformación plástica del antebrazo: revisión y caso clínico

La deformidad plástica de un hueso es una rara entidad, que en ocasiones pasa desapercibida. Se trata de una lesión típica del niño, con un hueso más elástico que los adultos. La mayoría de las deformidades plásticas del antebrazo se producen por caídas con el brazo en extensión, causando deformidad, dolor y una limitación de la pronosupinación. Para reducir la curvatura del hueso se precisan fuerzas contrarias a las que produjeron la lesión, mantenidas en el tiempo. En niños menores de 4 años, con enorme capacidad de remodelación, sólo grandes deformidades >20º deberían ser reducidas. En los mayores de 10 años, con escaso potencial remodelador, deben manipularse aquellas angulaciones >10-15º. La mayor complicación derivada de una mala reducción es la limitación de la pronosupinación, que en la mayoría de las ocasiones no altera la funcionalidad de la extremidad.Plastic bowing of a bone is a rare entity that some- times goes unnoticed. It’s a typical injury in children, who have more elastic bones than adults. Most of the plastic bowing of the forearm take place by falls with an outstretched arm, causing deformities, pain and a limitation of pronation and supination. In order to reduce the curvature of the bone, opposing forces to those that produced the injury are needed, maintained for a long time. In children younger than 4 years, with an enormous remodelling capacity, only great deformi- ties >20º should be reduced. For those older than 10 years, with little remodelling capacity, angulations >10-15º must be manipulated. The greatest complication derived from a bad reduction is the limitation of the pronation and supination, which in most cases does not modify the functionality of the extremity

Palaeoenvironmental analysis of the Aragonian (middle Miocene) mammalian faunas from the Madrid Basin based on body-size structure

As a consequence of the growth of the Antarctic ice-sheet during the middle Miocene, a global decrease of temperatures and an associated increase in aridity provoked several environmental changes all around the world. Such environmental variations can be detected in the continental record of the mammalian prey community structure using a synecological approach. Because of the good quality of its faunas, the rich Aragonian vertebrate fossil record from the Madrid Basin (Spain) appears as a good candidate to explore these environmental changes. In order to analyse the climatic evolution of the Iberian Peninsula associated to the Global Cooling Event, two classic palaeosynecological methodologies (cenograms and body size diversity), based on body-size community structure, were applied to 6 fossil sites from the Madrid Basin, ranging over 2 million years (15.5 – 13.5 Ma). To establish a comparative framework, we used the ecological faunal data from 100 modern localities uniformly distributed all around the world. Our palaeoenvironmental inference is based on multivariate discriminant analysis of the dataset containing both modern and fossil mammals. Finally, we can conclude that the Aragonian mammalian assemblage from the Madrid Basin showed a predominance of semiarid environments with pulses of higher aridity in biozones Dc, E and F associated with the Global Cooling Event of the middle Miocene.Como consecuencia del crecimiento del casquete polar Antártico, durante el Mioceno medio, se produjo un descenso global de la tem­peratura asociado a un aumento de la aridez. Este tipo de cambios ambientales pueden ser detectados en el registro continental, siguiendo un modelo sinecológico para analizar la estructura de las comunidades de las faunas de mamíferos herbívoros. Debido a la calidad de sus faunas, el registro fósil de las faunas de vertebrados del Aragoniense de la Cuenca de Madrid se antoja como un buen candidato para explorar estos patrones de cambio ambiental. Con el objetivo de analizar la evolución climática de la Península Ibérica asociada al evento de enfriamiento global durante este lapso temporal, dos metodologías paleosinecológicas clásicas (cenogramas y espectros de diversidad de tamaño corporal), basadas en la estructura de tamaños corporales de las comunidades de mamíferos, han sido aplicadas a la fauna de herbívoros fósiles presente en seis yacimientos de la Cuenca de Madrid, abarcando aproximadamente 2 millones de años (15.5 – 13.5 Ma). Se ha establecido un marco comparativo usando los datos ecológicos de la fauna de mamíferos presente en 100 localidades uniformemente distribuidas por todo el planeta. Esta inferencia paleoambiental está basada en la aplicación de análisis discriminante multivariante sobre el conjunto de datos de las faunas actuales y fósiles. Finalmente, las faunas de mamíferos del Aragoniense de la Comunidad de Madrid mostraron una predominancia de ambientes semiáridos con varios pulsos de mayor aridez en las biozonas Dc, E y F asociados al evento de enfriamiento global del Mioceno medio

