The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Report: Labour and social security law in Spain in 2013

El informe ha sido elaborado por la Sección Juvenil de la Asociación Española de Derecho del Trabajo y Seguridad SocialEste documento intenta reflejar algunos de los principales cambios y novedades del ordenamiento laboral español en 2013, levantando acta de cómo la mutabilidad de nuestro Derecho del Trabajo es imparable. Este informe, consciente de ello, ofrece una selección de elementos esenciales, a juicio de sus autores, especialistas en cada una de las materias, encuadrados en la Sección Juvenil de la Asociación Española de Derecho del Trabajo y de la Seguridad Social. En él, conforme a la organización de dicha Sección en grupos de trabajo, se abordan las novedades más relevantes en materia de derechos fundamentales inespecíficos, contratación laboral, vicisitudes del contrato de trabajo, Derecho colectivo, conciliación y corresponsabilidad, protección social y prevención de riesgos laborales.This paper tries to show some of the many changes and novelties in Spanish Labour Law during 2013, drawing up a record of the unstoppable character of our Labour legal system. This report offers a selection of essential elements, according to its authors, all of them specialists in each one of the subjects, being part of the Young Scholars’ Section of the Spanish Association for Labour and Social Security Law. According to the organization of the said Section in working groups, we can find novelties concerning unspecific fundamental rights, work contracts, the life of the work contract and collective Labour Law, reconciliation and co responsibility, social protection and occupational risk preventio

Geodivulgar: Geología y Sociedad 2018

Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasFALSEsubmitte

Feather mite abundance constraints

<p>Data and code for analyses for a study on the allometry of symbiont abundance by investigating feather mites (Acariformes: Analgoidea, Pterolichoidea) on 26,604 individual birds from 106 European passerine species. We parameterized metabolic theory equations to predict how bird species' body size and the mean body size of their feather mite species relate to feather mite abundance according to potential energy (uropygial gland size, microbial abundance) and space constraints <span>(wing area, total length of barbs, and number of feather barbs). </span>We compared these theoretical predictions with the empirical allometry of feather mite abundance across bird species (using phylogenetic modelling and quantile regression).</p><p>Only R software is required to run the script using the datasets.</p><p>Methods are described in related papers.</p&gt

Nuevos escenarios para la innovación educativa : el Grupo CREA (Centros en Red para las Enseñanza Activas) y la renovación metodológica de los centros educativos

Convocatoria Proyectos de innovación de Extremadura 2018/2019Proyecto que agrupa a cinco centros educativos: el IES Jaranda (Jarandilla de la Vera, Cáceres), el IESO Sierra la Mesta (Santa Amalia, Badajoz), el IES Albarrega (Mérida, Badajoz), el IESO Val de Xálima (Valverde del Fresno, Badajoz), IESO Matías Ramón Martínez (Burguillos del Cerro, Badajoz) que conforman el Grupo CREA y que comparten una trayectoria común: el uso de metodologías educativas activas. A las iniciativas innovadoras llevadas a cabo colectivamente se suman las individuales de cada centro debido a la particularidad de cada uno de ellos. Los objetivos principales del proyecto son: la creación de una estructura organizativa y de coordinación entre los distintos centros participantes que permita la planificación y puesta en marcha de acciones educativas conjuntas; la introducción de cambios organizativos, funcionales, espaciales y metodológicos para llevar a cabo aprendizajes basados en proyectos, orientados al servicio a la comunidad y a los problemas sociales, centrados en el aprendizaje cooperativo, etc.; el diseño y desarrollo de programas de innovación coordinados entre los distintos centros educativos participantes; el establecimiento de mecanismos de coordinación para hacer efectiva la comunicación, el intercambio de información, el análisis y la reflexión del profesorado participante en los programas de innovación de cada uno de los centros; la formación conjunta del profesorado; el desarrollo de proyectos conjuntos para los alumnos participantes, su conexión en entornos virtuales, el intercambio de experiencias en encuentros periódicos, etc. y la generación y fomento de una nueva red creando un portal web y un espacio de comunicación e intercambio de documentaciónExtremaduraES

Anchuelo. Propuestas bioclimáticas en el espacio público

Anchuelo. Propuestas bioclimáticas en el espacio público. Publicación digital de los trabajos elaborados por los estudiantes del curso 2021/22 de la asignatura La Ciudad y el Medio de la Escuela Técnica Superior de Arquitectura de Madrid de la Universidad Politécnica de Madrid. Muestra una serie de propuestas elaboradas en la asignatura para mejorar bioclimáticamente diferentes espacios públicos municipales en el marco del acuerdo realizado entre el Departamento de Urbanística y Ordenación del Territorio y el Excmo. Ayuntamiento de Anchuelo (Madrid)

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved