El proceso de planificación del alta en centros de rehabilitación: sistemas de información para la evaluación de pacientes

IV Congreso Nacional de Informática de la Salud; 2001 Mar 28-30; Madrid; organizado por la Sociedad Española de Informática de la Salud[Resumen] La planificación del alta es un proceso que debe comenzar desde el mismo momento del ingreso. Debe ser sistemático, interdisciplinario y coordinado por un especialista sanitario. Debe involucrar al paciente y a su familia e incluir la valoración de su entorno de vida, soporte familiar, valoración de la discapacidad y posibilidades de llevar a cabo una rehabilitación vocacional. Todas las decisiones que se tomen en el proceso del alta deben implicar y reflejar el consenso de la familia y el propio paciente con el equipo médico (1). Por lo tanto, surge la necesidad de utilizar algún sistema de medición de incapacidad, dada la gran variedad de patologías que abarca la Medicina Física y Rehabilitación y la existencia de cuadros nosológicos muy diferentes en cuanto a su etiología, gravedad y pronóstico. En este contexto, se hace necesaria la utilización de escalas de valoración funcional, que simplifiquen este trabajo y posibiliten un mayor control de todo el proceso desde su inicio. Existen múltiples escalas de valoración, tanto específicas como de propósito general, siendo la más utilizada la Functional Independence Measure (FIM) de la Uniform Data System for Medical Rehabilitation. A partir de estas escalas se han desarrollado diferentes sistemas de datos: el Union Data System (UDS) y el TBI Model Systems National Database del National Institute on Disability and Rehabilitation Research entre los más destacados. En este artículo, además de exponer las distintas fases del proceso de planificación del alta, se hará un estudio de los distintos sistemas de información desarrollados, así como de las escalas de valoración utilizadas

Glycerol electrooxidation on Pd modified Au surfaces in alkaline media: Effect of the deposition method

The catalytic effect of Pd on gold electrodes for glycerol oxidation is evaluated for Pd-Au surfaces prepared using three different methods: irreversible adsorption of palladium by a simple immersion of a gold electrode in palladium solution, the deposition of palladium on the gold substrate by a step potential from 1 to 0.75 V, and the forced deposition of palladium on the gold electrode with the help of a reducing hydrogen atmosphere. Voltammetry has been used for the electrochemical characterization of the Pd-Au deposits and to determine its reactivity towards glycerol oxidation, whereas FTIR experiments have allowed detecting adsorbed species and products formed during the oxidation reaction. Pd-Au surfaces prepared by irreversible adsorption are the electrodes that show the highest activity for the glycerol complete oxidation to carbonate, whereas Pd-Au surfaces made by the step potential are the catalyst that exhibits the highest rate for the formation and adsorption CO before carbonate production, poisoning the surface and diminishing their electrocatalytic properties. In addition to carbonate, glycerate, glycolate, and formate are detected as oxidation products. The integrated bands of the spectra are used to give quantitative information for comparing the product distribution of the different Pd-Au deposits prepared.This work has been financially supported by the Ministerio de Economía y Competitividad and Generalitat Valenciana by Project Nos. CTQ2016-76221-P and PROMETEOII/2014/013, respectively. G.A.B.M. also thanks her post-doctorate fellowship from CNPq (Grant No. PDE 233268/2014-6)

Understandings on the Inhibition of Oxygen Reduction Reaction by Bromide Adsorption on Pt(111) Electrodes at Different pH Values

Oxygen reduction reaction (ORR) is studied on Pt(111) in the presence of different concentrations of bromide anions at different pH values ranging from very acidic to neutral solutions. While adsorbed bromide inhibits the ORR, the strength of the inhibition decreases when the pH is increased. This is a consequence of the lower relative adsorption energy of bromide at higher pH values, caused by the lower absolute applied potential. This is reflected in a shift of the onset of the ORR (as measured with the hanging meniscus rotating disc electrode, HMRDE) to higher values as the pH is increased. HMRDE measurements reveal that the limiting current density (jlim) coincides with the theoretical value for two electrons only at very acidic solutions. However, when pH is increased, jlim tends toward the value for a four electrons reaction. From pH > 3 jlim coincides both in the presence and in the absence of bromide despite the specific anion adsorption. Experiments in solutions with different ionic strength and hydrogen peroxide reduction measurements suggest that the formation of a reaction intermediate different from H2O2 is favored at neutral pH values.This work has been financially supported by the MCINN-FEDER (Spain) through project CTQ2016-76221-P. VBM thankfully acknowledges to MINECO the award of a pre-doctoral grant (BES-2014-068176, project CTQ2013-44803-P). GABM thanks the post-doctorate fellowship from CNPq (grant no. PDE 233268/2014-6)

The large longitudinal spread of solar energetic particles during the January 17, 2010 solar event

We investigate multi-spacecraft observations of the January 17, 2010 solar energetic particle event. Energetic electrons and protons have been observed over a remarkable large longitudinal range at the two STEREO spacecraft and SOHO suggesting a longitudinal spread of nearly 360 degrees at 1AU. The flaring active region, which was on the backside of the Sun as seen from Earth, was separated by more than 100 degrees in longitude from the magnetic footpoints of each of the three spacecraft. The event is characterized by strongly delayed energetic particle onsets with respect to the flare and only small or no anisotropies in the intensity measurements at all three locations. The presence of a coronal shock is evidenced by the observation of a type II radio burst from the Earth and STEREO B. In order to describe the observations in terms of particle transport in the interplanetary medium, including perpendicular diffusion, a 1D model describing the propagation along a magnetic field line (model 1) (Dr\"oge, 2003) and the 3D propagation model (model 2) by (Dr\"oge et al., 2010) including perpendicular diffusion in the interplanetary medium have been applied, respectively. While both models are capable of reproducing the observations, model 1 requires injection functions at the Sun of several hours. Model 2, which includes lateral transport in the solar wind, reveals high values for the ratio of perpendicular to parallel diffusion. Because we do not find evidence for unusual long injection functions at the Sun we favor a scenario with strong perpendicular transport in the interplanetary medium as explanation for the observations.Comment: The final publication is available at http://www.springerlink.co

Sensitivity of the NEXT experiment to Xe-124 double electron capture

Double electron capture by proton-rich nuclei is a second-order nuclear process analogous to double beta decay. Despite their similarities, the decay signature is quite different, potentially providing a new channel to measure the hypothesized neutrinoless mode of these decays. The Standard-Model-allowed two-neutrino double electron capture (2¿EC EC) has been predicted for a number of isotopes, but only observed in 78Kr, 130Ba and, recently, 124Xe. The sensitivity to this decay establishes a benchmark for the ultimate experimental goal, namely the potential to discover also the lepton-number-violating neutrinoless version of this process, 0¿EC EC. Here we report on the current sensitivity of the NEXT-White detector to 124Xe 2¿EC EC and on the extrapolation to NEXT-100. Using simulated data for the 2¿EC EC signal and real data from NEXT-White operated with 124Xe-depleted gas as background, we define an optimal event selection that maximizes the NEXT-White sensitivity. We estimate that, for NEXT-100 operated with xenon gas isotopically enriched with 1 kg of 124Xe and for a 5-year run, a sensitivity to the 2¿EC EC half-life of 6 × 1022 y (at 90% confidence level) or better can be reached. [Figure not available: see fulltext.

Mitigation of backgrounds from cosmogenic 137Xe in xenon gas experiments using 3He neutron capture

136Xe is used as the target medium for many experiments searching for 0¿ßß. Despite underground operation, cosmic muons that reach the laboratory can produce spallation neutrons causing activation of detector materials. A potential background that is difficult to veto using muon tagging comes in the form of 137Xe created by the capture of neutrons on 136Xe. This isotope decays via beta decay with a half-life of 3.8 min and a Q ß of ~4.16 MeV. This work proposes and explores the concept of adding a small percentage of 3He to xenon as a means to capture thermal neutrons and reduce the number of activations in the detector volume. When using this technique we find the contamination from 137Xe activation can be reduced to negligible levels in tonne and multi-tonne scale high pressure gas xenon neutrinoless double beta decay experiments running at any depth in an underground laboratory

Boosting background suppression in the NEXT experiment through Richardson-Lucy deconvolution

Next-generation neutrinoless double beta decay experiments aim for half-life sensitivities of ~ 1027 yr, requiring suppressing backgrounds to < 1 count/tonne/yr. For this, any extra background rejection handle, beyond excellent energy resolution and the use of extremely radiopure materials, is of utmost importance. The NEXT experiment exploits differences in the spatial ionization patterns of double beta decay and single-electron events to discriminate signal from background. While the former display two Bragg peak dense ionization regions at the opposite ends of the track, the latter typically have only one such feature. Thus, comparing the energies at the track extremes provides an additional rejection tool. The unique combination of the topology-based background discrimination and excellent energy resolution (1% FWHM at the Q-value of the decay) is the distinguishing feature of NEXT. Previous studies demonstrated a topological background rejection factor of ~ 5 when reconstructing electron-positron pairs in the 208Tl 1.6 MeV double escape peak (with Compton events as background), recorded in the NEXT-White demonstrator at the Laboratorio Subterráneo de Canfranc, with 72% signal efficiency. This was recently improved through the use of a deep convolutional neural network to yield a background rejection factor of ~ 10 with 65% signal efficiency. Here, we present a new reconstruction method, based on the Richardson-Lucy deconvolution algorithm, which allows reversing the blurring induced by electron diffusion and electroluminescence light production in the NEXT TPC. The new method yields highly refined 3D images of reconstructed events, and, as a result, significantly improves the topological background discrimination. When applied to real-data 1.6 MeV e-e+ pairs, it leads to a background rejection factor of 27 at 57% signal efficiency. [Figure not available: see fulltext.]. © 2021, The Author(s)

Effects on short term outcome of non-invasive ventilation use in the emergency department to treat patients with acute heart failure: A propensity score-based analysis of the EAHFE Registry

Objective: To assess the effects of non-invasive ventilation (NIV) in emergency department (ED) patients with acute heart failure (AHF) on short term outcomes. Methods: Patients from the EAHFE Registry (a multicenter, observational, multipurpose, cohort-designed database including consecutive AHF patients in 41 Spanish EDs) were grouped based on NIV treatment (NIV+ and NIV–groups). Using propensity score (PS) methodology, we identified two subgroups of patients matched by 38 covariates and compared regarding 30-day survival (primary outcome). Interaction was investigated for age, sex, ischemic cardiomyopathy, chronic obstructive pulmonary disease, AHF precipitated by an acute coronary syndrome (ACS), AHF classified as hypertensive or acute pulmonary edema (APE), and systolic blood pressure (SBP). Secondary outcomes were intensive care unit (ICU) admission; mechanical ventilation; in-hospital, 3-day and 7-day mortality; and prolonged hospitalization (>7 days). Results: Of 11, 152 patients from the EAHFE (age (SD): 80 (10) years; 55.5% women), 718 (6.4%) were NIV+ and had a higher 30-day mortality (HR = 2.229; 95%CI = 1.861–2.670) (p 85 years, p < 0.001), AHF associated with ACS (p = 0.045), and SBP < 100 mmHg (p < 0.001). No significant differences were found in the secondary endpoints except for more prolonged hospitalizations in NIV+ patients (OR = 1.445; 95%CI = 1.122–1.862) (p = 0.004). Conclusion: The use of NIV to treat AHF in ED is not associated with improved mortality outcomes and should be cautious in old patients and those with ACS and hypotension

A Compact Dication Source for Ba2+^{2+} Tagging and Heavy Metal Ion Sensor Development

We present a tunable metal ion beam that delivers controllable ion currents in the picoamp range for testing of dry-phase ion sensors. Ion beams are formed by sequential atomic evaporation and single or multiple electron impact ionization, followed by acceleration into a sensing region. Controllability of the ionic charge state is achieved through tuning of electrode potentials that influence the retention time in the ionization region. Barium, lead, and cobalt samples have been used to test the system, with ion currents identified and quantified using a quadrupole mass analyzer. Realization of a clean $\mathrm{Ba^{2+}}$ ion beam within a bench-top system represents an important technical advance toward the development and characterization of barium tagging systems for neutrinoless double beta decay searches in xenon gas. This system also provides a testbed for investigation of novel ion sensing methodologies for environmental assay applications, with dication beams of Pb$^{2+}$ and Cd$^{2+}$ also demonstrated for this purpose

Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study

Objective: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. Methods: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. Results: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4–11): 2934 (34.3%) had a LOH 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0–64.9) when LOH was 11–15 days, and by 72.0% (95%CI = 42.6–107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4–36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. Conclusions: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments