Evaluación de la competencia clínica en el posgrado de medicina familiar mediante el Examen Clínico Objetivo Estructurado

ObjetivoValorar la competencia clínica de los residentes de primer año del Curso de Especialización en Medicina Familiar aplicando un examen clínico objetivo estructurado (ECOE) para evaluar en forma simultánea las áreas cognoscitiva, afectiva y psicomotriz.DiseñoDescriptivo, observacional.EmplazamientoClínicas de medicina familiar del área metropolitana de la Ciudad de México.ParticipantesOchenta y nueve médicos en capacitación del curso de especialización en medicina familiar, de la Universidad Nacional Autónoma de México.Mediciones principalesPrevio diseño de listas de cotejo, validación de contenido por expertos, diseño de material de apoyo para la evaluación y prueba piloto, se aplicó un ECOE con 10 temas o estaciones, ocho de ellas dinámicas y dos estáticas. El criterio para considerar un nivel de desempeño competente fue de 60 puntos de un máximo de 100, tanto en cada estación como en el promedio global. El análisis estadístico fue univariado, utilizando estadística descriptiva.ResultadosEl promedio global de las calificaciones en todas las estaciones fue inferior a 60. El promedio porcentual más alto fue 73 en la estación de control de niño sano. En las cinco estaciones con mejor puntuación, la dispersión fue menor que en las cinco estaciones con la puntuación más baja. En la estación de estudio de familia se obtuvo una puntuación baja.ConclusionesEl rendimiento académico evaluado mediante ECOE para valorar la competencia clínica fue bajo. La aplicación de este tipo de examen permitió evaluar de forma más objetiva la competencia clínica. Se requiere probar escalas de evaluación de intervalo para valorar de forma más adecuada la calidad de la realización de las actividades clínicas.ObjectiveTo evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas.DesignObservational and descriptive.SettingFamily medicine clinics in the metropolitan area of Mexico City.Participants89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM).Main measurementsAfter prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics.ResultsThe overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section.ConclusionsAcademic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities

Surface morphologies of Ti and Ti-Al-V bombarded by 1.0-MeV Au+ Ions

Ion implantation is known to enhance the mechanical properties of biomaterials such as, e.g., the wear resistance of orthopedic joints. Increasing the surface area of implants may likewise improve their integration with, e.g., bone tissue, which requires surface features with sizes in the micron range. Ion implantation of biocompatible metals has recently been demonstrated to induce surface ripples with wavelengths of a few microns. However, the physical mechanisms controlling the formation and characteristics of these patterns are yet to be understood. We bombard Ti and Ti-6Al-4V surfaces with 1.0-MeV Au+ ions. Analysis by scanning electron and atomic force microscopies shows the formation of surface ripples with typical dimensions in the micron range, with potential indeed for biomedical applications. Under the present specific experimental conditions, the ripple properties are seen to strongly depend on the fluence of the implanted ions while being weakly dependent on the target material. Moreover, by examining experiments performed for incidence angle values theta = 8 degrees, 23 degrees, 49 degrees, and 67 degrees, we confirm the existence of a threshold incidence angle for (ripple) pattern formation. Surface indentation is also used to study surface features under additional values of., agreeing with our single-angle experiments.This work was financially supported by Dirección General de Asuntos del Personal Académico-UNAM under Contracts No. Programa de Apoyo a Proyectos de Investigación e Innovación Tecnológica IN110116 and No. IN111717, and by CONACYT under Contract No. 222485. L. R. d. l. V. is supported by the Programa de Estancias Sabáticas Nacionales del Consejo Nacional de Ciencia y Tecnología (CONACyT). R. C. acknowledges the kind hospitality and support of the Instituto de Física at UNAM while part of this work was being carried out, as well as partial support from Ministerio de Economía y Competitividad/Fondo Europeo de Desarrollo Regional (Spain/European Union) through Grants No. FIS2012- 38866-C05-01 and No. FIS2015-66020-C2-1-P

RESULTADOS PRELIMINARES EN LOS ESTUDIOS DE IMPLANTACIÓN DE ENERGÍAS RENOVABLES EN EL REGADÍO DEL PROYECTO I+D+i OPTIREG: GESTIÓN EFICIENTE DE REGADÍOS

