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Los trabajadores de la salud, especialmente el personal de enfermería, se encuentran expuestos a una  importante variedad de factores de riesgo laborales y personales que pueden provocar accidentes de trabajo dependiendo del tipo de tareas que desempeñan y el puesto de trabajo que ocupan. La Clínica Villapilar ESE  Rita Arango Álvarez del Pino de Manizales como institución de alta complejidad, y la cual tiene una gran  demanda por parte de la población del departamento de Caldas, debido a la amplia cantidad de servicios  hospitalarios y especializados que ofrece, fue la institución escogida para realizar esta investigación. Se  estudiaron los factores laborales y personales que incidieron en la ocurrencia de accidentes de trabajo  biológicos, así como la notificación de los mismos en el personal de enfermería tanto auxiliar como  profesional durante el periodo de junio a noviembre de 2005. Se realizó un estudio cuantitativo descriptivo,  en donde se utilizaron como instrumentos para la recolección de información: una encuesta estructurada de  acuerdo a los parámetros de las normas ANSI-Z-2, revisión documental y una guía de observación; del  análisis de los resultados se pudo concluir que: De 11 accidentes de trabajo notificados, 7 (63%) fueron en el  personal de enfermería, siendo el más frecuente el accidente por punción, al cual se le realiza seguimiento  según los protocolos establecidos. El 100% de la población que ha tenido accidentes de trabajo, ha notificado  el hecho y, de éstos, el 90% considera que los elementos de protección personal que proporciona la  institución son suficientes. Los resultados obtenidos son similares a los de otros centros hospitalarios en  donde el riesgo de punción es el más frecuente. Dada la posibilidad de transmisión de agentes infecciosos  por esta vía de entrada, se destaca la importancia de desarrollar programas preventivos de este frecuente  accidente laboral (1).Health workers, especially nursing personnel, are usually exposed to a large variety of work and personal risk factors that can cause industrial accidents depending on the types of duties they perform. VillaPilar ESE Rita  Arango Alvarez del Pino Clinic of Manizales is an institution that develops complex surgeries and procedures.  Because of this, its services are highly demanded by the people that live in the Department of Caldas. The  clinic offers a wide range of specialized health services and this was the reason it was chosen to carry out this research process. The work and personal factors that influence the occurrence of biological work factors  were studied, as well as the notification of these by professional and assistant nursing personnel from June  to November 2005. A descriptive quantitative study was carried out, using the following tools for gathering  information: a survey designed according to the regulations established by ANSI-Z-2 norms, document  analysis and an observation guide. The conclusions include: from 11 reported work accidents, 7 (63%)  happened to nursing personnel. The most frequent accident was puncturing, which is monitored according  to the protocol established. 100% of the population that has had work accidents has notified the event, and  90% of them think that the personal protection tools provided by the institution are enough. The results  obtained are similar to those of other hospital centers, where puncturing risk is the most frequent. Due to  the possibility of transmission of infectious agents by this entry way, it its important to develop prevention  programs against this frequent work accident (2)

Black list and Alert list of the Aquatic Invasive Alien Species in the Iberian Peninsula: an action of the LIFE INVASAQUA

Resumen del trabajo presentado en VI Congreso Nacional sobre Especies Exóticas Invasoras y I Congreso Ibérico sobre EEI (EEI 2022) celebrado en Navarra del 20 al 23 de abril de 2022.One of the objectives of LIFE INVASQUA project is to develop tools that will be more efficient the Early Warning and Rapid Response (EWRR) framework for Invasive Alien Species in the Iberian Peninsula. Horizon scanning for high-risk IAS is basic in implementing measures to reduce new invasions, developing Alert lists, and to focus effort in the species already established, for instance making a Black list. We developed a trans national horizon scanning exercise focused on inland waters of Spain and Portugal in order to provide a prioritized lists (Black list and Alert list) of aquatic IAS that may pose a threat to aquatic ecosystems and socio economic sectors in the future. We followed a step approach of existing information about IAS (Plants, Freshwater Invertebrates, Estuarine Invertebrates and Vertebrates; 127 established taxa in Black list; 90 non established taxa in Alert list) combining with an expert scoring of prioritized taxa. IAS established in the Iberian aquatic system consistently highlighted as the worst included vertebrates (e.g. Cyprinus carpio, Gambusia holbrooki, Silurus glanis), freshwater and estuarine invertebrates (e.g. Procambarus clarkii, Dreissena polymorpha, Pacifastacus leniusculus, Ficopomatus enigmaticus, Callinectes sapidus, Corbicula fluminea) and plants (e.g. Eichhornia crassipes, Azolla filiculoides, Ludwigia grandiflora). Amongst taxa not yet established (Alert list), expert pointed to Perna viridis, Hydroides dirampha, Dreissena bugensis, Procambarus fallax f. virginallis, Perccottus glenii with higher risk of invasion, ecological and socioeconomic impacts. Over 20.6% of the taxa in the preliminary black list received no votes (no prioritization) by experts, 17.8% in the innitial alert list. Our horizon scanning approach is inclusive of all-taxa, prioritizes both established and emerging biological threats across trans-national scales, and considers not only the ecological impact, but also potential direct economic consequences as well as the manageability of invasive species.This work received funds from the LIFE Programme (LIFE17 GIE/ES/000515)

