2,281 research outputs found
Patient Safety in the Critical Care Setting: Common Risks and Review of Evidence-Based Mitigation Strategies
The Intensive Care Unit (ICU) has evolved in the last 50 years. This evolution’s main drivers include equipment and software improvements, the patient safety movement, and a better pathophysiological understanding of critical illness. There is mounting pressure from accreditation agencies, governmental regulation, financial challenges, operational dynamics, staffing changes, and increased acuity affecting-ICU care delivery and impacting patient safety. There are higher than ever expectations to improve clinical outcomes after an intensive care stay, to enhance patient safety, to increase family involvement in decision making, and merge the multidisciplinary medical experience into an effective teamwork. Leadership focus is directed towards increasing diversity and inclusion in the workforce while enhancing psychological safety. This review addresses the common risks for patient safety in the intensive care setting and describes the changes in mindset and application of evidence-based mitigation strategies
Arbuscular mycorrhizal fungi associated with the rhizosphere of seedlings and mature trees of Swietenia macrophylla (Magnoliophyta: Meliaceae) in Los Tuxtlas, Veracruz, Mexico
Formation of polycrystalline TiO2 on the ablated surfaces of RbTiOPO4 single crystals by thermal annealing
We investigated the structural effects that ultrafast laser ablation has on RbTiOPO4 (RTP) single crystals. Raman scattering analysis revealed that a polycrystalline layer of RTP substituted the original material on the surface of the microstructured areas which is mainly responsible for the roughness observed in these structures. A later annealing treatment on the ablated samples resulted in the formation of a layer of sub-micrometric particles of TiO2 in a mixed form of anatase and rutile, due to the decomposition of the polycrystalline RTP layer. This allows the development of engineering strategies to fabricate RTP–TiO2 composites, with mixed properties, that might allow the combination of the non-linear optical properties of RTP and the light dispersive and electrical properties of TiO2.This work was supported by the EU Framework 7 under project FP7-SPA-2010-263044, by the Spanish Government under projects MAT2011-29255-C02-02, TEC2010-21574-C02-02, FIS2009-09522 and CSD2007-00013, by Generalitat de Catalunya under project 2009SGR235 and by Junta de Castilla y León under project SA086A12-2
Placental thrombosis in acute phase abortions during experimental Toxoplasma gondii infection in sheep
43 p.After oral administration of ewes during mid gestation with 2000 freshly prepared sporulated oocysts of T. gondii
isolate M4, abortions occurred between days 7 and 11 in 91.6% of pregnant and infected ewes. Afterwards, a
further infection was carried out at late gestation in another group of sheep with 500 sporulated oocysts. Abortions
happened again between days 9 and 11 post infection (pi) in 58.3% of the infected ewes. Classically, abortions in
natural and experimental ovine toxoplasmosis usually occur one month after infection. Few experimental studies
have reported the so-called acute phase abortions as early as 7 to 14 days after oral inoculation of oocysts, and
pyrexia was proposed to be responsible for abortion, although the underline mechanism was not elucidated. In the
present study, all placentas analysed from ewes suffering acute phase abortions showed infarcts and thrombosis in
the caruncullar villi of the placentomes and ischemic lesions (periventricular leukomalacia) in the brain of some
foetuses. The parasite was identified by PCR in samples from some placentomes of only one sheep, and no antigen
was detected by immunohistochemical labelling. These findings suggest that the vascular lesions found in the
placenta, and the consequent hypoxic damage to the foetus, could be associated to the occurrence of acute phase
abortions. Although the pathogenesis of these lesions remains to be determined, the infectious dose or virulence
of the isolate may play a role in their developmentS
TICs y Test
En este trabajo continuamos con un estudio acerca de la deserción universitaria en las Carreras de IngenierÃa. En un trabajo publicado anteriormente presentamos el test de seguimiento como una herramienta para ayudar en la prevalencia de los alumnos en la carrera. En este estudio mostraremos que la introducción de los tests en la evaluación parcial mejora el porcentaje de aprobados, reflejado en los datos obtenidos de aprobación, desaprobación y deserción del 2017. Luego presentamos cómo combinar las TecnologÃas de la Información y la Comunicación (TIC) y los tests de seguimiento para mejorar la recolección y procesamiento de los datos, agilizando los tiempos de análisis, respuesta y modificación de las estrategias de enseñanza.
