9 research outputs found

    Flexible Graphene Solution-Gated Field-Effect Transistors : Efficient Transducers for Micro-Electrocorticography

    Get PDF
    Brain-computer interfaces and neural prostheses based on the detection of electrocorticography (ECoG) signals are rapidly growing fields of research. Several technologies are currently competing to be the first to reach the market; however, none of them fulfill yet all the requirements of the ideal interface with neurons. Thanks to its biocompatibility, low dimensionality, mechanical flexibility, and electronic properties, graphene is one of the most promising material candidates for neural interfacing. After discussing the operation of graphene solution-gated field-effect transistors (SGFET) and characterizing their performance in saline solution, it is reported here that this technology is suitable for Ό-ECoG recordings through studies of spontaneous slow-wave activity, sensory-evoked responses on the visual and auditory cortices, and synchronous activity in a rat model of epilepsy. An in-depth comparison of the signal-to-noise ratio of graphene SGFETs with that of platinum black electrodes confirms that graphene SGFET technology is approaching the performance of state-of-the art neural technologies

    Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

    Get PDF
    This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer 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)

    Get PDF
    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

    Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

    Get PDF
    Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

    Anales de EdafologĂ­a y AgrobiologĂ­a Tomo 41 NĂșmero 9-10

    Get PDF
    Suelos. CaracterĂ­sticas petroquĂ­micas y micromorfolĂłgicas de Haploxeralfs, por P. ArĂ©valo. J. Gallardo y J. Benayas.-- DeterminaciĂłn de manganeso total en suelos, por J. Moreno Caselles, M. GuillĂ©n y M. Romero.-- Rendolles de la Sierra de MarĂ­a (AlmerĂ­a), por L J. Alias y J. MartĂ­nez.-- Estudio de tres perfiles de suelos de La Alpujarra, por Barahona. E., GarcĂ­a Chicano. J. L. Guardiola. J. L. lriarte. A, PĂ©rez-Pujalte, A. y Quirantes, J.-- DetecciĂłn de concordancias fisonĂłmico-edĂĄficas por J. M. GĂłmez. R. RodrĂ­guez GonzĂĄlez. A. GarcĂ­a Miranda y C. de Hoyos Alonso.-- Suelos y sedimentos de zonas semiĂĄridas, por A. GarcĂ­a RodrĂ­guez, J. Forteza Bonnin y L F. Lorenzo MartĂ­n.-- Suelos sobre jumillita de la Sierra de las Cabras (Albacete), por JoaquĂ­n HernĂĄndez Bastida, MarĂ­a Teresa FernĂĄndez Tapia y Francisco Alcaraz Ariza.-- Estudio microscĂłpico de aridisoles de las Islas Canarias, por A. RodrĂ­guez RodrĂ­guez, M. C. PĂ©rez Angles. M. C. DĂ­ez de la Lastra Bosch y E. FernĂĄndez Caldas.-- El material original: propiedades de los suelos de Galicia, por F. Macias. R. M. Calvo, C. GarcĂ­a. E. GarcĂ­a-Rodeja y B. Silva.-- Las sierras de Queixa e invernadeiro y sus estribaciones, por Grupo de EdafĂłlogos de Santiago.-- Suelos forestales de la cordillera costero-catalana, por A. Escuredo. V. R. Vallejo y J. Bech.-- Materia orgĂĄnica de suelos forestales, por A. Escuredo. V. Vallejo y J. Bech.--Dificultades en el empleo del sistema "USDA-Soil Taxonomy", por Carlos Roquero de Laburu.-- Nematodos fitoparĂĄsitos de la superfamilia "criconematoidea", por A. Bello y Ma. Paz Lara.—Silicatos. RetenciĂłn del diazinon por montmorillonita, sepiolita y caolinita, por G. Dios Cancela, S. GonzĂĄlez GarcĂ­a y M. MartĂ­n Aguilar.—GeoquĂ­mica. AlteraciĂłn de minerales de estaño, por Guijarro, J. Casas, J. y Hoyos, M.A.—NutriciĂłn y FisiologĂ­a Vegetal.-- Capacidad fotosintĂ©tica de maĂ­z, por U. VelĂĄzquez, M. Lasaña y J. Cardus.-- El alerce en Chile. II. Su nutriciĂłn mineral, por M. Lachica, C. GonzĂĄlez O. y M. Baez. C. AnomalĂ­as por deficiencias de Ca o de Mg en raĂ­ces de plantas de zea mays L., por JosĂ© Manuel Pozuelo Guanche.-- Competencia de avena sterilis L .. por R. GonzĂĄlez Ponce.-- AbcisiĂłn de las hojas de phaseolus vulgaris, por Ana MarĂ­a Vieitez y MarĂ­a Luisa Vieitez. El castaño y su resistencia a phytophthora cinnamomi y Ph. cambivora, por Ernesto Vieitez, MarĂ­a Luisa Vieitez y Ana MarĂ­a Vieitez.-- Observaciones sobre el injerto juvenil.del castaño, por MarĂ­a Luisa Vieitez y Ana MarĂ­a Vieitez.-- Crecimiento y nutriciĂłn del trĂ©bol violeta, por J. Arines y R. FĂĄbregas.-- La proliferaciĂłn celular en meristemos. por G. GimĂ©nez-ManĂ­n, J. F. LĂłpez-SĂĄez, A. GonzĂĄlez-FernĂĄndez. C. de la Torre y M. H. Navarrete.—MicrobiologĂ­a.-- Formaciones quimĂ©ricas anĂłmalas en cultivos bacterianos, por RomĂĄn de Vicente. AnĂĄlisis.-- DeterminaciĂłn de fenoles y formas de N en aguas, por Bolarin, M. C. Romero, M. y Caro, M.-- Agua ReutilizaciĂłn de aguas y lodos residuales. I., por Sa/got, M. y Cardus, J. II por Felipo M. T., Garau, M. A., Pascual, M. D. y Cardus, J.-- EcologĂ­a. Aspectos ecolĂłgicos de sotos y riberas, por Pedro Montserrat Recoder.-- Control Sanitario.EvoluciĂłn de clorobencilato en brotes de limonero, por J. Ma. Abrisqueta, A. Onuño, J. GĂłmez y A. HernansĂĄez.-- Riesgos de los productos quĂ­micos potencialmente tĂłxicos, por Eugenio Laborda. Eduardo de la Peña y Elina Valcarece.-- GeografĂ­a. Otra crĂ­tica del neomalthusianismo, por MarĂ­a Isabel Bodega FernĂĄndez, Sici/ia GutiĂ©rrez Ronco, MarĂ­a AsunciĂłn MartĂ­n Lou, Antonio Higueras Arnal y JosĂ© Manuel Casas Torres.-- Notas.-- BibligrafĂ­aPeer reviewe

    Biodiversidad en la cuenca del Orinoco. Bases cientĂ­ficas para la identificaciĂłn de ĂĄreas prioritarias para la conservaciĂłn y uso sostenible de la biodiversidad

    No full text
    Es un placer para el Instituto de Investigación de Recursos Biológicos Alexander von Humboldt presentar a la comunidad científica, conservacionista y autoridades ambientales de Colombia y Venezuela la obra Biodiversidad de la cuenca del Orinoco: bases científicas para la identificación de åreas prioritarias para la conservación y el uso sostenible de la biodiversidad. Este libro es fruto de un esfuerzo de una década de trabajo y recoge numerosos proyectos de caråcter institucional que han venido desarrollåndose en la Orinoquia, incluyendo el Plan de acción en biodiversidad para la cuenca del Orinoco (2005-2015), ademås de los resultados de reuniones técnicas de caråcter binacional

    Comparison of 1-year outcome in patients with severe aorta stenosis treated conservatively or by aortic valve replacement or by percutaneous transcatheter aortic valve implantation (data from a multicenter Spanish registry)

    No full text
    The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies

    SLAVERY: ANNUAL BIBLIOGRAPHICAL SUPPLEMENT (2005)

    No full text
    corecore