Modulation of the electroluminescence emission from ZnO/Si NCs/p-Si light-emitting devices via pulsed excitation

In this work, the electroluminescence (EL) emission of zinc oxide (ZnO)/Si nanocrystals (NCs)-based light-emitting devices was studied under pulsed electrical excitation. Both Si NCs and deep-level ZnO defects were found to contribute to the observed EL. Symmetric square voltage pulses (50-μs period) were found to notably enhance EL emission by about one order of magnitude. In addition, the control of the pulse parameters (accumulation and inversion times) was found to modify the emission lineshape, long inversion times (i.e., short accumulation times) suppressing ZnO defects contribution. The EL results were discussed in terms of the recombination dynamics taking place within the ZnO/Si NCs heterostructure, suggesting the excitation mechanism of the luminescent centers via a combination of electron impact, bipolar injection, and sequential carrier injection within their respective conduction regimes

Light-activated electroforming in ITO/ZnO/p-Si resistive switching devices

We report on light-activated electroforming of ZnO/p-Si heterojunction memristors with transparent indium tin oxide as the top electrode. Light-generated electron-hole pairs in the p-type substrate are separated by the external electric field and electrons are injected into the active ZnO layer. The additional application of voltage pulses allows achieving different resistance states that end up in the realization of the low resistance state (LRS). This process requires much less voltage compared to dark conditions, thus avoiding undesired current overshoots and achieving a self-compliant device. The transport mechanisms governing each resistance state are studied and discussed. An evolution from an electrode-limited to a space charge-limited transport is observed along the electroforming process before reaching the LRS, which is ascribed to the progressive formation of conductive paths that consequently induce the growth of conductive nanofilaments through the ZnO layer. This work was financially supported by the Spanish Ministry of Economy and Competitiveness (Project Nos. TEC2012-38540-C02-01 and TEC2016-76849-C2-1-R). O.B. also acknowledges the subprogram "Ayudas para Contratos Predoctorales para la Formación de-Doctores" from the Spanish Ministry of Economy and Competitiveness for economical support. J.L.F. acknowledges the subprogram "Ayudas para la Formación de Profesorado Universitario" (No. FPU16/06257) from the Spanish Ministry of Education, Culture and Sports for economical support. X.P., C.L., and C.G. are grateful to C. Frilay for his expertise in the maintenance of the sputtering setup used for the growth of the ZnO films

The risk of incident depression when assessed with the lifestyle and well-being index

Objectives: Novel findings indicate links between unhealthy lifestyles and depression based on active inflammatory processes. Thus, identifying participants with poor habits could reveal differences in trends of incident depression. This study aimed to examine the association between an objective lifestyle assessment, as measured by the Lifestyle and Well-Being Index (LWB-I), and incident depression in healthy participants of a Spanish cohort. Study design: This was a longitudinal analysis of a subsample of 10,063 participants from the Seguimiento Universidad de Navarra cohort study. Methods: Group comparisons and Cox proportional hazard models were conducted using the LWB-I, which categorizes the sample into groups with healthy and unhealthy lifestyles and well-being. The main outcome was incident depression as well as secondary outcomes. Results: Those classified to the transition category of LWB-I were associated with a hazard ratio of 0.67 (95% confidence interval: 0.52-0.87), and those in the excellent category showed a hazard ratio of 0.44 (95% confidence interval: 0.33-0.58), which in both groups reflects a significantly lower risk of incident depression compared with the group including those classified in the poor LWB-I level. Moreover, the available sensitivity analyses concerning time of depression diagnosis or antidepressant treatment further supported the role of nutrition and physical activity on incident depression. Interestingly, throughout the follow-up, incident depression was inversely related to healthier daily habits as measured by the LWB-I. Conclusions: A global assessment of lifestyles such as the LWB-I provides valuable insight into the complex relationship between lifestyle factors and their link to depression risk.Funding was received from the Spanish Government-Instituto de Salud Carlos III , the European Regional Development Fund (FEDER; RD 06/0045, CIBER-OBN, grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795, PI20/00564 and G03/140), the Navarra Regional Government (27/2011, 45/2011, 122/2014), the National Plan on Drugs (2020/021), and the University of Navarra

