An example of adaptation: experience of virtual clinical skills circuits of internal medicine students at the Faculty of Medicine, University of Granada (Spain) during the COVID-19 pandemic

Background: The state of alarm declared in Spain in response to the Coronavirus pandemic (COVID-19) has had far-reaching consequences in all areas of life. At the University of Granada’s (UGR) Faculty of Medicine, online teaching was implemented immediately without any preexisting plan. Second-year undergraduates in medicine, particularly those enrolled in the subject ‘Bases of Internal Medicine,’ would normally undergo clinical skills circuits in faceto- face group settings. Objective: To facilitate undergraduates’ acquisition of specific transversal skills by means of an integrated online working system. Design: Before the pandemic, teaching/learning methods consisted of 1) face-to-face group work; 2) teletutoring; 3) written work uploaded to the PRADO online platform for marking by the teletutor; and 4) presentation of written work to the group. As a result of the lockdown, presentations in class were suspended and replaced by online presentations. The means adopted by students in online presentations were freely chosen using various communication techniques: linear projection systems (6); acting/simulation (4); dramatization (1); and roleplaying (1). Results: The number of online clinical skills circuits developed was 12, one for each of the clinical skills circuits established for imparting this subject. A total of 12 presentations were made by the 10 groups, each lasting 15 minutes followed by a 5-minute discussion to settle any questions raised. The presentations were marked jointly by the teaching staff, coordinator, and students. Conclusions: The transference of classroom learning to the online environment proved an essential resource for teaching/learning clinical/practical skills during the lockdown, which have never before been imparted at distance

Design of a specific physical training program for first-time participants in basic life support

Objetivo: diseñar un programa de entrenamiento físico específico para profesionales del soporte vital básico que permita superar la fatiga que éstos padecen durante el desarrollo de la reanimación cardiopulmonar con el fin de proporcionar un masaje cardiaco de mayor calidad durante periodos de tiempo más largos. Método: el entrenamiento interválico de alta intensidad mejora la capacidad física y la salud al tiempo que reduce los niveles de grasa y aumenta el metabolismo basal mediante la alternancia entre ejercicios de alta y baja intensidad mejorando la capacidad anaeróbica y la disponibilidad aeróbica, lo que hace de este tipo de entrenamiento una herramienta idónea para trabajar con los profesionales de la reanimación cardiopulmonar. Resultado: programa de entrenamiento por estaciones que combinando actividades dinámicas de alta intensidad, ejercicios de fuerza en los que se implica directamente la musculatura interviniente en la reanimación cardiopulmonar y ejercicios en los que se utiliza el propio simulador de reanimación cardiopulmonar, permite adecuarnos al entrenamiento de alta intensidad aumentando la fuerza y la funcionalidad. Conclusiones: la relación existente entre el ejercicio físico y la calidad de las técnicas de reanimación cardiopulmonar impone la necesidad de desarrollar estudios específicos de las rutas metabólicas y los grupos musculares específicos que participan en estas técnicas con el objetivo de generar un programa de entrenamiento físico específico para los profesionales que participan en esta actividad para mejorar la calidad de dichas técnicas e influir de forma positiva en la supervivencia de los pacientes afectados por un episodio de parada cardiorrespiratoria.Objective: to design a specific physical training program for basic life support professionals to overcome the fatigue they suffer during the development of cardiopulmonary resuscitation in order to provide a higher quality cardiac massage for longer periods. Method: high intensity interval training improves physical fitness and health, reduce fat levels and increase basal metabolism by high and low intensity exercises alternation, improving anaerobic capacity and aerobic availability, which make this type of training an ideal tool for working with cardiopulmonary resuscitation professionals. Result: a circuit training program that allow us for adapting to a high intensity interval training combining high intensity activities, strength exercises that work the participant musculature in cardiopulmonary resuscitation and exercises in which the cardiopulmonary resuscitation simulator is used. Conclusions: the connection between physical exercise and cardiopulmonary resuscitation techniques quality impose the need to develop specific studies of metabolic pathways and participant muscle groups in cardiopulmonary resuscitation to generate a specific physical training program for professionals who participate in this activity in order to improve these techniques quality and cardiorespiratory arrest survival

Analysis of the development of the forgetfulness curve within a program of training in Basic Life Support for students of the Degree of Medicine from de University of granada. Pilot study.

