Compétence en Technologie de l’Information Géographique (TIG) dans les études universitaires: réflexions et propositions participative

El objetivo de este trabajo es ofrecer una reflexión que conduzca a una asignación coherente de competencias en la enseñanza sobre Tecnologías de la Información Geográfica (Cartografía, Sistemas de Información Geográfica y Teledetección) que se imparte en la universidad. Tras analizar diversas propuestas al respecto, en España y a nivel internacional, y a través de una serie de talleres participativos, un grupo de académicos de la Universidad de Alcalá ha generado su propia propuesta sobre las competencias más importantes y necesarias a conseguir en cada nivel de la educación superior (grado, master y doctorado). La propuesta ha sido contrastada con los resultados de una encuesta realizada entre un conjunto de académicos universitarios españoles.The aim of this paper is to offer an insight on competences leading to their consistent allocation in the different courses on Geographic Information Technologies (Cartography, Geographic Information Systems - GIS and Remote Sensing) taught in universities. To do this, after analyzing the various proposals on the subject, both in Spain and internationally, and after conducting a series of participatory workshops, a group of academics from the University of Alcalá has generated its own proposal on the most important and necessary competences to acquire at each level of higher education (bachelor, master and doctorate). Furthermore, the proposal has been contrasted with the results of a survey conducted by a wide range of Spanish university academics.Le but de cet article est de proposer une réflexion conduisant à une allocation cohérente des compétences dans les différents cours sur les technologies d’information géographique (Cartographie, Système d’Information Géographique- SIG et télédétection) enseignées dans les universités. Pour ce faire, après avoir analysé les différentes propositions sur le sujet, à la fois en Espagne et à l’étranger, et après la réalisation d’une série d’ateliers participatifs, un groupe de l’Université de Alcalá a généré sa propre proposition sur les compétences les plus importants et nécessaires pour obtenir à chaque niveau de l’enseignement supérieur (licence, master et doctorat). En outre, la proposition a été contrastée avec les résultats d’une enquête menée par un large éventail d’universitaires espagnols

Preferències dels estudiants en relació al tema d’estudi del TFG de Farmàcia (UB)

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524El TFG del grau de farmàcia UB es porta a terme en el marc d’un àmbit docent principal i integra coneixements de com a mínim, dos àmbits docents addicionals atès la seva funció integradora. En el moment de definir les directrius i organització de l’assignatura, es van establir a la Facultat de Farmàcia 27 àmbits docents. Tanmateix, les característiques del TFG quan a tipus de projectes o estudis es van establir inicialment en base a tres opcions..

Population-based sequencing of Mycobacterium tuberculosis reveals how current population dynamics are shaped by past epidemics

23 páginas, 4 figuras, 1 tabla.Transmission is a driver of tuberculosis (TB) epidemics in high-burden regions, with assumed negligible impact in low-burden areas. However, we still lack a full characterization of transmission dynamics in settings with similar and different burdens. Genomic epidemiology can greatly help to quantify transmission, but the lack of whole genome sequencing population-based studies has hampered its application. Here, we generate a population-based dataset from Valencia region and compare it with available datasets from different TB-burden settings to reveal transmission dynamics heterogeneity and its public health implications. We sequenced the whole genome of 785 Mycobacterium tuberculosis strains and linked genomes to patient epidemiological data. We use a pairwise distance clustering approach and phylodynamic methods to characterize transmission events over the last 150 years, in different TB-burden regions. Our results underscore significant differences in transmission between low-burden TB settings, i.e., clustering in Valencia region is higher (47.4%) than in Oxfordshire (27%), and similar to a high-burden area as Malawi (49.8%). By modeling times of the transmission links, we observed that settings with high transmission rate are associated with decades of uninterrupted transmission, irrespective of burden. Together, our results reveal that burden and transmission are not necessarily linked due to the role of past epidemics in the ongoing TB incidence, and highlight the need for in-depth characterization of transmission dynamics and specifically tailored TB control strategies.European Research Council 638553-TB-ACCELERATE; European Research Council 101001038-TBRECONNECT; Ministerio de Ciencia e Innovación SAF2016-77346-RPeer reviewe

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Valor discriminatori de la mesura de la diferència de potencial nasal per valorar la funció de la proteïna reguladora de la conductància transmembrana de la fibrosi quística pel diagnòstic etiològic de malalts amb bronquièctasis difuses

Introducció: Avui en dia, el diagnòstic de FQ es basa fonamentalment en la prova de la suor i l’estudi de les mutacions CFTR. Les formes no clàssiques i les formes monosimptomátiques de FQ com les bronquièctasi poden tenir una prova de la suor normal o dubtosa i una o cap mutació de la CFTR. Per poder realitzar el diagnòstic de FQ en aquests malalts, s’aconsella utilitzar una prova funcional de la CFTR que demostri “in vivo” de manera fiable el funcionament de la CFTR. La prova descrita darrerament i més fiable es la mesura de la diferència de potencial nasal (DPN). Objectius: s’han dividit en dos grans grups. En primer lloc establir els criteris de formació d’un tècnic, constatar la repetibilitat de la prova, determinar la sensibilitat (S), especificitat (E), valor predictiu positiu (VPP) i valor predictiu negatiu (VPN), establir i determinar els valors de referència en el nostra medi. El següent gran objectiu es establir si la DPN pot confirmar o excloure el diagnòstic de FQ o disfunció de CFTR en els malalts amb bronquièctasis difuses i prova de la suor no patològica i si la DPN basal pot ser útil com a prova de cribratge en pacient s amb bronquièctasi difuses. Material i Mètodes Poblacions estudiades: Controls sans no portadors de mutacions CFTR; Fibròtics quístics (FQ clàssica); Pacients adults amb bronquièctasis ; Individus sans portadors d’una mutació de CFTR. Instrumentalització: prova de la suor, mesura de la diferència de potencial nasal (basal i després de la irrigació amb diferents solucions- amilorida, solució lliure de clor i isoproterenol), estudi genètic. Resultats: població: es varen estudiar respectivament 14, 17, 112 i 30 individus Primer estudi: El nostre tècnic ha fet 352 determinacions; repetibilitat de la tècnica: s’ha obtingut un coeficient de correlació intraclasse de 0.857. Comparant amb la prova de la suor, la DPN va mostrar una S: 91.7%; E: 80%; VPP: 78%; VPN: 92,3% i es van establir els valors de referència pel nostre laboratori. L’estudi de la DPN (basal més irrigació amb les diferents solucions) va mostrar que la darrera mesura, després de la irrigació amb isoproterenol un increment de DPN entre 1 i 11 mV,permetia diagnosticar de FQ malalts amb BD i prova de la suor no patològica. Un 82% d’aquests malalts tenien mutacions considerades de menor severitat. Conclusions: Hem comprovat que un tècnic que relaitzi 350 mesures està ensinistrat per fer la tècnica. La repetibilitat de la tècnica fou excel·lent, la qual cosa permet establir valors de referència per un laboratori en concret. La determinació de la DPN en pacients afectes de BD no filiades permet el diagnòstic de FQ. Els nostres resultats aconsellen la implementació de la mesura de la DPN basal en el algoritme diagnòstic de la FQ.Introduction: nowadays, the diagnosis of Cystic Fibrosis (CF) is based on the sweat test and the presence of characteristic mutations. Non classical forms as well as monosymptomatic patients of CF such as difuse bronchiectasis can have a sweat test normal or mildly altered and one or none mutation of the CFTR (Cystic Fibrosis Transmembrane Regulator) gen. To achieve a diagnosis of CF, a functional test that shows “in vivo” the activity of the CFTR is recommended. The most recent and reliable test implemented is the measurement of the nasal potential difference (NPD). Objectives: they were divided into two groups. The first one pretended to establish the criteria for the training of a technician to state the repeatability of the test, determine the sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPV) and establish the reference values of the technique in our environment. The second objective was to evaluate whether the NPD meaurement can confirm or exclude the diagnosis of CF and/or CFTR dysfunction in patients with diffuse bronchiectasis and normal sweat test as well as to establish its usefulness as a screening test in patients with diffuse bronchiectasis. Material and Methods: Population: controls healthy without any mutation of the CFTR; Classic CF (carrying two CFTR mutations); Adult patients with diffuse bronchiectasis; Healthy individuals carrying a mutation of CFTR. Interventions: sweat test, measurement of nasal potential difference (baseline and after irrigation with different solutions: amiloride, chlorine-free solution and isoproterenol), genetic study. Results: population: 14, 17, 112 and 30 individuals were respectively studied. First study: Our technician performed 352 determinations; Repeatability of the technique: an intraclass correlation coefficient (ICC) of 0.857 was obtained. Comparing with the sweat test, the DPN showed a S: 91.7%; E: 80%; PPV: 78%; NPV92.3%. We could establish the reference values of the NPD technique for our laboratory. Second study: the different NPD measurements (the baseline and those obtained after irrigation with different solutions) showed that the last measurement, the one obtained after irrigation with isoproterenol, in the group of patients with and increment of NPD values between 1 and 11 mV allowed a diagnosis of CF in patients with diffuse brionchiectasis and a normal sweat test. Eighty two percent of this group of patients had CFTR mutations, most of which considered of less severity. Conclusions: We have found that a technician training is achieved after 350 NPD measurements. The repeatability of the technique was excellent, allowing to establish reference values for a particular laboratory. The measurement of NPD in patients with diffuse bronquiectasis allows a diagnosis of CF. Our results recommend the implementation of the NPD measurement for the diagnosis of CF

Valor discriminatori de la mesura de la diferència de potencial nasal per valorar la funció de la proteïna reguladora de la conductància transmembrana de la fibrosi quística pel diagnòstic etiològic de malalts amb bronquièctasis difuses

Introducció: Avui en dia, el diagnòstic de FQ es basa fonamentalment en la prova de la suor i l'estudi de les mutacions CFTR. Les formes no clàssiques i les formes monosimptomátiques de FQ com les bronquièctasi poden tenir una prova de la suor normal o dubtosa i una o cap mutació de la CFTR. Per poder realitzar el diagnòstic de FQ en aquests malalts, s'aconsella utilitzar una prova funcional de la CFTR que demostri "in vivo" de manera fiable el funcionament de la CFTR. La prova descrita darrerament i més fiable es la mesura de la diferència de potencial nasal (DPN). Objectius: s'han dividit en dos grans grups. En primer lloc establir els criteris de formació d'un tècnic, constatar la repetibilitat de la prova, determinar la sensibilitat (S), especificitat (E), valor predictiu positiu (VPP) i valor predictiu negatiu (VPN), establir i determinar els valors de referència en el nostra medi. El següent gran objectiu es establir si la DPN pot confirmar o excloure el diagnòstic de FQ o disfunció de CFTR en els malalts amb bronquièctasis difuses i prova de la suor no patològica i si la DPN basal pot ser útil com a prova de cribratge en pacient s amb bronquièctasi difuses. Material i Mètodes Poblacions estudiades: Controls sans no portadors de mutacions CFTR; Fibròtics quístics (FQ clàssica); Pacients adults amb bronquièctasis ; Individus sans portadors d'una mutació de CFTR. Instrumentalització: prova de la suor, mesura de la diferència de potencial nasal (basal i després de la irrigació amb diferents solucions- amilorida, solució lliure de clor i isoproterenol), estudi genètic. Resultats: població: es varen estudiar respectivament 14, 17, 112 i 30 individus Primer estudi: El nostre tècnic ha fet 352 determinacions; repetibilitat de la tècnica: s'ha obtingut un coeficient de correlació intraclasse de 0.857. Comparant amb la prova de la suor, la DPN va mostrar una S: 91.7%; E: 80%; VPP: 78%; VPN: 92,3% i es van establir els valors de referència pel nostre laboratori. L'estudi de la DPN (basal més irrigació amb les diferents solucions) va mostrar que la darrera mesura, després de la irrigació amb isoproterenol un increment de DPN entre 1 i 11 mV,permetia diagnosticar de FQ malalts amb BD i prova de la suor no patològica. Un 82% d'aquests malalts tenien mutacions considerades de menor severitat. Conclusions: Hem comprovat que un tècnic que relaitzi 350 mesures està ensinistrat per fer la tècnica. La repetibilitat de la tècnica fou excel·lent, la qual cosa permet establir valors de referència per un laboratori en concret. La determinació de la DPN en pacients afectes de BD no filiades permet el diagnòstic de FQ. Els nostres resultats aconsellen la implementació de la mesura de la DPN basal en el algoritme diagnòstic de la FQ.Introduction: nowadays, the diagnosis of Cystic Fibrosis (CF) is based on the sweat test and the presence of characteristic mutations. Non classical forms as well as monosymptomatic patients of CF such as difuse bronchiectasis can have a sweat test normal or mildly altered and one or none mutation of the CFTR (Cystic Fibrosis Transmembrane Regulator) gen. To achieve a diagnosis of CF, a functional test that shows "in vivo" the activity of the CFTR is recommended. The most recent and reliable test implemented is the measurement of the nasal potential difference (NPD). Objectives: they were divided into two groups. The first one pretended to establish the criteria for the training of a technician to state the repeatability of the test, determine the sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPV) and establish the reference values of the technique in our environment. The second objective was to evaluate whether the NPD meaurement can confirm or exclude the diagnosis of CF and/or CFTR dysfunction in patients with diffuse bronchiectasis and normal sweat test as well as to establish its usefulness as a screening test in patients with diffuse bronchiectasis. Material and Methods: Population: controls healthy without any mutation of the CFTR; Classic CF (carrying two CFTR mutations); Adult patients with diffuse bronchiectasis; Healthy individuals carrying a mutation of CFTR. Interventions: sweat test, measurement of nasal potential difference (baseline and after irrigation with different solutions: amiloride, chlorine-free solution and isoproterenol), genetic study. Results: population: 14, 17, 112 and 30 individuals were respectively studied. First study: Our technician performed 352 determinations; Repeatability of the technique: an intraclass correlation coefficient (ICC) of 0.857 was obtained. Comparing with the sweat test, the DPN showed a S: 91.7%; E: 80%; PPV: 78%; NPV92.3%. We could establish the reference values of the NPD technique for our laboratory. Second study: the different NPD measurements (the baseline and those obtained after irrigation with different solutions) showed that the last measurement, the one obtained after irrigation with isoproterenol, in the group of patients with and increment of NPD values between 1 and 11 mV allowed a diagnosis of CF in patients with diffuse brionchiectasis and a normal sweat test. Eighty two percent of this group of patients had CFTR mutations, most of which considered of less severity. Conclusions: We have found that a technician training is achieved after 350 NPD measurements. The repeatability of the technique was excellent, allowing to establish reference values for a particular laboratory. The measurement of NPD in patients with diffuse bronquiectasis allows a diagnosis of CF. Our results recommend the implementation of the NPD measurement for the diagnosis of CF

La coordinación administrativa en salud laboral a propósito de un caso: Zapatas de freno con amianto en una empresa

ABSTRACT The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administra tions. In this context, the principle of coordination is fundamental for the co hesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in re lation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon’s Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultu ral machinery by a Company from Zaragoza; the collaboration from Aragon’s Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of the se administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese com pany. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.RESUMEN La actual estructura del Estado de las Autonomías se caracteriza por el pluralismo institucional y la autonomía de las diferentes administraciones públicas. En este contexto el principio de coordinación es fundamental para la cohesión del Estado, pero la experiencia muestra que es difícil su puesta en práctica. En este trabajo se examinó el conjunto de actuaciones realizado por las administraciones en relación a un problema de salud laboral y de salud pública planteado en marzo de 2016. La Dirección General de Salud Pública del Gobierno de Aragón tuvo conocimiento de la posible utilización por una empresa de Zaragoza de zapatas de freno con amianto para fabricar ejes de maquinaria agrícola. Se recabó la colaboración del Instituto Arago nés de Seguridad y Salud Laboral (ISSLA), del Departamento de Industria y de la Inspección de Trabajo y Seguridad Social, dichas administraciones detectaron la utilización de varios modelos de zapatas con un contenido de crisotilo del 2-5%. Las zapatas procedían de una empresa china. Los ejes eran comercializados en varias Comunidades Autónomas. Se activó una alerta nacional a través del SIRIPQ (Sistema de Intercambio Rápido de In formación de Productos Químicos) coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Se tomaron medidas tales como el cese del trabajo con las zapatas, la sustitución de las ya instaladas mediante la aplica ción de un Plan Único de Trabajo, la inmovilización de las zapatas presentes en la empresa, etc. Este caso muestra que la cooperación y la corresponsabi lidad de administraciones públicas de diferentes ámbitos territoriales, secto riales y competenciales permite mejorar la prevención de riesgos laborales