El acceso intraoseo en reanimación pediátrica. 1999-2001. Intra-osseous approach in pediatric resuscitation. 2001-2002

El establecimiento de un acceso en la circulación es un componente crítico en la resucitación. La infusión intraósea fue descrita por primera vez en 1922 y utilizada para la administración de drogas en 1940, permitiendo un rápido acceso intravascular en pacientes críticamente enfermos, con el objetivo de demostrar sus beneficios en la reanimación infantil en situaciones emergentes. Se realizó una investigación longitudinal, prospectiva y descriptiva en el servicio de cuidados intensivos pediátricos del Hospital General Docente Comandante Pinares, San Cristóbal. Pinar del Río. Cuba. En la etapa comprendida entre enero-1999 a diciembre-2001. Se estudiaron 11 pacientes menores de 5 años que necesitaron medidas de reanimación, realizándose una encuesta que contaba con las siguientes variables: edad, diagnóstico al ingreso, tiempo de obtención de la vía y mantenimiento, drogas, fluidos administrados y complicaciones, se le aplicó el método de estadística descriptivo, distribución de frecuencia y test de proporción. Se concluyó que el 28,2 % (11) de la muestra requirió canalización intraósea, los lactantes (menores de 6 meses) con deshidratación severa necesitaron esta vía en el 54,5% (6), se logró obtener en un tiempo menor de un minuto en 81,8% (7) de los pacientes y se mantuvo hasta 4 horas en el 90,9% de los casos estudiados, las drogas y fluidos mayormente administrados fueron las catecolaminas y la solución salina fisiológica en el 63,6% y el 100% respectivamente, es una técnica con muy raras complicaciones reportándose solo un 9,1%. DeCS: INFUSIÓN INTRAÓSEA, SITUACIONES EMERGENTES, REANIMACIÓN, CATECOLAMINAS, ACCESO INTRAVASCULAR. ABSTRACTThe establishment of an access in Circulation is a very important component in resuscitation. The intraosseous infusion was described for the first time in 1922 and use to administer medications in 1940 allowing a fast intravascular access in critically ill patients. A longitudinal, prospective and descriptive research was carried out at Intensive Care Pediatric Unit belonging to Comandante Pinares General Hospital, San Cristobal, Pinar del Rio aimed at showing its benefits in child resuscitation mainly in emergent situations. During January 1999 to December 2001 eleven patients under 5 years old needing resuscitation measures were studied. A survey taking into account age, diagnosis at admission, time obtained for route and maintenance, drugs, administration of fluids and complications was conducted. Descriptive method, frequency distribution and proportion test were statistically used. Concluding that 28.2 % (11) of the sample required intraosseous infusions, infants (under 6 months) suffering from severe dehydration needed this via (54.5 %) (6), it was obtained (less than a minute) the 81.8 % (7) of the patients and the maintenance was 4 hours in the 90.9 % of the cases studied, drugs and fluids having a greater administration were catecholamines and hypertonic saline solution in 63.6 % and in 100 % of the cases respectively, this technique provoked scarcely complications, only 9.1 % could be reported. DeCS: INTRAOSSEOUS INFUSION, CRITICAL CARE, RESUSCITATION, CATECHOLAMINES, INTRAVASCULAR ACCESS