Objetivo: El objetivo del estudio es analizar la curva del olvido en el aprendizaje del Soporte Vital Básico en estudiantes de medicina de la Universidad de Granada. Material y métodos: Se trata de un estudio observacional, descriptivo transversal, que establece como población diana a los estudiantes de Grado de Medicina de la Universidad de Granada que cursan cuarto y quinto curso. Periodo de estudio comprendido entre octubre de 2015 y enero de 2017.Se emplearon los datos obtenidos en una evaluación inicial que se realizó en la Facultad de Medicina, y los de una reevaluación que se les realizó a una muestra de cada uno de los cursos. Se incluyeron en el estudio de forma voluntaria todos los alumnos matriculados en la asignatura bases de la medicina interna II para cada uno de los cursos académicos. El análisis se realizó utilizando medidas de tendencia central, tablas de frecuencias y posteriormente se realizó un análisis estadístico mediante la Prueba T de Student. Resultados: Los alumnos de cuarto consiguieron una media en la primera evaluación de 13,91 sobre 15 puntos, mientras que en la segunda la media fue de 13,81. Por otro lado, los alumnos de quinto consiguieron una media de 13,80 en la primera evaluación y una de 13,18 en la reevaluación. Estos datos nos hablan de que, a pesar de que los cursos resultaron muy satisfactorios en ambos cursos, encontramos un mayor impacto de la curva del olvido en alumnos que llevan más tiempo sin realizar un reciclaje en Soporte Vital Básico. Conclusiones: A pesar de existir una disminución de los conocimientos y habilidades relacionados con la práctica del soporte vital al año de recibir la formación específica en ambos grupos, no existen diferencias estadísticamente significativas para los sujetos de nuestro grupo que obliguen a establecer programas de reciclaje entre seis y nueve meses como establecen las recomendaciones actuales. A la luz de nuestro estudio, recomendamos el desarrollo de programas específicos de reciclaje en períodos de tiempo superiores a los doce meses después de recibir la formación inicial.Aim: The aim of this study was to analyze the oblivion curve after the learning of Basic Life Support (BLS) in medicine students from the University of Granada. Method: This was an observational, transversal descriptive study, which established as target population students from the Faculty of Medicine (University of Granada) who attended fourth and fifth year. The Study period comprised between October 2015 and January 2017. The data which was used was obtained in an initial evaluation that was done at the Faculty of Medicine and in a re-evaluation which was applied to a selected sample of students from each year. All the students included voluntarily in the study were enrolled in the subject Internal Medicine II. The analysis was carried out using measures of central tendency, frequency tables and after that, a statistical analysis using the Student´s T-test. Results: Fourth year students obtained an average in the first evaluation of 13,91 over 15 points, while in the second evaluation it was 13,81. Meanwhile, fifth year students achieved an average of 13,80 in the first evaluation and of 13,18 in the re-evaluation. This data speak of very satisfactory results for students in both years, although the impact of the oblivion curve is higher in students who have spent more time without taking a recycling course of BLS. Conclusions:.Even though there is a decrease of knowledge and abilities related to the practice of basic life support a year after receiving the specific training in both groups, there are not differences statistically significant for the subjects of our group that would make us establish recycling programs after six or nine months, as advice the actual recommendations. 2.Based on the results we obtained, we would recommend the development of specific recycling programs in periods of time bigger than twelve months after receiving the initial training

Implementation of a Training Program in Advanced Life Support within map competence of future students of Medicine, University of Granada

Objetivo: Analizar la primera experiencia de formación en soporte vital avanzado (SVA) en estudiantes de medicina, incluyéndola como asignatura de libre configuración siguiendo las normas de la European Resuscitation Council. Metodología: Estudio observacional descriptivo transversal. Los datos se recogieron de los alumnos que participaron en el curso de SVA, como asignatura de libre configuración, realizado en la facultad de medicina de la Universidad de Granada. Se recogieron mediante encuesta variables sociodemográficas, variables de aspectos específicos de calidad del curso, así como la consideración de los alumnos ante la posibilidad de implantación del SVA en los estudios de Grado en la facultad de medicina. (Escala de puntuación= 1 mínimo- 5 máximo). Resultados: Se encuestaron a los 25 alumnos que asistieron al curso y su evaluación fue: Evaluación global del curso= 5,0, docentes participantes=4,8+ 0,3, material empleado=4,2+ 0,5 y las instalaciones= 3,7+ 0,6. Necesidad de la implantación de la formación en soporte vital avanzado en los estudios de Grado= 84% imprescindible y el 16% recomendable. Formación de los docentes que impartan esta asignatura= 4% Formación específica en urgencias y emergencias, 4% Formación específica en soporte vital y el 92% formación específica en soporte vital y metodología de la formación. Espacios docentes específicos para la formación en soporte vital = 56% imprescindible, 40% recomendable y el 4% opcional. Escogería la asignatura=100% de alumnos respondió que SI. Posible dotación de créditos=4% 8 créditos, 80% 6 créditos y el 16% se mostró indiferente. Elección del año académico a impartir la asignatura=52% en quinto y el 48% en sexto. Necesidad de reciclaje= el 100% de los alumnos respondieron SI. Conclusiones: El grado de satisfacción con la acción formativa es muy elevado, destacando la valoraciòn a los docentes. Los alumnos consideran imprescindible que los docentes sean expertos clínicos en la atención al paciente en situación de PCR, y además dispongan de formación específica en metodología de la formación aplicada a la enseñanza del soporte vital. Además consideran que el desarrollo de un mapa competencial específico en soporte vital debe estar incorporado al curriculum formativo de cualquier estudiante del Grado de Medicina.Objective: To analyze the first training experience in advanced life support (ALS) in medical students, including it as a free elective course following the rules of the European Resuscitation Council. Method: This is a cross-sectional observational study. Data were collected from the students who participated in the course of ALS, as free elective course, held at the Faculty of Medicine of the University of Granada. Dates were collected: sociodemographic, specific aspects of quality of the course, as well as consideration of the students at the possibility of implementation of SVA in graduate studies in the faculty of medicine. (Rating scale = 1, minimum 5 maximum).Results: The 25 students who attended the course and its evaluation was surveyed was: Overall Course Evaluation = 5.0, participating teachers = 4.8 + 0.3, material used = 4.2 + 0.5 = 3 facilities, 7 + 0.6. Need for the implementation of training in advanced life support in the Degree = 84 % essential and 16% recommended. Training of teachers to impart this course = 4 % Specific training in emergency , 4 % Specific training in life support and 92% specific training in life support and training methodologies . Specific teaching areas for training in life support = 56 % essential, 40 % and 4% recommended optional. Choose the course = 100 % of students answered YES. Possible allocation of credits = 4% 8 credits 6 credits 80 % and 16% were indifferent. Election of the academic year to teach the subject = 52% in the fifth and sixth 48 %. Need for recycling = 100% of the students answered YES. Conclusions: The degree of satisfaction with the training is very high, highlighting the valuation teachers. The students believe that teachers must be skilled in clinical patient care at-PCR, and also have specific training in training methodology applied to the teaching of life support. Also to consider developing a specific competence map in life support should be incorporated into the training curriculum for any student of Degree of Medicine

Hyperspectral image processing for the identification and quantification of lentiviral particles in fluid samples

Optical spectroscopic techniques have been commonly used to detect the presence of biofilm-forming pathogens (bacteria and fungi) in the agro-food industry. Recently, near-infrared (NIR) spectroscopy revealed that it is also possible to detect the presence of viruses in animal and vegetal tissues. Here we report a platform based on visible and NIR (VNIR) hyperspectral imaging for non-contact, reagent free detection and quantification of laboratory-engineered viral particles in fluid samples (liquid droplets and dry residue) using both partial least square-discriminant analysis and artificial feed-forward neural networks. The detection was successfully achieved in preparations of phosphate buffered solution and artificial saliva, with an equivalent pixel volume of 4 nL and lowest concentration of 800 TU.mu L-1. This method constitutes an innovative approach that could be potentially used at point of care for rapid mass screening of viral infectious diseases and monitoring of the SARS-CoV- 2 pandemic.This research was funded by grants number COV20-00080 and COV20-00173 of the 2020 Emergency Call for Research Projects about the SARS-CoV-2 virus and the COVID-19 disease of the Institute of Health 'Carlos III', Spanish Ministry of Science and Innovation, and by grant number EQC2019-006240-P of the 2019 Call for Acquisition of Scientific Equipment, FEDER Program, Spanish Ministry of Science and Innovation. This work has been supported by the European Commission through the JRC HUMAINT project. ABR was supported by grant number RTI2018-094465-J funded by the Spanish National Agency of Research. The authors would like to gratefully acknowledge the assistance of the members of the EOD-CBRN Group of the Spanish National Police, whose identities cannot be disclosed, and who are represented here by JMNG. Authors thank continuous support from their institutions

