Evaluation of Three Methods for CPR Training to Lifeguards: a Randomised Trial Using Traditional Procedures and New Technologies

[Abstract] Background and objectives: When the drowning timeline evolves and drowning occurs, the lifeguard tries to mitigate the event by applying the last link of the drowning survival chain with the aim of treating hypoxia. Quality CPR (Cardiopulmonary Resuscitation) and the training of lifeguards are the fundamental axes of drowning survival. Mobile applications and other feedback methods have emerged as strong methods for the learning and training of basic CPR in the last years so, in this study, a randomised clinical trial has been carried out to compare the traditional method as the use of apps or manikins with a feedback system as a method of training to improve the quality of resuscitation. Materials and Methods: The traditional training (TT), mobile phone applications (AP) and feedback manikins (FT) are compared. The three cohorts were subsequently evaluated through a manikin providing feedback, and a data report on the quality of the manoeuvres was obtained. Results: Significant differences were found between the traditional manikin and the manikin with real-time feedback regarding the percentage of compressions with correct depth (30.8% (30.4) vs. 68.2% (32.6); p = 0.042). Hand positioning, percentage correct chest recoil and quality of compressions exceeded 70% of correct performance in all groups with better percentages in the FT (TT vs. FT; p < 0.05). Conclusions: As a conclusion, feedback manikins are better learning tools than traditional models and apps as regards training chest compression. Ventilation values are low in all groups, but improve with the feedback manikin

Reducción de residuos orgánicos en el ámbito gastronómico colombiano

Colombia actualmente enfrenta la problemática concerniente al destino final de cada uno de los desechos orgánicos que produce las cocinas colombianas, generando grandes consecuencias en el marco de una contaminación por desechos, tanto de manera explorativa con consultas bibliográficas y aplicación de instrumentos en una muestra de 26 personas, buscando identificar los diferentes factores que están causando el incremento contaminante afectando el entorno socio ambiental, con el objeto de llegar hacia la consecución de alternativas en una posible caracterización de cada uno de los sobrantes que se generan desde el entorno familiar proyectado al gremio gastronómico y determinar estrategias, basadas en la normatividad vigente, y llegar así a disminuir los daños ambientales que se generan al no realizar una respectiva descomposición y darle un segundo vistazo a como los desechos orgánicos pueden ser una fuente de beneficios, con un adecuado proceso, el cual nos puede permitir crear una excelente transformación mediante compostaje, para la oportuna descomposición de cada uno de los productos agrícolas que se utiliza para la alimentación de nuestro país mediante la educación, para fomentar la concientización social

Evaluation of Three Methods for CPR Training to Lifeguards: A Randomised Trial Using Traditional Procedures and New Technologies

[EN] Background and objectives: When the drowning timeline evolves and drowning occurs, the lifeguard tries to mitigate the event by applying the last link of the drowning survival chain with the aim of treating hypoxia. Quality CPR (Cardiopulmonary Resuscitation) and the training of lifeguards are the fundamental axes of drowning survival. Mobile applications and other feedback methods have emerged as strong methods for the learning and training of basic CPR in the last years so, in this study, a randomised clinical trial has been carried out to compare the traditional method as the use of apps or manikins with a feedback system as a method of training to improve the quality of resuscitation. Materials and Methods: The traditional training (TT), mobile phone applications (AP) and feedback manikins (FT) are compared. The three cohorts were subsequently evaluated through a manikin providing feedback, and a data report on the quality of the manoeuvres was obtained. Results: Significant differences were found between the traditional manikin and the manikin with real-time feedback regarding the percentage of compressions with correct depth (30.8% (30.4) vs. 68.2% (32.6); p = 0.042). Hand positioning, percentage correct chest recoil and quality of compressions exceeded 70% of correct performance in all groups with better percentages in the FT (TT vs. FT; p < 0.05). Conclusions: As a conclusion, feedback manikins are better learning tools than traditional models and apps as regards training chest compression. Ventilation values are low in all groups, but improve with the feedback manikin.S

Statistical downscaling with the downscaleR package (v3.1.0): contribution to the VALUE intercomparison experiment