Evaluamos ventajas y desventajas en los primeros resultados del 2018.Facultad de Ciencias Agrarias y Forestale
Surface ablation of RbTiOPO4 by femtosecond laser
We report here the results obtained in surface ablation of RbTiOPO4 single crystals by femtosecond laser. We fabricated and characterized one-dimensional (1D) diffraction gratings with different lattice spacings of 15 and 20 μm, and with a sub-modulation of the period introduced in the later. The optical and electronic microscopy characterization and filling factor analysis of these diffraction gratings are reported. We also show that the roughness generated on the grooves by the ablation process can be improved by chemical etching.This work was partially funded by the European Commission under the Seventh Framework Program under Project Cleanspace FP7-SPACE-2010-1-GA-263044, supported by the Spanish Government under Projects PI09/90527, TEC2009-09551, AECID A/024560/09, FIS2009-09522, HOPE CSD2007-00007 and SAUUL CSD2007-00013 (Consolider-Ingenio 2010), by Catalan Government under Projects 2009SGR235 and 2009SGR549, by Junta de Castilla y León under Project GR27, and by the Research Center on Engineering of Materials and Systems (EMaS) of the URV. J.J.C. is supported by the Education and Science Ministry of Spain and European Social Fund under the Ramón y Cajal program, RYC2006-858. We also acknowledge support from the Centro de Laseres Pulsados, CLPU, Salamanca, Spain
Risk Factors for and Prediction of Post-Intubation Hypotension in Critically Ill Adults: A Multicenter Prospective Cohort Study
OBJECTIVE: Hypotension following endotracheal intubation in the ICU is associated with poor outcomes. There is no formal prediction tool to help estimate the onset of this hemodynamic compromise. Our objective was to derive and validate a prediction model for immediate hypotension following endotracheal intubation.
METHODS: A multicenter, prospective, cohort study enrolling 934 adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 was conducted to derive and validate a prediction model for immediate hypotension following endotracheal intubation. We defined hypotension as: 1) mean arterial pressure \u3c 65 mmHg; 2) systolic blood pressure \u3c 80 mmHg and/or decrease in systolic blood pressure of 40% from baseline; 3) or the initiation or increase in any vasopressor in the 30 minutes following endotracheal intubation.
RESULTS: Post-intubation hypotension developed in 344 (36.8%) patients. In the full cohort, 11 variables were independently associated with hypotension: increasing illness severity; increasing age; sepsis diagnosis; endotracheal intubation in the setting of cardiac arrest, mean arterial pressure \u3c 65 mmHg, and acute respiratory failure; diuretic use 24 hours preceding endotracheal intubation; decreasing systolic blood pressure from 130 mmHg; catecholamine and phenylephrine use immediately prior to endotracheal intubation; and use of etomidate during endotracheal intubation. A model excluding unstable patients’ pre-intubation (those receiving catecholamine vasopressors and/or who were intubated in the setting of cardiac arrest) was also developed and included the above variables with the exception of sepsis and etomidate. In the full cohort, the 11 variable model had a C-statistic of 0.75 (95% CI 0.72, 0.78). In the stable cohort, the 7 variable model C-statistic was 0.71 (95% CI 0.67, 0.75). In both cohorts, a clinical risk score was developed stratifying patients’ risk of hypotension.
CONCLUSIONS: A novel multivariable risk score predicted post-intubation hypotension with accuracy in both unstable and stable critically ill patients.