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Resignificando la educación: 12 reflexiones pedagógicas sobre la escuela

208 páginasEste libro reúne 12 artículos de maestros y maestras de la ciudad que reflexionan sobre el rol de la Escuela en la actualidad. Sin duda, la pandemia es un hecho que atraviesa varias de estas páginas, pues esta coyuntura ha hecho que estudiantes, docentes y familias resignifiquen su papel en la educación. Pero este libro no se agota allí, en tanto aparecen iniciativas como las redes de maestros y maestras en torno a la paz, la interculturalidad, así como nuevas miradas sobre la inclusión educativa y la evaluación que aportan al diálogo pedagógico. De esta manera, el Instituto para la Investigación Educativa y el Desarrollo Pedagógico (IDEP) busca que docentes y directivos de las instituciones educativas aporten a la transformación educativa desde sus saberes y experiencias.I. La Escuela en Casa. Página 17: Transitando por la Escuela: realidades y posibilidades. Página 29: Relación Familia- Escuela, Educación Asistida y Ambientes de Aprendizaje en Casa. Página 43: Percepciones de familias sobre su participación en la Escuela. Articulando voces de madres, padres y acudientes de estudiantes en Jardín y Transición. II. Nuevas miradas de la evaluación Página 71: Del pensamiento a la acción: la evaluación en el preescolar. Página 87: La evaluación durante el confinamiento educativo: evidencias investigativas de una crisis en sus prácticas y usos. III. Redes de paz, reconciliación y ciudadanía. Página 103: La Red Elegguá: Abriendo caminos para la tolerancia y la interculturalidad. Página 113: Pedagogías colectivas para la Paz- Tejido de esperanzas de maestras y maestros de la Red Chisua. IV. Inclusión educativa. Página 131: Experiencias de apropiación: Narrativas de maestras desde la inclusión. Página 149: El rol del docente de apoyo frente al reto de una educación inclusiva de calidad para la atención a la población estudiantil con discapacidad. Página 161: La oferta bilingüe-bicultural a nivel distrital, una apuesta en la educación de la persona sorda. V. Estudiantes y maestros en cambio. Página 177: El maestro investigador en el aula y su caracterización pedagógica. Página 195: Los Procesos de Lectura y Escritura Creativa en niños, niñas y adolescentes. Análisis de una experiencia

Adelante / Endavant

Séptimo desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere "Purificación Escribano" de la Universitat Jaume

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data

Study of downward Terrestrial Gamma-ray Flashes with the surface detector of the Pierre Auger Observatory

The surface detector (SD) of the Pierre Auger Observatory, consisting of 1660 water-Cherenkov detectors (WCDs), covers 3000 km2 in the Argentinian pampa. Thanks to the high efficiency of WCDs in detecting gamma rays, it represents a unique instrument for studying downward Terrestrial Gamma-ray Flashes (TGFs) over a large area. Peculiar events, likely related to downward TGFs, were detected at the Auger Observatory. Their experimental signature and time evolution are very different from those of a shower produced by an ultrahigh-energy cosmic ray. They happen in coincidence with low thunderclouds and lightning, and their large deposited energy at the ground is compatible with that of a standard downward TGF with the source a few kilometers above the ground. A new trigger algorithm to increase the TGF-like event statistics was installed in the whole array. The study of the performance of the new trigger system during the lightning season is ongoing and will provide a handle to develop improved algorithms to implement in the Auger upgraded electronic boards. The available data sample, even if small, can give important clues about the TGF production models, in particular, the shape of WCD signals. Moreover, the SD allows us to observe more than one point in the TGF beam, providing information on the emission angle