Evolución Histórica de los conocimientos sobre la mola hidatiforme

Inclou referències bibliogràfique

Diseño y construcción de una vehículo del tipo Kart Cross para rally

The “Design and construction of a Kart Cross type vehicle for Rally” project, responds to the motivation of experimenting with planning, designing and constructing of a competing vehicle; the “Fórmula Automovilística Universitaria”, project proposed by Escuela Superior Politecnica del Chimborazo, which conjugates the purpose of motivating students majoring in Mechanical Engineering at national level to develop and enhance their ingenuity in the automotive field. Both of these facts have derived in the execution of this project.El proyecto “Diseño y construcción de un vehículo del tipo Kart Cross para Rally”, responde a la motivación de experimentar con la planificación, diseño y construcción de un vehículo de competencia deportiva; la Fórmula Automovilística Universitaria, proyecto mentalizado por la Escuela Superior Politécnica del Chimborazo, conjuga el propósito de incentivar a los estudiantes de la carrera de Ingeniería Mecánica a nivel nacional, a desarrollar y potenciar su ingenio en el área automotriz. La complementariedad de estos hechos ha derivado en la ejecución de este trabajo

East Africa rainfall trends and variability 1983–2015 using three long-term satellite products

Daily time series from the Climate Prediction Center (CPC) Africa Rainfall Climatology version 2.0 (ARC2), Climate Hazards Group InfraRed Precipitation with Stations (CHIRPS) and Tropical Applications of Meteorology using SATellite (TAMSAT) African Rainfall Climatology And Time series version 2 (TARCAT) high-resolution long-term satellite rainfall products are exploited to study the spatial and temporal variability of East Africa (EA, 5S–20N, 28–52E) rainfall between 1983 and 2015. Time series of selected rainfall indices from the joint CCl/CLIVAR/JCOMM Expert Team on Climate Change Detection and Indices are computed at yearly and seasonal scales. Rainfall climatology and spatial patterns of variability are extracted via the analysis of the total rainfall amount (PRCPTOT), the simple daily intensity (SDII), the number of precipitating days (R1), the number of consecutive dry and wet days (CDD and CWD), and the number of very heavy precipitating days (R20). Our results show that the spatial patterns of such trends depend on the selected rainfall product, as much as on the geographic areas characterized by statistically significant trends for a specific rainfall index. Nevertheless, indications of rainfall trends were extracted especially at the seasonal scale. Increasing trends were identified for the October–November–December PRCPTOT, R1, and SDII indices over eastern EA, with the exception of Kenya. In March–April–May, rainfall is decreasing over a large part of EA, as demonstrated by negative trends of PRCPTOT, R1, CWD, and R20, even if a complete convergence of all satellite products is not achieved.This study was supported by the European Union’s Seventh Programme for research, technological development, and demonstration under Grant Agreement 603608 (eartH2Observe)

East Africa precipitation variability during recent decades

Póster presentado en: 8th Ipwg and 5th Iwssm Joint Workshop celebrado en Bolonia, Italia, del 3 al 6 de octubre de 2016.Estimating space-time variability of precipitation is an important task in East Africa, considering the observed increased frequency of extreme events, drought episodes in particular. These events deeply affect the population with implications on agriculture and consequently food security. Daily accumulated precipitation time series from satellite retrieval algorithms, ARC, CHIRPS, TAMSAT, TMPA-3B42, and CMORPH are exploited to study the spatial and temporal variability of East Africa (EA – 5°S-20°N, 28°E-52°E) precipitation during last decades. The analysis is carried out by computing the time series of the joint CCI/CLIVAR/JCOMM Expert Team on Climate Change Detection and Indices (ETCCDI, http://etccdi.pacificclimate.org/index.shtml), e.g. CDD, CWD, SDII, PRCPTOT, and R1, at the yearly and seasonal scales. The purpose is to identify the occurrence of extreme events (droughts and floods), and extract precipitation spatial patterns of variation by trend analysis (Mann-Kendall technique). Prior to the analysis satellite time series are checked for the possible presence of inhomogeneities due to variations in rain gauge density and/or in the satellite retrieval algorithms

Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study

Background: All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. Methods: An observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent. Results: A total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample. Conclusions: Patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns. © 2023, BioMed Central Ltd., part of Springer Nature

Adverse events: an expensive and avoidable hospital problem

Introduction: Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. Methods: This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. Results: A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. Conclusions: The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient’s death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messages Adverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization. Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels. Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE

Prevalence, characteristics, and impact of adverse events in 34 Madrid hospitals. The ESHMAD study

Introduction: Adverse Events (AE) are one of the main problems in healthcare. Therefore, many policies have been developed worldwide to mitigate their im pact. The Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD) measures the results of them in the region. Methods: Cross-sectional study, conducted in May 2019, in hospitalised patients in 34 public hospitals using the Harvard Medical Practice Study methodology. A logistic regression model was carried out to study the association of the variables with the presence of AE, calibrated and adjusted by patient. Results: A total of 9975 patients were included, estimating a prevalence of AE of 11.9%. A higher risk of AE was observed in patients with surgical procedures (OR[CI95%]: 2.15[1.79 to 2.57], vs. absence), in Intensive Care Units (OR[CI95%]: 1.60[1.17 to 2.17], vs. Medical) and in hospitals of medium complexity (OR[CI95%]: 1.45[1.12 to 1.87], vs. low complexity). A 62.6% of AE increased the length of the stay or it was the cause of admission, and 46.9% of AE were considered prevent able. In 11.5% of patients with AE, they had contributed to their death. Conclusions: The prevalence of AE remains similar to the previously estimated one in studies developed with the same methodology. AE keep leading to longer hospital stays, contributing to patient's death, showing that it is necessary to put focus on patient safety again. A detailed analysis of these events has enabled the detection of specific areas for improvement according to the type of care, centre and patient

causes and economic consequences in the Murcia Health System, 2002 to 2018

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Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Background: Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. Objectives: To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. Design and Participants: This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients’ intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. Main Measures and Key Results: A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). Conclusions: The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact

How Does Vaccination against SARS-CoV-2 Affect Hospitalized Patients with COVID-19?

Background: The development of effective COVID-19 vaccines has reduced the impact of COVID-19 on the general population. Our study aims to analyze how vaccination modifies the likelihood of death and length of stay in hospitalized patients with COVID-19; (2) Methods: A retrospective cohort study of 1927 hospitalized patients infected with COVID-19 was conducted. Information was gathered on vaccination status, hospitalization episode, and clinical profile of the patients. The effect of vaccination on mortality was analyzed using a multiple logistic regression model, and length of stay was analyzed using linear regression. The performance and fit of the models were evaluated; (3) Results: In hospitalized patients with COVID-19, the risk of dying during admission in vaccinated patients was half that of non-vaccinated (OR: 0.45; CI 95%: 0.25 to 0.84). In patients who were discharged due to improvement, the reduction in hospital stay in vaccinated patients was 3.17 days (CI 95%: 5.88 to 0.47); (4) Conclusions: Patients who, despite having been vaccinated, acquire the infection by SARS-CoV-2, have a significant reduction of the risk of death during admission and a reduction of hospital stay compared with unvaccinated patients