STUDY REGISTRATION: Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101
Ischemic Tolerance Protects the Rat Retina from Glaucomatous Damage
Glaucoma is a leading cause of acquired blindness which may involve an ischemic-like insult to retinal ganglion cells and optic nerve head. We investigated the effect of a weekly application of brief ischemia pulses (ischemic conditioning) on the rat retinal damage induced by experimental glaucoma. Glaucoma was induced by weekly injections of chondroitin sulfate (CS) in the rat eye anterior chamber. Retinal ischemia was induced by increasing intraocular pressure to 120 mmHg for 5 min; this maneuver started after 6 weekly injections of vehicle or CS and was weekly repeated in one eye, while the contralateral eye was submitted to a sham procedure. Glaucoma was evaluated in terms of: i) intraocular pressure (IOP), ii) retinal function (electroretinogram (ERG)), iii) visual pathway function (visual evoked potentials, (VEPs)) iv) histology of the retina and optic nerve head. Retinal thiobarbituric acid substances levels were assessed as an index of lipid peroxidation. Ischemic conditioning significantly preserved ERG, VEPs, as well as retinal and optic nerve head structure from glaucomatous damage, without changes in IOP. Moreover, ischemia pulses abrogated the increase in lipid peroxidation induced by experimental glaucoma. These results indicate that induction of ischemic tolerance could constitute a fertile avenue for the development of new therapeutic strategies in glaucoma treatment
Declaración de Chinchón: decálogo sobre eldulcorantes sin y bajos en calorÃas (ESBC)
Multidisciplinary experts in the areas of nutrition and
health met in Chinchón, Madrid, on November 25-26, 2013
under the auspices of the Fundación para la Investigación
Nutricional (Nutrition Research Foundation) and with the
collaboration of the Madrid Regional Government’s Health
Ministry, the International Sweeteners Association and the
Carlos III Health Institute CIBER of Physiopathology of
Obesity and Nutrition. They analyzed the current status
of scientific knowledge on low- and no-calorie sweeteners
(LNCS) and developed a consensus Decalogue on their use;
this constitutes the Chinchón Declaration. Sweeteners,
including sugar, represent a subject of undeniable
interest and are currently a popular topic, although areas
relating to their safety and benefits remain unknown to
segments of academia and the general public. The nature
of LNCS makes them vulnerable to biased and even
contradictory information. They are food additives that
are broadly used as sugar substitutes to sweeten foods,
medicines and food supplements when non-nutritional or
non-caloric alternatives are needed. The Chinchón
Decalogue is the outcome of a meeting for reflection and
consensus by a group of experts with backgrounds in
different scientific disciplines (toxicology, clinical nutrition,
community nutrition, physiology, food science, public
health, pediatrics, endocrinology and nutrition, nursing,
pharmaceutical care and food legislation). The Decalogue
includes different aspects of LNCS related to regulation,
use, benefits and safety. In general, benefits of LNCS have
been traditionally neglected in comparison with the
tendency for emphasising unexisting or unproven possible
risks. The need to strengthen research on LNCS in Spain
was emphasized, as well as the need to educate both
professionals and the publicExpertos de carácter multidisciplinar de las áreas de
conocimiento de la nutrición y la salud reunidos en Chinchón,
Madrid, los dÃas 25 y 26 de noviembre de 2013 , bajo
los auspicios de la Fundación para la Investigación Nutricional
y con la colaboración de la ConsejerÃa de Sanidad
del Gobierno de la Comunidad de Madrid, la International
Sweeteners Association y el CIBER de FisiopatologÃa de la
Obesidad y la Nutrición del Instituto de Salud Carlos III,
analizaron el estado actual del conocimiento cientÃfico en
torno a los Edulcorantes sin y bajos en calorÃas (ESBC) y
desarrollaron un Decálogo sobre su uso que constituye la
Declaración de Chinchón. Los edulcorantes, incluido el
azúcar, constituyen un elemento de indudable interés y
actualidad, aunque no exento de desconocimiento por
algunos sectores tanto académicos como de la población en
general. La propia naturaleza de los ESBC los hace susceptibles
de informaciones tergiversadas e incluso contradictorias.
Son aditivos alimentarios ampliamente utilizados
como sustitutivos del azúcar para endulzar alimentos,
medicamentos y complementos alimenticios cuando se
persiguen fines no nutritivos. El Decálogo de Chinchón es
fruto de una reunión de reflexión y consenso por parte de
un grupo de expertos procedentes de distintas disciplinas
cientÃficas (toxicologÃa, nutrición clÃnica, nutrición comunitaria,
fisiologÃa, bromatologÃa, salud pública, atención
primaria, pediatrÃa, endocrinologÃa y nutrición, enfermerÃa,
atención farmacéutica y legislación alimentaria). El
decálogo incluye diferentes aspectos de los EBSC relacionados
con la legislación, uso, beneficios y seguridad. En
general, los beneficios de los EBSC han sido tradicionalmente
desatendidos en comparación con la tendencia de
destacar posibles riesgos inexistentes o que no han sido
probados. Hace especial hincapié en la necesidad de fortalecer
la investigación de los EBSC en España, asà como la
necesidad de formar en este ámbito a los profesionales y a
los consumidores en genera
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