Comparison of the performance of hydraulic lime- and clay-based grouts in the repair of rammed earth

Earth constructions constitute an important part of the built heritage and are spread worldwide. Rammed earth is among the most used earth construction techniques, though it exhibits a high seismic vulnerability. Nevertheless, the structural behaviour of rammed earth structures is still insufficiently comprehended. Thus, the preservation of this built heritage requires exhaustive characterisation of its mechanical and structural behaviours, as well as the development and validation of adequate intervention solutions. In this context, this paper presents an experimental program aimed at evaluating the effectiveness of grout injection to repair cracks and at further characterising the in-plane shear behaviour of rammed earth walls. The experimental program included the testing of rammed earth wallets under diagonal compression, which were subsequently repaired with injection of a clay-based or a hydraulic lime-based grout, and retested. Furthermore, sonic tests were conducted on the wallets before the destructive tests. The obtained results allowed to highlight that both grouts led to similar repairing performances, though the interlocking contribution promoted by the coarse particles of the rammed earth to the shear behaviour was found to be irrecoverable.Programa Operacional Temático Factores de Competitividade (POCI-01-0145-FEDER-007633

Proyecto HAD 2020: una propuesta para consolidar la hospitalización a domicilio en España

Hospital at home (HAH) appeared in Spain 36 years ago with the opening of several units. The initial push was truncated by the lack of political leadership and sometimes clinical as well. The current reality offers an irregular implementation with a wide disparity of assistance and resource models. The Sociedad Española de Hospitalización a Domicilio (SEHAD) has not played either the expected scientific or professional leadership roles. The “Plan HAD2020: key of the future” was designed as revulsive. This is an ambitious 4-year project to consolidate HAH as a care modality. Its deployment consists of five phases. Preparation: the foundations of the strategic plan (EP) were established. Situation analysis: a national survey was carried out on the 106 operational units (data 2014). Validation of the EP: contributions and proposals of action of the members of SEHAD. National Congress 2016: presentation and approval of EP conclusions and proposals. EP deployment phase: it will be extended until 2020 and will be executed by various teams of referents spread over five lines of work.The final objective set for the year 2020 is: to come up with a more homogenous care model; to promote the training and professional recognition of those who work in the HAD; that each hospital in Spain has a HAH unit; recognition and empowerment by the national health system.HAD2020 has marked an inflection point in the SEHAD. The traced path and the effort of all the HAH professionals will allow reaching the vision which the pioneers of the HAH in Spain pursued.La Hospitalización a Domicilio (HAD) apareció en España hace 36 años con la apertura de diversas unidades. El empuje inicial fue truncado por la falta de liderazgo político y en ocasiones también clínico. La realidad actual ofrece una implantación irregular con disparidad de modelos asistenciales y de recursos. La Sociedad Española de Hospitalización a Domicilio (SEHAD) no ha jugado el papel de liderazgo científico y profesional esperado. Se diseñó el «Plan HAD2020: clave de futuro» como revulsivo. Se trata de un ambicioso proyecto a 4 años para consolidar la HAD como modalidad asistencial. Su despliegue consta de cinco fases. Preparación: se establecieron las bases del plan estratégico (PE). Análisis de situación: se realizó una encuesta nacional a las 106 unidades operativas (datos 2014). Validación del PE: aportaciones y propuestas de actuación de los miembros de SEHAD. Congreso Nacional 2016: presentación y aprobación de conclusiones y propuestas del PE. Fase de despliegue PE: se extenderá hasta el año 2020 y la ejecutarán diversos equipos referentes, repartidos en cinco líneas de trabajo.El objetivo final fijado para el año 2020 consiste en: consensuar un modelo asistencial más homogéneo; promover la formación y reconocimiento profesional de quienes trabajan en la HAD; que cada hospital de España tenga una unidad de HAD; reconocimiento y potenciación por el sistema de salud nacional.HAD2020 ha marcado un punto de inflexión en la SEHAD. El camino trazado y el esfuerzo de todos los profesionales HAD permitirán alcanzar aquella visión que persiguieron los pioneros de la HAD en España

Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients

Background: the aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes. Methods: prospective multicentre study conducted at 21 Spanish hospitals of patients with MRSA bacteraemia diagnosed between June 2008 and December 2009. Patients with MRSA-CRB were selected. Data of patients on haemodialysis (HD-CRB) and those not on haemodialysis (non-HD-CRB) were compared. Results: among 579 episodes of MRSA bacteraemia, 218 (37.7 %) were CRB. Thirty-four (15.6 %) were HD-CRB and 184 (84.4 %) non-HD-CRB. All HD-CRB patients acquired the infection at dialysis centres, while in 85.3 % of the non-HD-CRB group the infection was nosocomial (p < .001). There were no differences in age, gender or severity of bacteraemia (Pitt score); comorbidities (Charlson score ≥ 4) were higher in the HD-CRB group than in the non-HD-CRB group (73.5 % vs. 46.2 %, p = .003). Although there were no differences in VAN-MIC ≥1.5 mg/L according to microdilution, using the E-test a higher rate of VAN-MIC ≥1.5 mg/L was observed in HD-CRB than in non-HD-CRB patients (63.3 % vs. 44.1 %, p = .051). Vancomycin was more frequently administered in the HD-CRB group than in the non-HD-CRB group (82.3 % vs. 42.4 %, p = <.001) and therefore the appropriate empirical therapy was significantly higher in HD-CRB group (91.2 % vs. 73.9 %, p = .029). There were no differences with regard to catheter removal (79.4 % vs. 84.2 %, p = .555, respectively). No significant differences in mortality rate were observed between both groups (Overall mortality: 11.8 % vs. 27.2 %, p = .081, respectively), but there was a trend towards a higher recurrence rate in HD-CRB group (8.8 % vs. 2.2 %, p = .076). Conclusions: in our multicentre study, ambulatory patients in chronic haemodialysis represented a significant proportion of cases of MRSA catheter-related bacteraemia. Although haemodialysis patients with MRSA catheter-related bacteraemia had significantly more comorbidities and higher proportion of strains with reduced vancomycin susceptibility than non-haemodialysis patients, overall mortality between both groups was similar

Hospitalización a domicilio

Hospitalització domiciliària; Revisió sistemàtica; Evidència científicaHospitalización domiciliaria; Revisión sistemática; Evidencia científicaHome hospitalization; Systematic review; Scientific evidenceInforme que evalúa la hospitalización domiciliaria en términos de eficacia y seguridad y analiza la situación de la hospitalización domiciliaria en Cataluña y EspañaInforme que avalua l’hospitalització domiciliària en termes d'eficàcia i seguretat i analitza la situació de l’hospitalització domiciliària a Catalunya i EspanyaReport that evaluates home hospitalization in terms of efficacy and safety and it analyzes the situation of home hospitalization in Catalonia and Spain

Manual de simulación clínica en especialidades médicas

Manual sobre técnicas y modos de simulación clínica en diversas especialidades médicas.La enseñanza y formación en medicina necesita el uso de la simulación. Existen evidencias de su uso desde hace cientos de años, pero, en los últimos años se ha incrementado y diseminado. La simulación clínica está validada científicamente en múltiples contextos médicos y de otras áreas profesionales de la salud. Y es considerada de gran importancia como proceso de entrenamiento y de mejora de las competencias y adquisición de habilidades médicas en campos que incluye desde la historia clínica, comunicación con el paciente, exploración, diagnóstico terapéutica médica-farmacológica y quirúrgica y seguridad al tratar al paciente. Hoy en día, para muchas técnicas y situaciones clínicas es inaceptable llegar junto a los pacientes sin un dominio adquirido en simulación. La simulación puede ocurrir sin el uso de recursos adicionales, solo las personas, o utilizando pocos o muchos recursos de baja hasta alta tecnología y se puede adaptar a los recursos disponibles, abarcando todas las áreas de conocimiento, y dentro de ellas competencias técnicas o actitudes, solas o en conjunto. El uso racional y basado en evidencia de la simulación es de la mayor importancia por la necesidad de una mayor efectividad y eficiencia en la transformación de los profesionales de la salud para que puedan mejorar su capacidad de atender a los pacientes. La simulación es también una buena herramienta de evaluación de competencias y habilidades en Medicina y otras disciplinas de las Ciencias de la Salud Este manual incluye técnicas y modos de simulación clínica en diversas especialidades médicas, útiles, para quien busque un manual práctico y actualizado.Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Terapias Avanzadas en Patología Cardiovascular Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Investigación Biomédica Quirón Salu

