Current state of antimicrobial stewardship and organ transplantation in Spain

Introduction Solid-organ transplantation (SOT) remains the best therapeutic option for end-stage organ disease. Regrettably, SOT recipients are disproportionately affected by nosocomial infections produced by multidrug-resistant (MDR) microorganisms and antimicrobial adverse events. Both have a negative impact on the patient´s outcome. Methods Description of data concerning the antimicrobial stewardship program (ASP) in SOT recipients of the University Hospital “12 de Octubre”, and review of other Spanish ASPs. Results From May 2017 to December 2021, the ASP issued 2.785 recommendations. Approximately, 4.9% were aimed at improving the antimicrobial treatment administered to SOT recipients. Treatment discontinuation or change to a better therapeutic regimen was recommended in 51.8% and 26.3% of cases, respectively. The acceptance rate of the recommendations was close to 92%. Between June 2015 and March 2016, a quasi-experimental study consisting of a joint ASP and hospital-acquired infection control (HAIC) initiative, which included kidney transplant recipients, reported a significant reduction in the consumption of meropenem, vancomycin and ciprofloxacin, and a reduction in the incidence of global bacterial infections, upper urinary tract infections, and cystitis. Although Spain has several robust regional ASPs (e.g., VINCat and PIRASOA), data specifically concerning SOT patients is lacking. Conclusion ASP coupled with HAIC programs have proven to be effective in SOT, and should be implemented in centers that perform transplantation. Since data is scarce, Spanish centers which have ASP should report their experience in SOT. Understanding the efficacy and safety of the Spanish ASP´s intervention in the SOT population is essential and deserves further study

An in-depth look at media susidies in Spain's Autonomous Communities in 2019

This article focuses on public subsidies for the communication media in Spain for the year 2019, presenting an in-depth analysis of the situation. State subsidies for media is a phenomenon that became widespread in Europe during the 1960s and 1970s. In Spain, they were regulated in the 1980s, but shortly thereafter the state almost completely halted its support, and it was Spain's autonomous regions who then promoted the subsidies. In the midst of the professional debate about whether it is possible to reinstate this support from the Spanish government because of the coronavirus crisis, we identify nine autonomous regions which promote these types of subsidies. Through a study that is both prospective and propositional, our analysis will thoroughly examine the institutions granting subsidies, the sectors benefiting from them, their aim and justification, and the margin of discretionary compliance with which they are granted

A comparison of the Euro-Mediterránean and the Australian press models

The aim of this article is to analyze the evolution, development and consolidation of the Australian pressmodel from its beginning to the present day and compare it to the Euro-Mediterranean model (Spain, France,Italy and Portugal). To do so, the consequences of these countries' participation in World Wars I and II, thelegislative, cultural and business changes produced and the internal events that meant consolidation of aspecific press system within the Anglo-Saxon model, are studied.Whereas in the Euro-Mediterranean countries between 1926 and 1976 the different dictatorships modified therole of the press and also what the state's relationship with it should be, Australia's perfectly consolidatedand stable democracy led to concerns with and the development of other forms of evolution between thepress and the State as well as between the press and the other economic and social actors

Staphylococcus aureus poststernotomy mediastinitis: Description of two distinct acquisition pathways with different potential preventive approaches

ObjectiveDetermining the acquisition routes of infection is crucial to designing specific preventive approaches against Staphylococcus aureus poststernotomy mediastinitis.MethodsFrom 2002 to 2004, a nasal sample was obtained from patients before cardiac surgery. We collected clinical and microbiologic data of all episodes of S aureus poststernotomy mediastinitis. A case–control study (3:1) was performed to confirm the role of previous preoperative nasal colonization by S aureus as a risk factor for S aureus poststernotomy mediastinitis. Pulsed field gel electrophoresis molecular analysis of nasal and surgical site S aureus isolates was performed to analyze their relatedness in each patient with poststernotomy mediastinitis and with other patients of the study cohort.ResultsS aureus nasal cultures were positive in 228 (15.9%) of 1432 patients: methicillin-susceptible S aureus in 222 (15.5%) and meticillin-resistant S aureus in 6 (0.4%). S aureus poststernotomy mediastinitis was diagnosed in 17 (1.2%) of 1432 patients: 9 (3.95%) of 228 in colonized patients versus 8 (0.66%) of 1204 in noncolonized patients (P < .0001). Seven of 9 patients (1.2%) with methicillin-susceptible S aureus had an identical isolate by pulsed field gel electrophoresis in preoperative nasal and surgical-site cultures, but no clonal relatedness was shown among the isolates from these 9 patients. None of the 8 patients with methicillin-resistant S aureus poststernotomy mediastinitis had an identical isolate by pulsed field gel electrophoresis in preoperative nasal and surgical-site cultures, and the same clone of methicillin-resistant S aureus was responsible for all these cases.ConclusionsNasal colonization often precedes methicillin-resistant S aureus poststernotomy mediastinitis, which suggests that decontamination is adequate for preventing methicillin-resistant S aureus poststernotomy mediastinitis, whereas hospital infection control measures seem to be the major factor for preventing methicillin-resistant S aureus poststernotomy mediastinitis

EQUIPO DE TIRADORES DE PRECISIÓN DE FUSIL BARRETT 12’70MM. PROPUESTA DE UNA PRUEBA NORMALIZADA DE CERTIFICACIÓN DE NIVELES DE INSTRUCCIÓN

Los equipos de tiradores de precisión forman un elemento de apoyo de fuego selectivo y preciso a disposición de los jefes de Batallón / Compañía en las unidades del ejército de tierra. Facilitan la libertad de acción y la protección contra la sorpresa, formando parte del proceso de obtención de información. La importancia de los equipos de tiradores en la maniobra de las pequeñas unidades junto a la inexistencia de un curso de tiradores de precisión a nivel Ejército de Tierra, hace imprescindible desarrollar un método de certificación mediante unos niveles estándar. Dichos niveles servirán como referencia de las capacidades y posibilidades de empleo que posee cada equipo de tiradores, sirviendo asimismo como guía que oriente la instrucción de los mismos. En base a la información recopilada de un gran número de tiradores experimentados, y analizando diversa documentación relacionada con el tema del proyecto se propone un sistema de certificación para equipos de tiradores de precisión. Este sistema servirá para acreditar las distintas capacidades que cada equipo aporta a la unidad en la que se encuentre encuadrado.<br /

Mulher escarlate: Senhora, Musa e Escrava do Sexo (1904-1947)