[ES] OPTIREG, tiene el objetivo de alcanzar nuevas posibilidades de ahorro a partir de una buena gestión en toda la cadena de valor. Para ello trabaja en cuatro bloques interrelacionados: 1) implantación de energías renovables, 2) mercados eléctricos y compraventa de energía, 3) eficiencia hídrica y 4) eficiencia energética. En el presente Trabajo Técnico se presentan los resultados obtenidos, hasta el momento, en el bloque 1) implantación de energías renovables, mediante el cual se busca una disminución del coste energético del regadío, así como una mayor independencia de los proveedores de electricidad. Se ha investigado el uso y rentabilidad de la energía fotovoltaica, eólica y minihidráulica para su integración en una red de regadío actual.Fernández, K.; Ortega, A.; Carpio, F.; Mayordomo, A.; Martinez, M.; Iglesias, S. (2015). RESULTADOS PRELIMINARES EN LOS ESTUDIOS DE IMPLANTACIÓN DE ENERGÍAS RENOVABLES EN EL REGADÍO DEL PROYECTO I+D+i OPTIREG: GESTIÓN EFICIENTE DE REGADÍOS. En XXXIII CONGRESO NACIONAL DE RIEGOS. Valencia 16-18 junio de 2015. Editorial Universitat Politècnica de València. https://doi.org/10.4995/CNRiegos.2015.1469OC

Methodology to improve water and energy use by proper irrigationscheduling in pressurised networks

With the aim of reducing energy consumption and improving water use in pressurised irrigation systems, the methodology to minimise energy consumption by grouping intakes of pressurised irrigation networks into sectors, as developed by Jimenez Bello et al. (2010a), was modified to enable irrigation intakes to operate during the scheduled period for each intake instead of operating during restricted irrigation periods of the same length. Moreover, a method was developed to detect the maximum number of intakes that can operate without extra energy if the source has sufficient head to feed at least some of the intakes. These methods were applied to a Mediterranean irrigation system, where the total cropped area was mainly citrus orchards. In this case study, water was allocated to two groups of intakes, one fed by gravity and the other by pumps. A saving of 36.3 % was achieved by increasing the total volume supplied by gravity, decreasing the injection pump head, and improving the pump performance. Therefore, all the intakes only operated during the irrigation periods at the minimum required pressure.This research was supported by funds from Climate-KIC AGADAPT and from EU 7th Framework Programme FIGARO projects. The authors wish to acknowledge the support provided by Picassent Sector XI staff. The revision of this paper was funded by "The Universitat Politecnica de Valencia, Spain".Jiménez Bello, MA.; Royuela Tomás, Á.; Manzano Juarez, J.; García Prats, A.; Martínez Alzamora, F. (2015). Methodology to improve water and energy use by proper irrigationscheduling in pressurised networks. Agricultural Water Management. 149:91-101. doi:10.1016/j.agwat.2014.10.026S9110114

Learning to live together: a challenge for schools located in contexts of social vulnerability

Currently, there are many educational centres that demonstrate the need to promote initiatives to improve coexistence at school at the international level, especially in those located in contexts of social vulnerability. A socio-educational programme has been developed, applied and evaluated at a Singular Education Action Centre (Centro de Acción Educativa Singular - C.A.E.S) in the city of Valencia (Spain). To ascertain the programme's impact and possible generalization to other contexts, a quasi-experimental pretest-posttest design with a control group was used. Information was collected from 297 students and 54 teachers based on questionnaires assessing coexistence at school. The results obtained demonstrate the satisfactory functioning of the programme. The faculty and students from the experimental group affirm the importance of continuing to work in this direction to invest in creating a democratic school that firmly believes in coexistence and participation. Areas for improvement include the need to incorporate actions to increase family participation and develop strategies to facilitate the implementation of a more comprehensive programme

Effectiveness and safety of first-generation protease inhibitors in clinical practice: Hepatitis C virus patients with advanced fibrosis

