Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado

Objective. The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). Methods. We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. Results. We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p= 2 and 0.698 (IC 95% 0.635- 0.761; p= 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). Conclusions. Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Low-Temperature Bainite: A Thermal Stability Study

The thermal stability of nanobainitic structures obtained by heat treating two different high-carbon high-silicon steels at temperatures between 200 °C and 600 °C has been investigated by means of three complementary techniques, i.e., field emission gun-scanning electron microscopy, X-ray diffraction, and high-resolution dilatometry. Three main stages have been established, each of them characterized by a distinctive microstructure. Furthermore, the nanocrystalline structure generated by the bainite reaction confers the steel with an extraordinary tempering resistance.The authors gratefully acknowledge the support for this work by the Research Fund for Coal and Steel under the Contracts RFSR-CT-2014-00016 and RFSR-CT-2016-754070. The authors also acknowledge the supports of the following laboratories at CENIM, X ray diffraction, Metallography and Phase Transformations, and thank Dr. Irene Llorente and Mr. Javier Vara, and the rest of technical staff for their valuable help with the measurements.Peer Reviewe

Chemical Compositions of Field and Globular Cluster RR Lyrae Stars. II. \u3c9 Centauri

We present a detailed spectroscopic analysis of RR Lyrae (RRL) variables in the globular cluster NGC 5139 (\u3c9 Cen). We collected optical (4580-5330 \uc5), high-resolution (R 3c 34,000), high signal-to-noise ratio ( 3c200) spectra for 113 RRLs with the multifiber spectrograph M2FS at the Magellan/Clay Telescope at Las Campanas Observatory. We also analyzed high-resolution (R 3c 26,000) spectra for 122 RRLs collected with FLAMES/GIRAFFE at the Very Large Telescope, available in the ESO archive. The current sample doubles the literature abundances of cluster and field RRLs in the Milky Way based on high-resolution spectra. Equivalent-width measurements were used to estimate atmospheric parameters, iron, and abundance ratios for \u3b1 (Mg, Ca, Ti), iron peak (Sc, Cr, Ni, Zn), and s-process (Y) elements. We confirm that \u3c9 Cen is a complex cluster, characterized by a large spread in the iron content: -2.58 64 [Fe/H] 64 -0.85. We estimated the average cluster abundance as , with \u3c3 = 0.33 dex. Our findings also suggest that two different RRL populations coexist in the cluster. The former is more metal-poor ([Fe/H] 72 - 1.5), with almost solar abundance of Y. The latter is less numerous, more metal-rich, and yttrium enhanced ([Y/Fe] \u2a86 0.4). This peculiar bimodal enrichment only shows up in the s-process element, and it is not observed among lighter elements, whose [X/Fe] ratios are typical for Galactic globular clusters

Position Paper on Global Extracorporeal Membrane Oxygenation Education and Educational Agenda for the Future: A Statement From the Extracorporeal Life Support Organization ECMOed Taskforce*

Objectives:The purpose of this position paper is two-fold: first, to describe the state of extracorporeal membrane oxygenation education worldwide, noting current limitations and challenges; and second, to put forth an educational agenda regarding opportunities for an international collaborative approach toward standardization.Design:Relevant medical literature was reviewed through literature search, and materials from national organizations were accessed through the Internet. Taskforce members generated a consensus statement using an iterative consensus process through teleconferences and electronic communication.Setting:In 2018, the Extracorporeal Life Support Organization convened the ECMOed Taskforce at two structured, face-to-face meetings of 40 healthcare practitioners and educators with expertise in caring for the extracorporeal membrane oxygenation patient and in extracorporeal membrane oxygenation education.Patients:None.Interventions:None.Measurements and Main Results:The ECMOed Taskforce identified seven educational domains that would benefit from international collaborative efforts. Of primary importance, the Taskforce outlined actionable items regarding 1) the creation of a standardized extracorporeal membrane oxygenation curriculum; 2) defining criteria for an extracorporeal membrane oxygenation course as a vehicle for delivering the curriculum; 3) outlining a mechanism for evaluating the quality of educational offerings; 4) utilizing validated assessment tools in the development of extracorporeal membrane oxygenation practitioner certification; and 5) promoting high-quality educational research to guide ongoing educational and competency assessment development.Conclusions:Significant variability and limitations in global extracorporeal membrane oxygenation education exist. In this position paper, we outline a road map for standardizing international extracorporeal membrane oxygenation education and practitioner certification. Ongoing high-quality educational research is needed to evaluate the impact of these initiatives.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care