The increasing demand for high-resolution climate information has attracted growing attention to statistical downscaling (SDS) methods, due in part to their relative advantages and merits as compared to dynamical approaches (based on regional climate model simulations), such as their much lower computational cost and their fitness for purpose for many local-scale applications. As a result, a plethora of SDS methods is nowadays available to climate scientists, which has motivated recent efforts for their comprehensive evaluation, like the VALUE initiative (http://www.value-cost.eu, last access: 29 March 2020). The systematic intercomparison of a large number of SDS techniques undertaken in VALUE, many of them independently developed by different authors and modeling centers in a variety of languages/environments, has shown a compelling need for new tools allowing for their application within an integrated framework. In this regard, downscaleR is an R package for statistical downscaling of climate information which covers the most popular approaches (model output statistics ? including the so-called ?bias correction? methods ? and perfect prognosis) and state-of-the-art techniques. It has been conceived to work primarily with daily data and can be used in the framework of both seasonal forecasting and climate change studies. Its full integration within the climate4R framework (Iturbide et al., 2019) makes possible the development of end-to-end downscaling applications, from data retrieval to model building, validation, and prediction, bringing to climate scientists and practitioners a unique comprehensive framework for SDS model development. In this article the main features of downscaleR are showcased through the replication of some of the results obtained in VALUE, placing an emphasis on the most technically complex stages of perfect-prognosis model calibration (predictor screening, cross-validation, and model selection) that are accomplished through simple commands allowing for extremely flexible model tuning, tailored to the needs of users requiring an easy interface for different levels of experimental complexity. As part of the open-source climate4R framework, downscaleR is freely available and the necessary data and R scripts to fully replicate the experiments included in this paper are also provided as a companion notebook.We thank the European Union Cooperation in Science and Technology (EU COST) Action ES1102 VALUE (http://www.value-cost.eu) for making publicly available the data used in this article and the tools implementing the comprehensive set of validation measures and indices. We also thank the THREDDS Data Server (TDS) software developed by UCAR/Unidata (https://doi.org/10.5065/D6N014KG, Unidata, 2006) and all R developers and their supporting community for providing free software facilitating open science. We acknowledge the World Climate Research Program’s Working Group on Coupled Modelling, which is responsible for CMIP, and we thank the EC-EARTH Consortium for producing and making available their model output used in this paper. For CMIP the U.S. Department of Energy’s Program for Climate Model Diagnosis and Intercomparison provides coordinating support and led the development of software infrastructure in partnership with the Global Organization for Earth System Science Portals. We are very grateful to the two anonymous referees participating in the interactive discussion for their insightful comments, helping us to considerably improve the original paper. Financial support. The authors acknowledge partial funding from the MULTI-SDM project (MINECO/FEDER, CGL2015-66583-R) and from the project INDECIS, part of the European Research Area for Climate Services Consortium (ERA4CS) with co-funding by the uropean Union (grant no. 690462)

Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] 15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activityS

Accuracy of Xpert Ultra for the diagnosis of paediatric tuberculosis in a low TB burden country: a prospective multicentre study

[Introduction] Childhood pulmonary tuberculosis (TB) remains a diagnostic challenge. This study aimed to evaluate the performance of Xpert Ultra for the diagnosis of pulmonary TB in children in a low TB prevalence setting.[Methods] Prospective, multicentre, diagnostic accuracy study. Children with clinical or radiological suspicion of pulmonary TB were recruited at 11 paediatric units in Spain. Up to three gastric or sputum specimens were taken on 3 consecutive days, and analysed by Xpert MTB/RIF, Xpert Ultra and culture in parallel.[Results] 86 children were included (median age 4.9 years, IQR 2.0–10.0; 51.2% male). The final diagnosis was pulmonary TB in 75 patients (87.2%); 33 (44.0%) were microbiologically confirmed. A total of 219 specimens, comprising gastric aspirates (n=194; 88.6%) and sputum specimens (n=25; 11.4%), were analysed. Using culture as reference standard and comparing individual specimens, the sensitivity was 37.8% (14/37) for Xpert MTB/RIF and 81.1% (30/37) for Xpert Ultra (p<0.001); specificity was 98.4% (179/182) and 93.4% (170/182), respectively (p=0.02). In the per-patient analysis, considering positive results on any specimen, the sensitivity was 42.9% (9/21) for Xpert MTB/RIF and 81.0% for Xpert Ultra (17/21, p=0.01); specificity was 96.9% (63/65) and 87.7% (57/65, p=0.07), respectively.[Conclusions] In children with pulmonary TB in a low burden setting, Xpert Ultra has significantly higher sensitivity than the previous generation of Xpert assay and only marginally lower specificity. Therefore, in children undergoing evaluation for suspected pulmonary TB, Xpert Ultra should be used in preference to Xpert MTB/RIF whenever possible.This study did not receive any project-specific funding. DA-A was supported by the Spanish Ministry of Health – Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union (FEDER) (Contrato Río Hortega CM18/00100). AN-J was supported by 'Subvencions per a la Intensificació de Facultatius Especialistes' (Departament de Salut de la Generalitat de Catalunya, Programa PERIS 2016-2020) (SLT008/18/00193). DBG was supported by the Spanish Ministry of Science and Innovation – Instituto de Salud Carlos III and Fondos FEDER by 'Contratos para la intensificación de la actividad investigadora en el Sistema Nacional de Salud, 2020 (INT20/00086)'. BS-G was supported by the Spanish Ministry of Health – Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union (FEDER) (Contrato Juan Rodés JR16/00036).Peer reviewe

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

The Caldera. No. 26

“La PALABRA tiene PODER”, más allá del lema que nos convocó en la décima versión del Concurso Inter colegiado de Oratoria, que en el marco de ULIBRO 2023, se llevó a cabo en NEOMUNDO, el 1 de septiembre pasado, esta frase es una profunda convicción que ha movido al Área de Lengua Castellana del Instituto Caldas, a propiciar y mantener este espacio en el que nuestros estudiantes son los protagonistas. Este año, al tratarse de una celebración especial, quisimos que el tema fundamental fuera el inmenso PODER que tiene la PALABRA; la palabra que construye, que transforma, que edifica, que fortalece, que acompaña, que “abriga”, a diario, al ser humano; en un mundo en el que se debe volver a entender y vivenciar, en el hogar, en la escuela, en la sociedad, el poder transformador de vocablos tan importantes como lo son: “Familia, Educación, Vida, Diversidad, Respeto, Literatura, Escritura, Creatividad, Lectura, Inclusión, Paz, Igualdad Social, Democracia, Ciudadanía y Diálogo”, la palabra cobró fuerza en las voces de nuestros educandos; de esta manera, analizar estos temas tiene que ver necesariamente con los “Futuros posibles”, que planteó la Gran Feria del Libro, ULIBRO, en su vigésima primera versión, para que sigamos trabajando por una sociedad mejor, razón de ser de todas las instituciones educativas del mundo entero.“The WORD has POWER”, beyond the motto that summoned us in the tenth version of the Intercollegiate Oratory Contest, which within the framework of ULIBRO 2023, was held in NEOMUNDO, last September 1, this phrase is a deep conviction that has moved the Spanish Language Area of ​​the Caldas Institute to promote and maintain this space in which our students are the protagonists. This year, as it is a special celebration, we wanted the fundamental theme to be the immense POWER that the WORD has; the word that builds, that transforms, that edifies, that strengthens, that accompanies, that “shelters”, daily, the human being; in a world in which we must understand and experience again, at home, at school, in society, the transformative power of words as important as: “Family, Education, Life, Diversity, Respect, Literature, Writing, Creativity, Reading, Inclusion, Peace, Social Equality, Democracy, Citizenship and Dialogue”, the word gained strength in the voices of our students; In this way, analyzing these issues necessarily has to do with the “Possible Futures”, which the Great Book Fair, ULIBRO, proposed in its twenty-first version, so that we continue working for a better society, the reason for being of all institutions. . educational institutions around the world.Modalidad Presencia

Sloan Digital Sky Survey IV: mapping the Milky Way, nearby galaxies, and the distant universe

We describe the Sloan Digital Sky Survey IV (SDSS-IV), a project encompassing three major spectroscopic programs. The Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2) is observing hundreds of thousands of Milky Way stars at high resolution and high signal-to-noise ratios in the near-infrared. The Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey is obtaining spatially resolved spectroscopy for thousands of nearby galaxies (median ). The extended Baryon Oscillation Spectroscopic Survey (eBOSS) is mapping the galaxy, quasar, and neutral gas distributions between and 3.5 to constrain cosmology using baryon acoustic oscillations, redshift space distortions, and the shape of the power spectrum. Within eBOSS, we are conducting two major subprograms: the SPectroscopic IDentification of eROSITA Sources (SPIDERS), investigating X-ray AGNs and galaxies in X-ray clusters, and the Time Domain Spectroscopic Survey (TDSS), obtaining spectra of variable sources. All programs use the 2.5 m Sloan Foundation Telescope at the Apache Point Observatory; observations there began in Summer 2014. APOGEE-2 also operates a second near-infrared spectrograph at the 2.5 m du Pont Telescope at Las Campanas Observatory, with observations beginning in early 2017. Observations at both facilities are scheduled to continue through 2020. In keeping with previous SDSS policy, SDSS-IV provides regularly scheduled public data releases; the first one, Data Release 13, was made available in 2016 July

INNOVA Research Journal

la Universidad Internacional del Ecuador (Sede Loja) en conjunto con la Fundación de Conservación Jocotoco, desde agosto de 2015, vienen desarrollando actividades de cuidado del tapir de montaña (Tapirus pinchaque) y los hábitats en los que se desarrolla en Los Andes del sur de Ecuador, en ambientes de bosque nublado y páramos de la Reserva Biológica Tapichalaca y zonas colindantes. Para ello se propuso la realización del presente proyecto que busca establecer un sistema de monitoreo e investigación de esta especie bandera con fines ecoturísticos, así como también para apoyar la capacitación en educación ambiental; mediante un diagnóstico preliminar y la implementación de un sistema de investigación y monitoreo de los especímenes mediante cámaras trampa y observación directa, con el fin de generar datos poblacionales e imágenes de esta especie en su hábitat natural e identificar los sitios más idóneos para observar estos animales en actividades de ecoturismo; se busca además crear cartillas y cuentos didácticos que describan los principales aspectos ecológicos del tapir de montaña, sin descuidar el desarrollo de propuestas de conservación, acordes con los objetivos del milenio, las metas estratégicas de los gobiernos autónomos descentralizados parroquiales y provinciales locales y los Planes de Manejo de los Parques Nacionales Podocarpus y Yacuri