Restoration of the historic libraries of Chinguetti, Mauritania

The ancient ksar of Chinguetti was named a UNESCO World Heritage Site in 1996. It is located in West Africa, on one of the most important caravan trading routes, in use from the eighth century until the beginning of the twentieth century. The trans-Sahara traffic – mainly based on products such as salt, gold and ivory – also fostered cultural development along the route. As commercial, cultural and religious contacts were established over the centuries, manuscripts were constantly being written, copied, carried, bought and sold. Following a failed attempt to build a museum to house Chinguetti’s most important manuscripts in 2000, the Spanish Agency for International Development Cooperation (AECID) decided to restore every traditional library within the ksar, the actual places where the ancient manuscripts have been kept for generations. Terrachidia NGO has spearheaded the Libraries Preservation Project, using traditional building techniques and local materials and labour to carry out these restorations.El antiguo ksar de Chinguetti fue declarado Patrimonio de la Humanidad por la UNESCO en 1996. Se encuentra en África Occidental, en una de las rutas comerciales de caravanas más importantes, en funcionamiento desde el siglo VIII hasta principios del siglo XX. El tráfico transahariano -principalmente basado en productos como la sal, el oro y el marfil– también fomentaba el desarrollo cultural a lo largo de la ruta. A medida que se fueron estableciendo contactos comerciales, culturales y religiosos a lo largo de los siglos, constantemente se escribían, copiaban, transportaban, compraban y vendían manuscritos. Tras un intento fallido de construir un museo que albergase los manuscritos más importantes de Chinguetti en el año 2000, la Agencia Española de Cooperación al Desarrollo (AECID) decidió restaurar todas las bibliotecas tradicionales del ksar, los lugares en que realmente se han mantenido los antiguos manuscritos durante generaciones. La ONG Terrachidia ha liderado el Proyecto de Preservación de las Bibliotecas y ha recurrido a técnicas de construcción tradicional y a materiales y mano de obra locales para llevar a cabo estas restauraciones

Innovation and quality improvement in doctoral training programmes: a model for the "Doctorate in Health Care" at the Faculty of Nursing, Physiothepay, and Podiatry

El presente proyecto pretende incorporar propuestas innovadoras para optimizar las Actividades Formativas del Programa de Doctorado de la Facultad de Enfermería, Fisioterapia y Podología, y configurar un modelo de buenas prácticas a seguir. Queremos ampliar y aplicar la experiencia adquirida en la innovación de recursos educativos semipresenciales, en abierto y mediante el uso de entornos virtuales, en el diseño de las actividades formativas del programa de doctorado “Cuidados en Salud” de la Facultad de Enfermería, Fisioterapia y Podología de la Universidad Complutense de Madrid, regulado por el Real Decreto 99/2011. Ante la creciente demanda en las solicitudes al programa de doctorado “Cuidados en Salud” de profesionales cuya actividad se desarrolla fuera del ámbito de la Comunidad de Madrid, y dada la dificultad para la asistencia de estos estudiantes a las actividades formativas programadas, se ha iniciado un proyecto de diseño en abierto, a través de plataforma virtual, de estas actividades. Este proyecto es una propuesta de innovación docente, un diseño de enseñanza semipresencial, de los dos workshop (“Workshop de Evidencia Científica” y del “Workshop de Investigación en Cuidados”) que como actividad formativa de obligado cumplimiento para los alumnos, se contemplan en la memoria verificada el programa de doctorado.The present project wants to incorporate innovative proposals to optimize the formative activities of the Doctorate Programme at the Faculty of Nursing, Physiotherapy, and Podiatry, as to set up a good practice model to follow. We want to extend and apply the experience gained in the innovation of open educational resources, through the use of virtual environments, in the design of the training activities of the Doctorate Programme "Health Care" of the Faculty of Nursing, Physiotherapy, and Podiatry of the Universidad Computense de Madrid, regulated by Royal Decree 99/2011. Faced with the growing demand for the doctoral programme "Health Care" of professionals whose activities are carried out outside the scope of the Community of Madrid, and given the difficulty in attending for these students to the programmed training activities, an open design project, through virtual platform, of these activities has been started. This project is a proposal of teaching innovation, a design of semi-presential teaching, of the two workshops ("Scientific Evidence Workshop" and "Care Research Workshop") as a compulsory training activity for students, are contemplated in the verified memory of the doctoral programme.Fac. de Enfermería, Fisioterapia y PodologíaFALSEsubmitte

Invasive Treatment Strategy in Adults With Frailty and Non-ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of a Randomized Clinical Trial

Importance: The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. Objective: To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. Design, setting, and participants: The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. Interventions: Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. Main outcomes and measures: The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. Results: Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. Conclusions and relevance: In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior.Centro de Investigacion Biomedica en Red Enfermedades Cardiovaculares (FIS 17/01736)13.8 Q1 JCR 20223.478 Q1 SJR 2023No data IDR 2022UE