Objetivo: Conocer las conductas sexuales de riesgo en el marco sociocultural de principios del siglo XX, e identificar la sumisión y liberación de género a que fueron sometidas las mujeres escarlatas. Metodología: Se llevó a cabo una revisión bibliográfica histórico-descriptiva para la que se emplearon fuentes primarias y secundarias, a través de un enfoque histórico cultural, el cual provee una relevancia al papel de la actividad humana y considera que esta trasciende el ámbito social. Los criterios de inclusión utilizados fueron: 1) manuscritos en español, inglés y portugués; 2) trabajos relacionados con las mujeres escarlata en el periodo 1904-1947. Los criterios de exclusión en el presente estudio han sido: 1) trabajos no ajustados al tema de estudio; 2) documentos duplicados; 3) manuscritos no encontrados a texto completo. Resultados: Las mujeres escarlatas fueron consideradas como iguales en un mundo paternalista, representadas como la forma corpórea de deidades superiores. Éstas acompañaron a Aleister Crowley, contribuyendo así en la evolución de la magia sexual, centrada en los fluidos sexuales y en alcanzar los deseos establecidos por cualquier mago. Conclusión: Dentro de la religión thelemítica, las mujeres escarlatas actuaban en ritos esotéricos sexuales, hecho que provocaba un deterioro en la vida de las mismas.Objective: To learn about risky sexual behaviour in the socio-cultural framework of the early 20th century, and to identify the gender subjugation and liberation to which Scarlet women were subjected. Methodology: A historical-descriptive literature review was carried out using primary and secondary sources, through a cultural historical approach, which provides relevance to the role of human activity and considers that it transcends the social sphere. The inclusion criteria used were: 1) manuscripts in Spanish, English and Portuguese; 2) works related to scarlet women in the period 1904-1947. The exclusion criteria in the present study were: 1) works not adjusted to the subject of study; 2) duplicate documents; 3) manuscripts not found in full text. Results: Scarlet women were seen as equals in a paternalistic world, represented as the corporeal form of higher deities. They accompanied Aleister Crowley, thus contributing to the evolution of sex magic, centred on sexual fluids and achieving the desires set by any magician. Conclusion: Within the Thelemic religion, scarlet women performed esoteric sexual rites, which led to a deterioration in their lives.Objectivo: Aprender sobre comportamentos sexuais de risco no quadro sociocultural do início do século XX, e identificar a submissão e libertação de género a que as mulheres escarlate foram sujeitas. Metodologia: Foi realizada uma revisão bibliográfica histórica-descritiva utilizando fontes primárias e secundárias, através de uma abordagem histórica cultural, que dá relevância ao papel da actividade humana e considera que esta transcende a esfera social. Os critérios de inclusão utilizados foram: 1) manuscritos em espanhol, inglês e português; 2) obras relacionadas com mulheres escarlate no período 1904-1947. Os critérios de exclusão no presente estudo foram: 1) trabalhos não ajustados ao tema de estudo; 2) documentos duplicados; 3) manuscritos não encontrados no texto integral. Resultados: As mulheres escarlate eram vistas como iguais num mundo paternalista, representado como a forma corpórea de divindades superiores. Eles acompanharam Aleister Crowley, contribuindo assim para a evolução da magia sexual, concentrando-se nos fluidos sexuais e alcançando os desejos estabelecidos por qualquer mágico. Conclusão: No seio da religião Teolémica, as mulheres escarlate agiram em ritos sexuais esotéricos, um facto que causou uma deterioração das suas vidas.Todos los autores están integrados en el proyecto: “Estudio Asociado de investigación HISAG-EP (España-Portugal). Escola Superior Enfermagem, Coimbra y Universidad de Castilla-La Mancha.Portugal”

Enfermeira Genene Jones: O papel de anjo da morte na Miséry de Stephen King

With the sublime emotional description that Stephen King achieves of the main characters in Misery, the writer manages to delve into the world of affections and feelings, exploring the art of care and its negative aspects. He manages to delve into the figure of the nurse Genene Jones, representative of the role of the angel of death, making visible theories that frame these typologies and their acts. Objective: to describe the behaviours, experiences, beliefs and values set out by Stephen King in the story "Misery" (1987). Methodology: Phenomenological-historical study with an exploratory approach in narrative and secondary sources of the events that took place in the period between 1950-1990. Results: The piece is a masterful analysis of Genene Jones' nursing practice. It also reflects the transformation from the role of an angel of death, carried out by a health professional, to become a serial killer. Conclusion: The study of the horror literature allows the study of the nursing role to deepen and increase the knowledge of the nursing role, both for health professionals and nursing students and the general population.Con la sublime descripción emocional que Stephen King logra de los protagonistas de Misery, el escritor consigue profundizar en el mundo de las afecciones y los sentimientos, explorando el arte del cuidado y sus aspectos negativos. Consigue ahondar en la figura de la enfermera Genene Jones, representante del rol de ángel de la muerte, visibilizando teorías que encuadran estas tipologías y sus actos. Objetivo: describir las conductas, vivencias, creencias y valores expuestos por Stephen King en la narración “Misery” (1987). Metodología: Estudio fenomenológico-histórico con abordaje exploratorio en fuentes narrativas y secundarias de los acontecimientos sucedidos en el periodo de tiempo comprendido entre 1950-1990. Resultados: La obra es un análisis magistral del proceder enfermero de Genene Jones. Asimismo, refleja la transformación desde el rol de ángel de la muerte, llevado a cabo por un profesional de la salud, hasta llegar a convertirse en un asesino en serie. Conclusión: El estudio de la literatura de terror permite profundizar e incrementar los conocimientos del rol enfermero, tanto a los profesionales de la salud como a los estudiantes de enfermería y la población en general.Com a sublime descrição emocional que Stephen King consegue nos protagonistas da Miséria, o escritor mergulha no mundo dos afectos e sentimentos, explorando a arte do cuidado e os seus aspectos negativos. A figura da enfermeira Genene Jones, um representante exemplar do papel do anjo da morte, é aprofundada, tornando visíveis as teorias que enquadram estas tipologias e os seus actos. Objectivo: descrever os comportamentos, experiências, crenças e valores expostos por Stephen King na história "Miséria" (1987). Metodologia: Estudo fenomenológico-histórico com uma abordagem exploratória em narrativa, com recurso a fontes secundárias dos acontecimentos que tiveram lugar no período de 1950-1990. Resultados: O trabalho é uma análise do procedimento de enfermagem de Genene Jones e de como o papel de anjo da morte, desempenhado por um profissional de saúde pode vir a personificar a figura de um assassino em série. Conclusão: O estudo da literatura de horror permite aprofundar, ver outras facetas, e aumentar o conhecimento do papel da enfermagem, tanto pelos profissionais de saúde e estudantes de enfermagem como pela população em geral

Assessing orbital vs. volcanic control on carbon cycle during the Early Cretaceous

The interval from the Valanginian to the Barremian stages (137?121 Ma; Early Cretaceous) ispunctuated by several episodes of environmental changes, accompanied by shifts in weatheringintensity on the continents and changes in the Tethyan neritic carbonate production. Wesynthetize here the astrochronology of two recent studies performed in the Neuquén basin,Vocontian Basin and Subbetic Domain (Aguirre-Urreta et al., 2019; Martinez et al., 2020), anchoredto CA-ID-TIMS U-Pb ages, which conclusions have been included in the Geologic Time Scale 2020(Gale et al, in press). We applied this time scale to a compilation of carbon-isotope ratio frombelemnites and proxies of detrital supply in the Tethyan area (Vocontian Basin and SubbeticDomain). From this compilation, we show that the episodes of environmental changes are pacedby a 2.4-Myr cycle and, with a lower amplitude, a 1.2-Myr cycle. In addition, the new time scaleshows the synchronicity between the Weissert Event and the Parana-Etendeka Large IgneousProvince. In the series of carbon-isotope ratios measured on belemnite rostra, the amplitude ofthe 2.4-Myr cycle is twice higher during the Valanginian than in the Late Barremian and threetimes higher than in the Hauterivian and Early Barremian, suggesting that the activity of theParana-Etendeka Large Igneous Province amplified the initial orbital forcing to trigger theenvironmental changes observed during the Mid-Valanginian.Fil: Martinez, M.. Géosciences Rennes; FranciaFil: Aguirre Urreta, María Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Lescano, Marina Aurora. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Dera, G.. Université Paul Sabatier; FranciaFil: Omarini, Julieta. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; ArgentinaFil: Tunik, Maisa Andrea. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Frederichs, Tomas. Universitat Bremen; AlemaniaFil: Palike, Heiko. Université Paul Sabatier; FranciaFil: O'Dogherty, Luis. Universidad de Cádiz; EspañaFil: Aguado, Roque. Universidad de Jaén; EspañaFil: Company, Miguel. Universidad de Granada; EspañaFil: Sandoval, Jose. Universidad de Granada; EspañaEGU General Assembly 2021AlemaniaEuropean Geosciences Unio

Results of students surveys in similar courses given in different centers of the Technical University of Madrid

We present and analyze the results of surveys conducted in recent years with students from two related subjects, but taught in different centers of the University of Madrid. These surveys are part of the objectives of various projects of educational innovation, and applied through the platform Moodle

Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen

Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP). Estudio transversal en una muestra de conveniencia. Seis centros de AP en España. Los criterios de inclusión fueron: pacientes entre 16 y 65 años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes. Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión. Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI. Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada. Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP