Deep Gaussian processes for biogeophysical parameter retrieval and model inversion

Parameter retrieval and model inversion are key problems in remote sensing and Earth observation. Currently, different approximations exist: a direct, yet costly, inversion of radiative transfer models (RTMs); the statistical inversion with in situ data that often results in problems with extrapolation outside the study area; and the most widely adopted hybrid modeling by which statistical models, mostly nonlinear and non-parametric machine learning algorithms, are applied to invert RTM simulations. We will focus on the latter. Among the different existing algorithms, in the last decade kernel based methods, and Gaussian Processes (GPs) in particular, have provided useful and informative solutions to such RTM inversion problems. This is in large part due to the confidence intervals they provide, and their predictive accuracy. However, RTMs are very complex, highly nonlinear, and typically hierarchical models, so that very often a single (shallow) GP model cannot capture complex feature relations for inversion. This motivates the use of deeper hierarchical architectures, while still preserving the desirable properties of GPs. This paper introduces the use of deep Gaussian Processes (DGPs) for bio-geo-physical model inversion. Unlike shallow GP models, DGPs account for complicated (modular, hierarchical) processes, provide an efficient solution that scales well to big datasets, and improve prediction accuracy over their single layer counterpart. In the experimental section, we provide empirical evidence of performance for the estimation of surface temperature and dew point temperature from infrared sounding data, as well as for the prediction of chlorophyll content, inorganic suspended matter, and coloured dissolved matter from multispectral data acquired by the Sentinel-3 OLCI sensor. The presented methodology allows for more expressive forms of GPs in big remote sensing model inversion problems.European Research Council (ERC) 647423Spanish Ministry of Economy and Competitiveness TIN2015-64210-R DPI2016-77869-C2-2-RSpanish Excellence Network TEC2016-81900-REDTLa Caixa Banking Foundation (Barcelona, Spain) 100010434 LCF-BQ-ES17-1160001

Implantación en Mallorca de un programa de Tratamiento multimodal de la Carcinomatosis Peritoneal mediante Quimioterapia Sistémica, Cirugía Citorreductora y Quimioterapia Intraperitoneal Hipertérmica (HIPEC)

Introducción: Las investigaciones de Sugarbaker et al demostraron desde principios de los 90 que muchos tumores de origen colorrectal y apendicular con extensión peritoneal pueden permanecer limitados al abdomen durante períodos relativamente largos antes de desarrollar metástasis a distancia. Con ello, la carcinomatosis peritoneal pasó de considerarse desde una perspectiva sistémica y prácticamente terminal a concebirse como una enfermedad loco-regional, susceptible de rescate quirúrgico y oncológico, con un aumento de la supervivencia. Los estudios experimentales de la cirugía citorreductora radical asociada a la quimioterapia intraperitoneal hipertérmica ofrecen mejores resultados en términos de supervivencia a largo plazo y de calidad de vida que los tratamientos convencionales. El tratamiento actual de la carcinomatosis peritoneal es multimodal, con tres líneas de acción: 1. Quimioterapia intravenosa preoperatoria de inducción; 2. Cirugía citorreductora y peritonectomía, y 3. Quimioterapia intraperitoneal hipertérmica. Su base científica se fundamenta en el sinergismo entre la hipertermia y varios quimioterápicos (Mitomicina-C, Cisplatino, Oxaliplatino, etc), en la citotoxicidad directa del calor sobre las células tumorales y en las ventajas farmacocinéticas de la quimioterapia administrada por vía intraperitoneal. Metodología: Objetivos del Programa: 1. Desarrollo del Protocolo de tratamiento multimodal oncológico y quirúrgico. 2. Formación continuada del grupo de trabajo multidisciplinario. 3. Formación continuada en el manejo de la técnica de perfusión de quimioterapia intraperitoneal hipertérmica. 4. Aplicación de un protocolo de seguridad laboral. 5. Definición de indicadores de resultados. 6. Diseño de base de datos informatizada para explotación de resultados. 7. Seguimiento y registro de morbilidad y mortalidad. 8. Seguimiento y análisis de supervivencia a medio y largo plazo. Evaluación clínica preoperatoria y estudio de extensión tumoral. 1. Indicaciones clínicas. Tipos de tumores. 2. Selección de pacientes. Criterios de inclusión y de exclusión. 3. Evaluación oncológica preoperatoria. 4. Evaluación radiológica preoperatoria. 5. Algoritmo de actuación. 6. Seguimiento de pacientes. 7. Seguridad laboral. Resultados: Hace cinco años se puso en marcha en el Hospital Son Llàtzer el programa completo de cirugía citorreductora con quimioterapia intraperitoneal hipertérmica para el tratamiento de la carcinomatosis peritoneal. Se han intervenido 46 pacientes (40 mujeres y 6 hombres), con una edad media de 58.3 años (47-73 años). De los 46 pacientes, 30 lo eran con cáncer de ovario, y en ellos se realizó cirugía citorreductora seguida de quimioterapia sistémica sin aplicación de quimioterapia intraperitoneal. El programa de cirugía citorreductora y quimioterapia intraperitoneal se compone de 17 pacientes en los que se realizaron un total de 20 procedimientos. El origen del tumor fue colorrectal en 11 casos, apendicular en 4 casos, gástrico en un caso y un mesotelioma peritoneal multiquísitico difuso. En 9 casos se realizó quimioterapia intraperitoneal normotérmica y en 11 casos quimioterapia intraperitoneal hipertérmica (HIPEC). La mortaliad perioperatoria fue de un 4.3% (tres pacientes). El índice de resecabildad tumoral fue de un 90.9%. En 17 casos (85%), se pudo conseguir una resección completa (CC-0). La morbilidad global fue de un 40%, siendo la complicación más frecuente la infección de catéter central. Fueron reintervenidos tres pacientes (hemorragia, fístula duodenal e isquemia mesentérica segmentaria). La duración media de la intervención fue de 6.5 horas y la estancia media de 18.2 días. La supervivencia media de los pacientes con diseminación peritoneal de origen colorrectal y apendicular ha sido de 27 y 31 meses respectivamente. La supervivencia global de los pacientes con carcinomatosis peritoneal de origen colorrectal al año, dos y tres años fue del 71%, 60% y 50% respectivamente. Conclusiones: a) La aplicación de un tratamiento multidisciplinar y multimodal puede mejorar de forma significativa la supervivencia en un grupo específico de pacientes con carcinomatosis peritoneal; b) Este tratamiento es costoso y complejo y supone una importante carga de trabajo para los profesionales y las instituciones, por lo que es esencial aplicar criterios rigurosos de selección de pacientes, fundamentados en la experiencia y en la evaluación por equipos multidisciplinares. Es esencial el diagnóstico precoz, el tratamiento de las complicaciones, el seguimiento de los pacientes y la evaluación continua de los resultados de morbilidad y supervivencia. c) los estudios randomizados en curso aportarán previsiblementeIntroduction: Research promoted since the early nineties by Sugarbaker et al in Washington, have demonstrated that many tumors of colorectal and appendiceal origen with peritoneal extension, may remain limited to the abdomen during relatively long periods before developing distant metastases. These findings have radically altered the consideration of peritoneal carcinomatosis from a systemic and almost terminal state, to a locoregional disease, with possibility of surgical and oncological rescue, and thus, increasing the survival. The results of experimental studies of radical cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy, have demonstrated better results in terms of long-term survival and quality of life than conventional treatments. The rationale for the current treatment of peritoneal carcinomatosis is organized around a multimodal treatment with three courses of action: 1. Preoperative intravenous induction chemotherapy, 2. Cytoreductive surgery and peritonectomy, and 3. Hyperthermic intraperitoneal chemotherapy (HIPEC). The scientific basis of this multimodal treatment is based on the synergism between the hyperthermia and several cytostatic agents (mitomycin-C, cisplatin, oxaliplatin, etc.), the direct heat cytotoxicity on tumor cells, and the pharmacokinetic advantages of chemotherapy administered intraperitoneally. Methodology: Program Objectives were the following: 1. Development of Multimodal surgical and oncologic treatment protocol; 2. Continuing education of the multidisciplinary group; 3. Ongoing training in the hyperthermic intraperitoneal perfusion chemotherapy; 4. Application of a Work Safety Protocol; 5. Definition of indicators; 6. Design of database for exploitation of results; 7. Monitoring of morbidity and mortality, and 8. Monitoring and analysis of survival. Clinical evaluation and preoperative tumor extension study. 1. Clinical Indications. Types of tumors; 2. Patient selection. Inclusion and exclusion criteria; 3. Preoperative Evaluation Oncology; 4. Preoperative radiological evaluation; 5. Clinical pathway algorithm; 6. Patients follow-up, and 7. Laboral safety. Results: Five years ago, we started cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in the Hospital Son Llàtzer. 46 patients were operated (40 women and 6 men) with a mean age of 58.3 years (47-73 years). Of these 46 patients, 30 were patients with ovarian cancer, and underwent cytoreductive surgery followed by chemotherapy without applying systemic intraperitoneal chemotherapy. The program consisted of 17 patients who underwent a total of 20 procedures. The origin of the tumor was colorectal in 11 cases, appendiceal in 4 cases, gastric in 1 case, and one case with a diffuse multicystic peritoneal mesothelioma. The intraperitoneally chemotherapy administered was normothermic in 9 patients, and hyperthermic (HIPEC) in 11 cases. The perioperative mortality was 4.3% (three patients). The resectability index was 90.9%. In 17 cases (85%) it was possible to get a complete resection (CC-0). Overall morbidity was 40%. The most frequent complication was central catheter infection. Three patients required reoperation (postoperative bleeding, duodenal fistula, and segmental mesenteric ischemia). The mean operative duration was 6.5 hours. The average stay was 18.2 days. The median survival of patients with peritoneal dissemination of appendiceal and colorectal origin was 27 and 31 months respectively. Overall survival of patients with peritoneal carcinomatosis of colorectal origin was at one, two, and three years 71%, 60% and 50% respectively. Conclusions: a) The application of a multidisciplinary and multimodal treatment can significantly improve survival in a specific group of patients with peritoneal carcinomatosis. b) This treatment is expensive, complex and represents a significant workload for professionals and institutions, so it is essential to apply strict criteria for patient selection, based on experience and the evaluation by multidisciplinary teams. Similarly, it is essential to achieve an early diagnosis, treatment of complications, patient monitoring, and continuous evaluation of morbidity outcomes and survival. c) Randomized studies currently underway will provide more evidence on the expected benefit of this treatment, and establish lines to improve results

Introducing instance label correlation in multiple instance learning. Application to cancer detection on histopathological images

In the last years, the weakly supervised paradigm of multiple instance learning (MIL) has become very popular in many different areas. A paradigmatic example is computational pathology, where the lack of patch-level labels for whole-slide images prevents the application of supervised models. Probabilistic MIL methods based on Gaussian Processes (GPs) have obtained promising results due to their excellent uncertainty estimation capabilities. However, these are general-purpose MIL methods that do not take into account one important fact: in (histopathological) images, the labels of neighboring patches are expected to be correlated. In this work, we extend a state-of-the-art GP-based MIL method, which is called VGPMIL-PR, to exploit such correlation. To do so, we develop a novel coupling term inspired by the statistical physics Ising model. We use variational inference to estimate all the model parameters. Interestingly, the VGPMIL-PR formulation is recovered when the weight that regulates the strength of the Ising term vanishes. The performance of the proposed method is assessed in two real-world problems of prostate cancer detection. We show that our model achieves better results than other state-of-the-art probabilistic MIL methods. We also provide different visualizations and analysis to gain insights into the influence of the novel Ising term. These insights are expected to facilitate the application of the proposed model to other research areas.European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska Curie grant agreement No 860627 (CLARIFY Project)Spanish Ministry of Science and Innovation under project PID2019-105142RBC22University of Granada and FEDER/Junta de Andalucía under project B-TIC-324-UGR20 (Proyectos de I+D+i en el marco del Programa Operativo FEDER Andalucía)Margarita Salas postdoctoral fellowship (Spanish Ministry of Universities with Next Generation EU funds

Hyperthermia iatrogenic with thermal blanket for patient under total pelvic exenteration

Exponemos un caso clínico con el objetivo de mostrar como puede presentarse un cuadro de hipertermia con consecuencias hemodinámicas graves, así como destacar que un diagnóstico (clínico y mediante sistemas de monitorización mínimamente invasivos) y tratamiento precoces son imprescindibles para conseguir una adecuada evolución del paciente. Es un caso de hipertermia iatrogénica en un hombre de 59 años sometido a exenteración pélvica total. Mostramos cómo la hipertermia puede presentarse con repercusión clínica importante y grave, en forma de Síndrome de Respuesta Inflamatoria Sistémica, que puede poner en peligro la vida del paciente, y como su diagnóstico y tratamiento precoz (mediante la monitorización con el sistema VIGILEO) puede ser clave para que la evolución del cuadro sea adecuada. La conclusión a la cual queremos llegar es que la hipertermia puede presentarse como un SRIS y que la monitorización hemodinámica y de la temperatura corporal puede ayudarnos en su diagnóstico y tratamiento.We report a case in order to show how you can present with symptoms of hyperthermia with severe hemodynamic consequences and noted that a diagnosis (clinically and by systems of minimally invasive monitoring) and early treatment are essential for adequate patient outcome. It’s a case of iatrogenic hyperthermia in a man of 59 years underwent total pelvic exenteration. We show how hyperthermia can present with significant and serious clinical consequences, as syndrome systemic inflammatory response, which may endanger the patient’s life, as early diagnosis and treatment (by monitoring the Vigileo system) can be key to the evolution of the condition is appropriate. The conclusion at which we arrive is that hyperthermia may occur as a SIRS and hemodynamic and body temperature monitoring may help in diagnosis and treatment

Influencia de la resección de vena porta/vena mesentérica superior en la morbilidad, mortalidad y supervivencia de los pacientes con adenocarcinoma ductal de páncreas en las Islas Baleares

Introduction: Recent developments have enabled associate to standard pancreaticoduodenectomy (DPC), vascular resections to increase resectability in pancreatic cancer. Objectives: Analyze morbidity, mortality and survival of a consecutive series of patients with pancreatic cancer, in which a DPC with portal vein resection was performed, and compared it with a group of patients with standard DPC without venous resection. Methodology: Consecutive series of 67 patients who underwent a DPC ought to pancreatic ductal adenocarcinoma, between January 2005 and January 2015. Results: Standard resection (RV-) was performed in 49 cases, and a venous resection in another 18 patients (RV+). There were no significant differences in age (65 vs 68.9 years), ASA, or intraoperative transfusion. Duration of intervention was significantly lower in the RV- group (6.1 vs 6.7; p = 0.05). Morbidity grade III -IV was 14.2 % Clavien in the RV- group and 16.6 % in the RV + group (p = 0.87). There were no differences in hospital mortality (0 % vs 5.5%), or hospital stay (14.4 vs 15.2 days). The surgical margin involvement was more frequent in the RV+ group (18 % vs 50 % ; p = 0.003). One, 3 and 5 years survival was 77, 34 and 11% in the RV- group and 92, 23 and 8% in the group with venous resection. Conclusions: DPC with venous resection can be performed with morbidity and mortality rates similar to standard DPC1. Survival shows no significant difference between the two groups.Venous resection may increase resectability in a selected group of patients with pancreatic adenocarcinoma.Introducción: Los progresos recientes han permitido asociar a la duodenopancreatectomía cefálica estándar (DPC), resecciones vasculares para incrementar la resecabilidad en el cáncer de páncreas. Objetivos: Analizar la morbi-mortalidad y supervivencia de una serie consecutiva de pacientes con cáncer de páncreas, en los que se realizó una DPC con resección de vena porta y compararla con un grupo de pacientes con DPC estándar sin resección venosa. Material y métodos: Serie consecutiva de 67 pacientes intervenidos con adenocarcinoma ductal de páncreas, entre enero 2005 y enero 2015. Resultados: En 49 casos se realizó una resección estándar (RV-) y en 18 pacientes, una resección venosa (RV+). No hubo diferencias significativas en la edad (65 vs 68,9 años), ASA, ni en la transfusión intraoperatoria. La duración de la intervención fue significativamente menor en el grupo RV- (6,1 vs 6,7; p= 0,05). La morbilidad grado III-IV de Clavien fue del 14,2% en el grupo RV- y del 16,6% en el grupo RV+ (p=0,87). No hubo diferencias en la mortalidad hospitalaria (0% vs 5,5%), ni en la estancia hospitalaria (14,4 vs 15,2 días). La afectación del margen quirúrgico fue más frecuente en el grupo RV+ (18% vs 50%; p=0,003). La supervivencia al año, 3 y 5 años fue del 77, 34 y 11% en el grupo RV-,y del 92, 23 y 8% en el grupo con resección venosa. Conclusiones: La DPC con resección venosa puede realizarse con tasas de morbi-mortalidad similares a la DPC estándar. La supervivencia no muestra diferencias significativas entre los dos grupos. La resección venosa puede aumentar la resecabilidad en un grupo seleccionado de pacientes con adenocarcinoma de páncreas

A Large Case-Control Study Performed in Spanish Population Suggests That RECQL5 Is the Only RECQ Helicase Involved in Breast Cancer Susceptibility.

Around 50% of the familial breast cancer (BC) cases are estimated to be caused by germline variants in known low-, moderate-, and high-risk susceptibility genes, while the other half is of unknown genetic origin. In the present study, we wanted to evaluate the role of the RECQ helicases, some of which have been studied in the past as candidates, with unclear results about their role in the disease. Using next-generation sequencing (NGS) technology, we analyzed the whole coding sequence of BLM, RECQL1, RECQL4, RECQL5, and WRN in almost 2000 index cases from BC Spanish families that had previously tested negative for the known BC susceptibility genes (BRCAX) and compared the results with the controls extracted from gnomAD. Our results suggest that BLM, RECQL1, RECQL4, and WRN do not play a major role in BC susceptibility. However, in the combined analysis, joining the present results with those previously reported in a series of 1334 BC Spanish patients and controls, we found a statistically significant association between Loss of Function (LoF) variants in RECQL5 and BC risk, with an OR of 2.56 (p = 0.009; 95% CI, 1.18-4.98). Our findings support our previous work and places the RECQL5 gene as a new moderate-risk BC gene.A.O. is partially funded by FIS PI19/00640 supported by FEDER funds and the Spanish Network on Rare Diseases (CIBERER). M.d.l.H. is partially funded by FIS PI20/00110 supported by FEDER funds.S

Caracterización de la red urbana y generación de modelo de proyección de viajes en la ciudad de Estelí, Nicaragua

The study aimed to characterize the urban network, model travel and make projections within the urban area in the city of Estelí, through household surveys and surveys of ups and downs. The urban route belonging to the Rosario was selected because it is the one that runs throughout the city. The following statistical travel model was obtained (number of trips made in one day) depends on age, income and the number of people living in a home, under the formula Y = 1.11 + 0.01 (age) - 5.57 * 10 -5 (income) +0.06 (number of people in the household) with p-value = 0.03. The 2.43 km stretch of road between the NACSA Tobacco Company and Las Segovias supermarket is the one with the highest demand with a value of 222,125 passengers per month. The most visited points are Universidad UNAN Managua FAREM - Estelí, tobacco factories and the San Juan de Dios Hospital, within the 53 existing stops. A proposal for a route change was also made in the principal avenues of the Estelícity, to reduce traffic congestion and a replacement analysis of electric bus units to improve supply, reduce environmental pollution and obtain better benefits; Economically speaking, the project proved convenient because a cost-benefit ratio of 1.35 and a net present value of C $56,951,947.10 was obtained, all with a total investment of C$ 59,427,675.00, recoverable in 1 year, 6 months and 8 days. In general, if the proposed models and solutions are applied, it will be possible to improve the urban transport system of the city of Estelí, increasing the quality of life of the inhabitants.El estudio tuvo como objetivo caracterizar la red urbana, modelar los viajes y realizar proyecciones dentro del casco urbano en la ciudad de Estelí, a través de encuestas al hogar y encuestas de sube y bajar de la ruta. Se seleccionó la ruta urbana perteneciente al barrio el Rosario por ser la que recorre toda la ciudad.  Se obtuvo el siguiente modelo estadístico de viaje (número de viajes realizados en un día) depende de la edad, los ingresos y la cantidad de personas que habitan en un domicilio, bajo la fórmula Y=1.11 + 0.01 (edad) - 5.57*10-5 (ingresos) +0.06 (cantidad de personas en el hogar) con p-valor = 0.03. El tramo vial de 2.43 km entre la tabacalera NACSA hasta el Supermercado las Segovias es el que tiene más demanda con un valor 222,125 pasajeros por mes. Los puntos más visitados son Universidad UNAN Managua FAREM - Estelí, fábricas de tabaco y el Hospital San Juan de Dios, dentro de las 53 paradas existentes. También se realizó una propuesta de cambio de ruta en  vías principales de la ciudad de Estelí, para disminuir el congestionamiento del tráfico y un análisis de reemplazo por  unidades de buses eléctricas para mejorar la oferta, disminuir la contaminación ambiental y obtener mejores beneficios; económicamente hablando el proyecto resultó ser conveniente porque se obtuvo una relación  beneficio-costo de 1.35 y un valor presente neto de C$56,951,947.10, todo ello con una inversión total de C$ 59,427,675.00, recuperable en 1 año, 6 meses y 8 días. En general, si se aplican los modelos y soluciones propuestas, será posible mejorar el sistema de transporte urbano de la ciudad de Estelí, incrementando la calidad de vida de los habitantes

Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis

BACKGROUND & AIMS: We investigated the effect of albumin treatment (20% solution) on hypoalbuminemia, cardiocirculatory dysfunction, portal hypertension, and systemic inflammation in patients with decompensated cirrhosis with and without bacterial infections. METHODS: We performed a prospective study to assess the effects of long-term (12 weeks) treatment with low doses (1 g/kg body weight every 2 weeks) and high doses (1.5 g/kg every week) of albumin on serum albumin, plasma renin, cardiocirculatory function, portal pressure, and plasma levels of cytokines, collecting data from 18 patients without bacterial infections (the Pilot-PRECIOSA study). We also assessed the effect of short-term (1 week) treatment with antibiotics alone vs the combination of albumin plus antibiotics (1.5 g/kg on day 1 and 1 g/kg on day 3) on plasma levels of cytokines in biobanked samples from 78 patients with bacterial infections included in a randomized controlled trial (INFECIR-2 study). RESULTS: Circulatory dysfunction and systemic inflammation were extremely unstable in many patients included in the Pilot-PRECIOSA study; these patients had intense and reversible peaks in plasma levels of renin and interleukin 6. Long-term high-dose albumin, but not low-dose albumin, was associated with normalization of serum level of albumin, improved stability of the circulation and left ventricular function, and reduced plasma levels of cytokines (interleukin 6, granulocyte colony-stimulating factor, interleukin 1 receptor antagonist, and vascular endothelial growth factor) without significant changes in portal pressure. The immune-modulatory effects of albumin observed in the Pilot-PRECIOSA study were confirmed in the INFECIR-2 study. In this study, patients given albumin had significant reductions in plasma levels of cytokines. CONCLUSIONS: In an analysis of data from 2 trials (Pilot-PRECIOSA study and INFECIR-2 study), we found that albumin treatment reduced systemic inflammation and cardiocirculatory dysfunction in patients with decompensated cirrhosis. These effects might be responsible for the beneficial effects of albumin therapy on outcomes of patients with decompensated cirrhosis. ClinicalTrials.gov, Numbers: NCT00968695 and NCT03451292

Use of interactive response devices for the improvement of teaching in the degrees of the Faculty of Sciences

La implantación de los nuevos Grados dentro del EEES supone un nuevo enfoque metodológico, pero sobre todo evaluador. El profesor debe esforzarse en ser capaz de valorar no sólo el nivel de conocimientos del alumnado sobre los contenidos, ya que la sociedad actual demanda un perfil de los egresados más completo basado en la formación por competencias. La adquisición de ambas facetas por parte del alumnado se basa principalmente en actividades presenciales y metodologías docentes aplicadas en el desarrollo de las asignaturas, tanto en grupo reducido como en grupo completo. Por tanto, cualquier herramienta adicional que ayude al docente a facilitar esta doble tarea es bien recibida, pues permitirá evaluar el rendimiento académico global del alumnado. Recientemente la Facultad de Ciencias ha puesto en marcha una experiencia piloto mediante la cual un nutrido grupo de profesores ha incorporado en su docencia un sistema de mandos inalámbricos de respuesta. Actualmente, la Facultad de Ciencias dispone de un total de 82 mandos inalámbricos de respuesta y tres antenas receptoras. Esta nueva tecnología ha permitido al docente realizar, de forma interactiva, preguntas colectivas al alumnado y recoger las respuestas individuales de forma inmediata. Los resultados obtenidos en este proyecto nos permiten ser muy optimistas con el uso de esta herramienta y nos animan a continuar en la misma línea. El profesorado participante se ha mostrado dispuesto a continuar empleando esta TIC en su docencia, tratando de abarcar más asignaturas, diversificar el tipo de pruebas, y emplear los mandos de respuesta en grupo completo, cuando el número de alumnos lo permita. La puesta en común de los resultados revela que, de forma general, este tipo de sistemas de respuesta incrementa el nivel de atención del alumnado, ya que se les demanda de forma continuada su participación activa durante la sesión. Se potencia la retención de conceptos, al suministrar en el acto la respuesta correcta a cada pregunta realizada. Permite también al profesorado conocer el nivel previo de conocimientos sobre la materia a impartir, ya que se puede realizar este tipo de preguntas al comienzo de la sesión y enfocar entonces su atención en las debilidades manifestadas. Asimismo se puede testar el grado de adquisición de dichos conocimientos, realizando este tipo de cuestionarios después de la sesión. Además, el tratamiento posterior de los resultados, de forma individualizada, permite gestionar de forma ágil el nivel de conocimientos y adquisición de competencias en lo que es un sistema de evaluación continua, tan necesario en los nuevos enfoques metodológicos nacidos de la implantación del EEES. Por último destacar que el profesorado participante ha considerado que se trata de una herramienta de gran utilidad para la consecución del objetivo de excelencia en la docencia, que además es eficaz y de fácil manejo, y entiende que no debe ser una actividad puntual, sino un proceso transformador en la actividad docente e interacción alumno-profesor, configurándose como una herramienta habitual en los sistemas de enseñanza-aprendizaje.Implementation of the new degrees in the EHEA involve a new methodological approach, but above all evaluation. The teacher should strive to be able to assess not only the level of knowledge of the students on the content, as the current society demands a profile of the most complete graduates based on training by competencies. The acquisition of both facets by students is based mainly on face-to-face activities and teaching methodologies applied in the development of the subjects, both in small group and in whole group. Therefore, any additional tool that helps the teacher to facilitate this double task is well received, since it will allow to evaluate the overall academic performance of the students. Recently the Faculty of Sciences has launched a pilot experience through which a large group of teachers has incorporated into their teaching a system of interactive response devices. Currently, the Faculty of Sciences has a total of 82 wireless response controllers and three receiving antennas. This new technology has enabled the teacher to interact interactively with the students and collect the individual answers immediately. The results obtained in this project allow us to be very optimistic with the use of this tool and encourage us to continue in the same line. The participating teachers have been willing to continue using this ICT in their teaching, trying to cover more subjects, diversify the type of tests, and use the full group response commands, when the number of students allows. The sharing of results reveals that, in a general way, this type of response systems increases the level of attention of the students, since they are continuously demanded their active participation during the session. The retention of concepts is strengthened by providing the correct answer to every question asked. It also allows the faculty to know the previous level of knowledge about the subject to be taught, since this type of questions can be asked at the beginning of the session and then focus their attention on the weaknesses manifested. It is also possible to test the degree of acquisition of this knowledge, performing this type of questionnaire after the session. In addition, the subsequent treatment of the results, in an individualized way, allows to manage in an agile way the level of knowledge and acquisition of competences in what is a system of continuous evaluation, so necessary in the new methodological approaches born from the implantation of the EHEA. Finally, it should be pointed out that the participating teachers have considered that this is a very useful tool for achieving the objective of excellence in teaching, which is also efficient and easy to use and understands that it should not be a specific activity, but a transforming process in the teaching activity and student-teacher interaction, being configured as a habitual tool in the teaching-learning systems

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies