EmergenciApp: aplicación personalizada para el direccionamiento de la atención de emergencias

The lack of knowledge of the people about the entities that can care for them in emergencies causes them to come to the wrong organization. Therefore, these organizations could not help people. This problem may end up affecting the physical and mental integrity of those whose emergency does not end up being resolved appropriately. We propose EmergenciApp, a solution that solves this problem about where and who can help the users during these events. While this system is conceptualized as capable of dealing with any emergency, this paper focuses on medical emergencies, particularly the redirection to medical centers and a system of notification to user´s loved people about emergencies that the user has.El bajo conocimiento por parte de las personas sobre las entidades que les pueden atender en situaciones de emergencia causa que éstas acudan ante el ente equivocado, y, por ende, no puedan ser atendidas correctamente. Esta problemática puede terminar afectando la integridad tanto física como mental de aquellos cuya situación de emergencia no termina siendo resuelta de forma adecuada. Por esta razón se propone EmergenciApp, una solución que aborde esta problemática sobre a quién y dónde acudir durante estas eventualidades. Si bien se plantea esta propuesta como capaz de atender cualquier tipo de emergencia, el presente artículo tiene como foco principal las emergencias de tipo médico, particularmente el re-direccionamiento hacia Instituciones Prestadoras de Salud (IPS), así como un sistema de notificación a seres queridos sobre emergencias que tenga el usuario

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Evolución reciente del endeudamiento externo de los bancos colombianos - Marzo de 2020

El objetivo de este informe es describir la evolución reciente de las líneas de crédito en moneda extranjera de los bancos colombianos y presentar los principales resultados de la última Encuesta de endeudamiento externo y cupos, la cual fue aplicada por el Departamento de Estabilidad Financiera del Banco de la República a una muestra representativa de bancos comerciales que tienen líneas de crédito en moneda extranjera

Evolución reciente del endeudamiento externo de los bancos colombianos - Diciembre de 2019

El objetivo de este informe es describir la evolución reciente de las líneas de crédito en moneda extranjera de los bancos colombianos y presentar los principales resultados de la última Encuesta de endeudamiento externo y cupos, la cual fue aplicada por el Departamento de Estabilidad Financiera del Banco de la República a una muestra representativa de bancos comerciales que tienen líneas de crédito en moneda extranjera

EmergenciApp: aplicación personalizada para el direccionamiento de la atención de emergencias

The lack of knowledge of the people about the entities that can care for them in emergencies causes them to come to the wrong organization. Therefore, these organizations could not help people. This problem may end up affecting the physical and mental integrity of those whose emergency does not end up being resolved appropriately. We propose EmergenciApp, a solution that solves this problem about where and who can help the users during these events. While this system is conceptualized as capable of dealing with any emergency, this paper focuses on medical emergencies, particularly the redirection to medical centers and a system of notification to user´s loved people about emergencies that the user has.El bajo conocimiento por parte de las personas sobre las entidades que les pueden atender en situaciones de emergencia causa que éstas acudan ante el ente equivocado, y, por ende, no puedan ser atendidas correctamente. Esta problemática puede terminar afectando la integridad tanto física como mental de aquellos cuya situación de emergencia no termina siendo resuelta de forma adecuada. Por esta razón se propone EmergenciApp, una solución que aborde esta problemática sobre a quién y dónde acudir durante estas eventualidades. Si bien se plantea esta propuesta como capaz de atender cualquier tipo de emergencia, el presente artículo tiene como foco principal las emergencias de tipo médico, particularmente el re-direccionamiento hacia Instituciones Prestadoras de Salud (IPS), así como un sistema de notificación a seres queridos sobre emergencias que tenga el usuario

A decade of research by the RomanArmy.eu collective: developments and challenges on the Roman conquest of north-western Iberia

[ES] En las últimas décadas, la arqueología ha vivido un proceso de renovación metodológica relacionada con la incorporación de herramientas y recursos digitales. Al creciente uso de tecnologías de información geográfica (TIG) o datos geoespaciales en acceso abierto (fotografía aérea, imágenes satelitales, LiDAR) se une la popularización de nuevos equipamientos técnicos –como los drones– y el notable avance vivido por las ciencias arqueométricas –técnicas de prospección geofísica, análisis paleoambientales, métodos de datación, etc.–. Desde el colectivo Romanarmy.eu hemos experimentado estos cambios en primera línea, incorporándolos a nuestra metodología con el objetivo de comprender mejor el impacto de la extensión del estado romano en los diversos paisajes arqueológicos del noroeste ibérico. La voluminosa información obtenida facilita la superación de las lecturas históricas tradicionales sobre este proceso, mientras que nuevos enfoques permiten plantear nuevos modelos interpretativos que valoren el papel desempeñado por las comunidades indígenas en este proceso de cambio.[EN] In recent times, archaeology has undergone a process of methodological renewal related to the incorporation of many digital tools and resources. The increasing use of Geographic Information Technologies (GIT), the open-access to geospatial datasets (aerial photography, satellite imagery, LiDAR), the popularisation of new technical equipment –such as UAVs–, or the remarkable progress experienced by the archaeological sciences –geophysics, palaeoenvironmental sampling, absolute dating methods, etc.– have forever changed the discipline. The Romanarmy.eu collective has experienced these changes firsthand, developing a modular methodology to understand better the impact of the extension of the Roman state on the diverse archaeological landscapes of north-western Iberia. The voluminous archaeological information gathered facilitates the overcoming of traditional historical readings of this process, while new approaches allow for new interpretative models that also value the role played by indigenous communities in this process of change.Peer reviewe

Communicating the Roman Military Presence in Northwest Iberia: The Romanarmy.eu Research Collective Model

Trabajo presentado en el RSE Project: Narratives of Roman Scotland in the Digital Age, celebrado online el 21 de octubre de 2021

A decade of research by the RomanArmy.eu collective: developments and challenges on the Roman conquest of north-western Iberia

[ES]En las últimas décadas, la arqueología ha vivido un proceso de renovación metodológica relacionada con la incorporación de herramientas y recursos digitales. Al creciente uso de tecnologías de información geográfica (TIG) o datos geoespaciales en acceso abierto (fotografía aérea, imágenes satelitales, LiDAR) se une la popularización de nuevos equipamientos técnicos –como los drones– y el notable avance vivido por las ciencias arqueométricas –técnicas de prospección geofísica, análisis paleoambientales, métodos de datación, etc.–. Desde el colectivo Romanarmy.eu hemos experimentado estos cambios en primera línea, incorporándolos a nuestra metodología con el objetivo de comprender mejor el impacto de la extensión del estado romano en los diversos paisajes arqueológicos del noroeste ibérico. La voluminosa información obtenida facilita la superación de las lecturas históricas tradicionales sobre este proceso, mientras que nuevos enfoques permiten plantear nuevos modelos interpretativos que valoren el papel desempeñado por las comunidades indígenas en este proceso de cambio