Improving the Care for Acute Ischemic Stroke Patients

Abstract Problem: Decreasing the time to assess acute ischemic stroke patients impacts the patients’ well-being. The clinical benefit of intravenous Alteplase for ischemic stroke patients results in better outcomes. Intravenous thrombolysis success is dependent on narrowing time to treat (Fonarow et al., 2014). Decreasing the time to intravenous thrombolysis for acute ischemic stroke patients augments the ability of patients to improve the quality of life by minimizing disability and improving health outcomes (Speirs & Mitchell, 2015). Context: The microsystem chosen for this evidence-based change of practice project change takes place in the Northern California emergency department (ED). The ED provides care for patients in life-threatening situations, acute, and chronic conditions. The ED also serves as a health care safety net for the Northern California community. The ED is a high functioning, stressful environment, that when there is an increase of patients and not enough resources this impacts on the Altepase administration timing. Interventions: The description of changes to test includes daily stroke team assignments, stroke kits, education through electronic modules, and stroke code simulation. At the start of every shift the assistant nurse manager (ANM) will choose the stroke team for each shift. Implementing stroke kits and placing them on top of the Telestroke Cisco Cart (video telemedicine platform) will help support the DTN time. Stroke kits will include a hard copy of a stroke check off list and intravenous (IV) start kit and IV tubing. We will also share current goals of AIS patients receiving Alteplase, which may include having staff watch modules. The team will initiate monthly simulation Stroke Codes. Test workflows during simulation Stroke Codes will be implemented at least three times day on various shifts. Measures: One of the ED-specific metrics that matter is the Stroke Alteplase door-to-needle (DTN) time, which should be less than or equal to 30 minutes. The quality gap in ED is not having enough resources for increase census and not meeting the monthly metrics measures baseline of 50%. Given that the number of patients arriving to the ED can impact the duration of time of Alteplase administration, the typical time is longer than 30 minutes. Results: Significantly, there is an improvement from January 2017 to April 2018. The DTN Alteplase administration to less and equal to 30 minutes increased from 43% prior to intervention to 55% after the intervention were implemented. Since the intervention, there was an increase on the ED DTN response time. However, there is not enough data that points to say that there is a trend in the process. The percentage of staff members completing modules in Health Connect (HC) is 90%. (Quality and Operations Support: The Permanente Medical Group, 2017). Conclusion: This project has been a great success and opportunity for staff to understand the importance of assessing AIS patients, documentation, simulations, electronic education modules and the importance of close loop communication, influence safe, quality stroke care outcomes. By administering Alteplase in a timely manner, fulfills Northern California Hospital’s vision as a leader in creating an overall improvement of living a quality life for patients and their families. Decreasing the time to intervention benefits AIS patients and their families by reducing disability, improving self-confidence, and quality care

The Ecology of Bioeroding Sponges on Caribbean Coral Reefs

Sponges contribute to large number of functions in coral reef ecosystems. Among these, bioerosion is perhaps one of the most widely studied, largely due to the important contribution of excavating sponges to the carbonate budget on coral reefs (up to 95 % of the total internal bioerosion). Despite our current knowledge, much of the literature is centred on individual-based observations, and little is known about their ecological role and interactions with other reef taxa in complex coral reef systems. The aim of this thesis was to quantify the ecological interactions of bioeroding sponges with major reef taxa by scaling up individual observations to population and ecosystem-based approaches. A cosmopolitan, abundant and highly competitive bioeroding sponge from Glover’s Atoll, Belize (Cliona tenuis) was used as model species. Monitoring of C. tenuis populations throughout 2009 indicated a trade-off between reproduction and growth, with the highest growth rates (31.4 ± 5.6 mm.y–1) occurring in summer, and a peak in reproductive output during winter. Populations typically show strong left-skewed size frequency distributions, mostly represented by juvenile-size individuals (46%), suggesting that regulating mechanisms (e.g. competition and predation) may be acting in constraining the transition of juveniles to adult sizes. Long-term in situ manipulations showed no effect of predation, yet competition with macroalgae significantly reduced the size of the sponge by 38% ± 11% (SE). While C. tenuis exhibit high growth and recruitment rates that could theoretically result in rapid population growth, the likelihood of sponges forming an alternative stable state as reefs sustain greater levels of disturbance is unclear. An analytical modelling approach of the interplay between macroalgae, coral and sponge was used to explore the likelihood of alternate stable states. The results show that irrespective of successful sponge invasion, inclusion of this third antagonist (in the interplay between coral and macroalgae) can qualitatively affect the likelihood of alternative stable state. The model exhibits emergent properties suggestive of intransitivity between the three competing taxa. Despite the potential of C. tenuis to benefit from disturbance, there are few cases in the literature reporting increases in bioeroding sponge abundance followed disturbance. Therefore, regulating mechanisms such as competition with other taxa, recruitment limitation or mortality are expected to exert demographic control on the populations of bioeroding sponges when space limitation is relaxed due to coral mortality. To determine processes regulating sponge populations, an individual-based spatial modelling approach was used to simulate the population dynamics of C. tenuis in a dynamic ecosystem environment. Using an orthogonal hypothesis testing approach, it was found that competition, and to a lesser extend partial mortality of the sponge tissue, largely regulate the population structure of C. tenuis. While reductions in coral cover may temporarily favour the rapid colonization by sponges, the competitive superiority of macroalgae may steal the opportunity from the opportunists.Fondo Nacional de Ciencia, Tecnología e Innovación (FONACIT

Under the same sky with Amanar

Due to its technological, scientific and cultural dimensions, astronomy is a unique discipline to help achieve the United Nations Sustainable Development Goals. According to the United Nations High Commissioner for Refugees (UNHCR), there are currently nearly 30 million refugees in the world. While there are many (and very necessary) programmes supporting their basic needs, different indicators suggest that the resolution to refugee and internal displacement situations require not only humanitarian interventions, but also development-led actions. One of these initiatives is Amanar: Under the Same Sky, a project designed to support the Sahrawi refugee community by using astronomy to enhance their resilience and engagement in the community, through skill development and self-empowerment activities.Comment: 5 pages, 2 figures. Comment published on Nature Astronom

Introducing a Human Activity Recognition Dataset Gathered on Real-Life Conditions

Cursos e Congresos, C-155[Abstract] Human activity recognition (HAR) has garnered significant scientific interest in recent years. The widespread use of smartphones enabled convenient and cost-effective data collection, eliminating the need for additional wearables. Given that, this paper introduces a novel HAR dataset in which participants had freedom in choosing smartphone orientation and placement during activities, ensuring data variability. It also includes contributions from diverse individuals, reflecting unique smartphone usage habits. Moreover, it comprises measurements from accelerometer, gyroscope, magnetometer, and GPS, corresponding to one of four activities: inactive, active, walking, or driving. Unlike other datasets, the collected data in this study were obtained from smartphones used in real-life scenariosThis work was funded by CITIC is funded by the Xunta de Galicia through the collaboration agreement between the Consellería de Cultura, Educación, Formación Profesional e Universidades and the Galician universities for the reinforcement of the research centres of the Galician University System (CIGUS), Xunta de Galicia/FEDER-UE (ConectaPeme, GEMA: IN852A 2018/14), MINECO-AEI/FEDER-UE (Flatcity: TIN2016-77158-C4-3-R) and Xunta de Galicia/FEDER-UE (AXUDAS PARA A CONSOLIDACION E ESTRUTURACION DE UNIDADES DE INVESTIGACION COMPETITIVAS.GRC: ED431C 2017/58 and ED431C 2018/49).Xunta de Galicia; ED431C 2017/58Xunta de Galicia; ED431C 2018/4

Assessment of cognitive performance among Mexican children and adolescents afflicted by simple to complex congenital heart diseases. Preliminary study