Polarimetric imaging for the detection of synthetic models of SARS-CoV-2: A proof of concept

Objective: To conduct a proof-of-concept study of the detection of two synthetic models of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using polarimetric imaging. Approach: Two SARS-CoV-2 models were prepared as engineered lentiviruses pseudotyped with the G protein of the vesicular stomatitis virus, and with the characteristic Spike protein of SARS-CoV-2. Samples were prepared in two biofluids (saline solution and artificial saliva), in four concentrations, and deposited as 5-µL droplets on a supporting plate. The angles of maximal degree of linear polarization (DLP) of light diffusely scattered from dry residues were determined using Mueller polarimetry from87 samples at 405 nm and 514 nm. A polarimetric camera was used for imaging several samples under 380–420 nm illumination at angles similar to those of maximal DLP. Per-pixel image analysis included quantification and combination of polarization feature descriptors in 475 samples. Main results: The angles (from sample surface) of maximal DLP were 3° for 405 nm and 6° for 514 nm. Similar viral particles that differed only in the characteristic spike protein of the SARS-CoV-2, their corresponding negative controls, fluids, and the sample holder were discerned at 10-degree and 15-degree configurations. Significance: Polarimetric imaging in the visible spectrum may help improve fast, non-contact detection and identification of viral particles, and/or other microbes such as tuberculosis, in multiple dry fluid samples simultaneously, particularly when combined with other imaging modalities. Further analysis including realistic concentrations of real SARS-CoV-2 viral particles in relevant human fluids is required. Polarimetric imaging under visible light may contribute to a fast, cost-effective screening of SARS-CoV-2 and other pathogens when combined with other imaging modalities.12 página

Guía docente común de las titulaciones de Ingeniero en Electrónica en las universidades andaluzas

El presente documento constituye el resultado del trabajo elaborado de acuerdo con la Convocatoria de Elaboración de Guías Docentes de Titulaciones Andaluzas conforme al Sistema de Créditos Europeos (años 2005/2006) de la Dirección General de Universidades, dependiente de la Secretaría General de Universidades, Investigación y Tecnología de la Consejería de Innovación, Ciencia y Empresa de la Junta de Andalucía

Cambio Climático en el Mediterráneo Español

Semi-enclosed and bounded by three continents, the Mediterranean sea is a region highly vulnerable to human activities, i.e.: the population surge along the coasts, the tourism pressure, the maritime traffic, the agriculture and the fishery exploitation, all have a potential impact on the Mediterranean environment. In addition, effective initiatives against the Global Climate Change need to be attempted in order to preserve our marine environment and to achieve a sustainable development of its resources. Prevention and adaptation to this new threat must be based on the rigorous and scientific knowledge accomplished through the systematic and continuous observation of the sea, and through the collection of multidisciplinary time-series and the subsequent analysis. This report responds to this necessity. The main goals of the Instituto Español de Oceanografía (IEO) are to generate scientific knowledge, as well as to assess and to inform the public about the state of the sea. The IEO is primary focussed on the study of the variety of phenomena influencing spanish coasts, including the process of Climate Change. To meet these objectives, a large set of actions have been planned. Some of them are already being implemented, such as a multidisciplinary observation system in the shelf and continental slope waters, or periodic scientific reports dealing with the detection and quantification of Climate Change effects and of other possible environmental impacts. The present report is the first of a series of future contributions. Besides the IEO, other Spanish institutions such as the ICM (CSIC), Puertos del Estado (PE), the IMEDEA (CSIC), the UMA, the UIB and the INM, involved in the monitoring, analysis and modelling of the Mediterranean sea, have also participated in it. The results show clear evidences of the effect of Climate Change in the physical properties of the mediterranean waters since 1948; in particular, the temperature and salinity increase of the deep waters, the accelerated rise of sea level since the early 1990s, and the air and sea surface temperature increase during the second half of the XX century.Versión del edito

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

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