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We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands

Tailorable synthesis of highly oxidized graphene oxides via an environmentally friendly electrochemical process

Graphene oxide (GO) is an attractive alternative to graphene for many applications due to its captivating optical, chemical, and electrical characteristics. In this work, GO powders with a different amount of surface groups were synthesized from graphite via an electrochemical two-stage process. Many synthesis conditions were tried to maximize the oxidation level, and comprehensive characterization of the resulting samples was carried out via elemental analysis, microscopies (TEM, SEM, AFM), X-ray diffraction, FT-IR and Raman spectroscopies as well as electrical resistance measurements. SEM and TEM images corroborate that the electrochemical process used herein preserves the integrity of the graphene flakes, enabling to obtain large, uniform and well exfoliated GO sheets. The GOs display a wide range of C/O ratios, determined by the voltage and time of each stage as well as the electrolyte concentration, and an unprecedented minimum C/O value was obtained for the optimal conditions. FT-IR evidences strong intermolecular interactions between neighbouring oxygenated groups. The intensity ratio of D/G bands in the Raman spectra is high for samples prepared using concentrated H2SO4 as an electrolyte, indicative of many defects. Furthermore, these GOs exhibit smaller interlayer spacing than that expected according to their oxygen content, which suggests predominant oxidation on the flake edges. Results point out that the electrical resistance is conditioned mostly by the interlayer distance and not simply by the C/O ratio. The tuning of the oxidation level is useful for the design of GOs with tailorable structural, electrical, optical, mechanical, and thermal properties.Ministerio de Ciencia, Innovacion y Universidade

Energy use optimization in ventilation of operating rooms during inactivity periods

Producción CientíficaHospitals are highly energy demanding buildings, where simple actuations can involve large savings. However, energy efficiency actions must comply with the high safety standards. Operating rooms demand continuous ventilation despite the short activity periods. Setback during non-occupation of the operating rooms can reduce ventilation loads but must not hinder indoor overpressure to avoid infiltrations. Besides, it prevents any existing heat recovery system from operation. This work evaluates setback ventilation in operating rooms at a case study in Spain, from two approaches: its effect on indoor overpressure and its preference to an existing coil heat recovery (runaround) loop. It bases on monitored data of two operating rooms under setback and normal ventilation with operation of the heat recovery system. Seven tests are performed throughout the year, whose comparison to estimated results enables extrapolation to yearly operation. Results show that indoor overpressure maintain at 15 Pa under setback, thus meeting current and coming standards. Setback turned to be always preferable to hear recovery under cooling needs. Estimated heating and electric yearly supply energy savings reach 29 MWht and 262 MWhe, the latter accounting for 2% of the total electric energy consumption of the hospital during 2019.Junta de Castilla y León (grant EREN_2019_L2_UVA

Modeling Response Variables in Taguchi Design Parameters Using CART and Random Forest Based Systems

[EN] Taguchi parameter design is a quality approach to design better products and processes, less sensitive to changes of the environmental and productive conditions. Robustness against changes in factors affecting processes is the key concept. Some recent papers have used a two steps methodology to improve parameter design. The first step determines the objective function using Artificial Neural Networks (ANN) to predict the value of the response variable when factors are in some specific levels (different to those included in the experiments). The second step looks for the optimal parameter combination. Our proposal here is centered in improving the first of these two steps, and consists in the development of new systems to model the response variable, based in Classification and Regression Trees (CART) and in Random Forest (RF), as an alternative to ANN and with the aim of creating a more robust strategy.Villa M, A.; Carrión García, A.; San Matías Izquierdo, S. (2012). Modeling Response Variables in Taguchi Design Parameters Using CART and Random Forest Based Systems. Communications in Dependability and Quality Management. 15(4):5-15. http://hdl.handle.net/10251/59860S51515

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

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

Evolution of Chemistry in the envelope of Hot Corinos (ECHOS). I. Extremely young sulphur chemistry in the isolated Class 0 object B335

Within the project Evolution of Chemistry in the envelope of HOt corinoS (ECHOS), we present a study of sulphur chemistry in the envelope of the Class 0 source B335 through observations in the spectral range 7, 3, and 2 mm. We have modelled observations assuming LTE and LVG approximation. We have also used the code Nautilus to study the time evolution of sulphur species. We have detected 20 sulphur species with a total gas-phase S abundance similar to that found in the envelopes of other Class 0 objects, but with significant differences in the abundances between sulphur carbon chains and sulphur molecules containing oxygen and nitrogen. Our results highlight the nature of B335 as a source especially rich in sulphur carbon chains unlike other Class 0 sources. The low presence or absence of some molecules, such as SO and SO+, suggests a chemistry not particularly influenced by shocks. We, however, detect a large presence of HCS+ that, together with the low rotational temperatures obtained for all the S species (<15 K), reveals the moderate or low density of the envelope of B335. We also find that observations are better reproduced by models with a sulphur depletion factor of 10 with respect to the sulphur cosmic elemental abundance. The comparison between our model and observational results for B335 reveals an age of 10$^4$$<$t$<$10$^5$ yr, which highlights the particularly early evolutionary stage of this source. B335 presents a different chemistry compared to other young protostars that have formed in dense molecular clouds, which could be the result of accretion of surrounding material from the diffuse cloud onto the protostellar envelope of B335. In addition, the analysis of the SO2/C2S, SO/CS, and HCS+/CS ratios within a sample of prestellar cores and Class 0 objects show that they could be used as good chemical evolutionary indicators of the prestellar to protostellar transition

Online audio-visual information on oral cancer for Spanish-speaking laypersons. A cross-sectional study

Lack of knowledge and awareness of oral cancer seem to be the main causes of diagnostic delay. Online resources are often used by patients to obtain health/medical information. However, there are no reports on the quality and usefulness of oral cancer audio-visual resources in Spanish. The aims of this investigation were to disclose the type of information about oral cancer available, and whether it may be useful to shorten the patients? oral cancer appraisal time-interval. Cross-sectional study undertaken at three video-sharing sites on October, 13th 2019. Keywords: ?Cáncer oral?; ?cáncer de boca?. The first 100 results in each viewing list were retrieved by three reviewers. Demographical data was recorded, and interaction indexes, viewing rates, comprehensiveness, and usefulness were calculated for each video. The presence of non-scientifically supported information was also assessed. A descriptive analysis was undertaken, and relationships between variables were explored using the Spearman correlation test. A total of 127 videos were selected. They were produced mainly by mass-media (46.5%; n=59) and their length ranged from 0.28 to 105.38 minutes (median 4.15 minutes; IQR: 2.34-9.67). The most viewed video (10,599,765 views; visualization rate 726,508.9) scored 0 both in usefulness and comprehensiveness. The most useful video gathered 44,119 views (visualization rate 2.033.13). A highly significant positive correlation (0.643; p<0.001) could be observed between usefulness and comprehensiveness of the videos, together with negative correlations between the visualization rate and usefulness (-0.186; p<0.05), and visualization rate and comprehensiveness (-0.183; p<0.05). Online audio-visual material about oral cancer in Spanish is incomplete, of limited usefulness, and often includes non-scientifically supported information. Most of these resources are produced by mass media and healthcare professionals, with minor contributions from educational and healthcare institutions. Visualization rates negatively correlated with the usefulness and comprehensiveness of the contents in these digital objects