Among patients afflicted by congenital heart diseases (CHD) diverse, and complex neurological alterations are commonly observed. These have neither been completely identified nor understood. With the aim of identifying specific neurocognitive alterations among children and adolescents afflicted by CHD we investigated the possible presence of cognitive disorders related to the presence of cardiovascular disease with the aid of a sample of 20 patients (12 teenagers and 8 school-age children). Taken altogether, 9 of them were afflicted by simple and 11 by complex pathologies (respectively, CHDs/c). The Neuropsychological Test for Memory and Attention (Neuropsi), standardized for Mexico by Ostrosky et al. (2004), was individually applied to all participants. The information of cognitive performance was obtained in relation to the categories attention and memory, and the same areas allowed us to assess global performance. CHDc subjects performed significantly poorer compared to CHDs in i) attention and executive function, ii) memory and iii) attention and memory. Likewise, among CHDc subjects a significantly higher proportion of cases were diagnosed as abnormal in the same variables. Also a significant and negative correlation was determined between CHD severity and neuropsychological scoring. Children and adolescents afflicted by CHD are at high risk of developing cognitive function alterations including aspects of memory, attention and executive functions, alterations which are likely to be worst among those cases carrying CHDc conditions

Las armas de la república europea de las letras: propaganda y pedagogía democráticas en la narrativa popular decimonónica. Ceferino Tresserra)

Tesis doctoral inédita de la Universidad Autónoma de Madrid, Facultad de Filosofía y Letras, Departamento de Filología Espaǫla. Fecha de lectura: 6-03-0

Perceptions on the management, exposure, biosafety and handling of cytostatics in the nursing staff of a private health institution in the Autonomous City of Buenos Aires

Artículo[ES] Introducción: El profesional de enfermería oncológica es formado con conocimientos sobre el cáncer, modalidades de tratamiento, escenarios de cuidado del paciente. El riesgo a la exposición resultante de la manipulación de los citostáticos puede afectar la salud de los agentes sanitarios. Objetivo: describir las medidas de bioseguridad para la manipulación de citostáticos y los signos clínicos y síntomas producto de la exposición a estos medicamentos en el personal de enfermería de una institución de salud privada de la Ciudad Autónoma de Buenos Aires. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, retrospectivo. La muestra estuvo conformada por 31 profesionales de enfermería. Como instrumento recolección de datos se utilizó el propuesto por Villa y Varela-Díaz (2020), este instrumento registra datos sociodemográficos, laborales, de salud y sobre medidas de bioseguridad. Resultados: La muestra estuvo confirmada por un 74,2% del sexo femenino, la edad promedio fue de 37,67±6,79, el 58,1% era Licenciado/a en Enfermería, con una experiencia promedio en oncología de 4,06±4,09. El 96,8 % de los participantes administraba citostáticos y el 51,6 % participaba en el desecho. Los principales síntomas reportados fueron la cefalea y el dolor abdominal con 64,5% y 45,2% respectivamente. El 41,9% refiere la realización de exámenes paraclínicos y control por parte de la institución. Conclusiones: El personal de enfermería está expuesto a altos riesgos laborales cuando se trata de citostáticos. Se requiere el cumplimiento de los protocolos el manejo y descarte, con la finalidad de elevar los estándares de seguridad del paciente y seguridad laboral. [EN] Introduction: The oncology nurse practitioner is trained with knowledge about cancer, treatment modalities, patient care scenarios. The risk to exposure resulting from handling cytostatics can affect the health of healthcare workers. Objective: to describe the biosafety measures for handling cytostatics and the clinical signs and symptoms resulting from exposure to these drugs in the nursing staff of a private health care institution in the Autonomous City of Buenos Aires. Methods: An observational, descriptive, retrospective, cross-sectional, retrospective study was carried out. The sample consisted of 31 nursing professionals. The data collection instrument used was the one proposed by Villa and Varela-Díaz (2020), which records sociodemographic, occupational, health and biosafety measures data. Results: The sample was 74.2% female, the average age was 37.67±6.79, 58.1% had a Bachelor’s degree in Nursing, with an average experience in oncology of 4.06±4.09. Of the participants, 96.8% administered cytostatics and 51.6% were involved in disposal. The main symptoms reported were headache and abdominal pain with 64.5% and 45.2% respectively. 41.9% referred to paraclinical examinations and control by the institution. Conclusions: Nursing personnel are exposed to high occupational risks when dealing with cytostatics. Compliance with protocols for handling and disposal is required in order to raise patient safety and occupational safety standards.S