AIM: To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PIs) in clinical practice against chronic C virus, especially in patients with advanced fibrosis. METHODS: Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1, treatment-nai¨ve (TN) or treatment-experienced (TE), who underwent triple therapy with the first generation NS3/4A protease inhibitors, boceprevir (BOC) and telaprevir (TVR), in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up. RESULTS: One thousand and fifty seven patients were included, 405 (38%) were treated with BOC and 652 (62%) with TVR. Of this total, 30% (n = 319) were TN and the remaining were TE: 28% (n = 298) relapsers, 12% (n = 123) partial responders (PR), 25% (n = 260) null-responders (NR) and for 5% (n = 57) with prior response unknown. The rate of sustained virologic response (SVR) by intention-to-treatment (ITT) was greater in those treated with TVR (65%) than in those treated with BOC (52%) (P < 0.0001), whereas by modified intention-to-treatment (mITT) no were found significant differences. By degree of fibrosis, 56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients, both TN and TE. In the analysis by groups, the TN patients treated with TVR by ITT showed a higher SVR (P = 0.005). However, by mITT there were no significant differences between BOC and TVR. In the multivariate analysis by mITT, the significant SVR factors were relapsers, IL28B CC and non-F4; the type of treatment (BOC or TVR) was not significant. The lowest SVR values were presented by the F4-NR patients, treated with BOC (46%) or with TVR (45%). 28% of the patients interrupted the treatment, mainly by non-viral response (51%): this outcome was more frequent in the TE than in the TN patients (57% vs 40%, P = 0.01). With respect to severe haematological disorders, neutropaenia was more likely to affect the patients treated with BOC (33% vs 20%, P = 0.0001), and thrombocytopaenia and anaemia, the F4 patients (P = 0.000, P = 0.025, respectively). CONCLUSION: In a real clinical practice setting with a high proportion of patients with advanced fibrosis, effectiveness of first-generation PIs was high except for NR patients, with similar SVR rates being achieved by BOC and TVR

The Atapuerca sites and the Ibeas hominids

The Atapuerca railway Trench and Ibeas sites near Burgos, Spain, are cave fillings that include a series of deposits ranging from below the Matuyama/Bruhnes reversal up to the end of Middle Pleistocene. The lowest fossil-bearing bed in the Trench contains an assemblage of large and small Mammals including Mimomys savini, Pitymys gregaloides, Pliomys episcopalis, Crocuta crocuta, Dama sp. and Megacerini; the uppermost assemblage includes Canis lupus, Lynx spelaea, Panthera (Leo) fossilis, Felis sylvestris, Equus caballus steinheimensis, E.c. germanicus, Pitymys subtenaneus, Microtus arvalis agrestis, Pliomys lenki, and also Panthera toscana, Dicerorhinus bemitoechus, Bison schoetensacki, which are equally present in the lowest level. The biostratigraphic correlation and dates of the sites are briefly discussed, as are the paleoclimatic interpretation of the Trench sequences. Stone artifacts are found in several layers; the earliest occurrences correspond to the upper beds containing Mimomys savini. A set of preserved human occupation floors has been excavated in the top fossil-bearing beds. The stone-tool assemblages of the upper levels are of upper-medial Acheulean to Charentian tradition. The rich bone breccia SH, in the Cueva Mayor-Cueva del Silo, Ibeas de Juarros, is a derived deposit, due to a mud flow that dispersed and carried the skeletons of many carnivores and humans. The taxa represented are: Vrsus deningeri (largely dominant), Panthera (Leo) fossilis, Vulpes vulpes, Homo sapiens var. Several traits of both mandibular and cranial remains are summarized. Preliminary attempts at dating suggest that the Ibeas fossil man is older than the Last Interglacial, or oxygen-isotope stage 5

Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV

Results are presented from a search for a W' boson using a dataset corresponding to 5.0 inverse femtobarns of integrated luminosity collected during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV. The W' boson is modeled as a heavy W boson, but different scenarios for the couplings to fermions are considered, involving both left-handed and right-handed chiral projections of the fermions, as well as an arbitrary mixture of the two. The search is performed in the decay channel W' to t b, leading to a final state signature with a single lepton (e, mu), missing transverse energy, and jets, at least one of which is tagged as a b-jet. A W' boson that couples to fermions with the same coupling constant as the W, but to the right-handed rather than left-handed chiral projections, is excluded for masses below 1.85 TeV at the 95% confidence level. For the first time using LHC data, constraints on the W' gauge coupling for a set of left- and right-handed coupling combinations have been placed. These results represent a significant improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe