Sistemas de clasificación de pacientes en centros de media y larga estancia: evolución y perspectivas de futuro

ResumenLa atención de media y larga estancia es un sector cada vez más importante de la prestación de cuidados sanitarios. La utilización de sistemas de clasificación de pacientes se contempla cada vez más como un elemento necesario tanto en la planificación como en la gestión de servicios en el sector de atención a enfermos crónicos y geriátricos.Aunque mucho menos conocidos, los sistemas de clasificación de pacientes han tenido en el sector de la atención de media y larga estancia un desarrollo mucho más rico y precoz que en el sector hospitalario. De este modo, puede verse la evolución desde clasificaciones basadas exclusivamente en la valoración de la capacidad funcional de los residentes, hacia clasificaciones que incluyen progresivamente variables de complejidad asistencial, hasta sistemas elaborados como la clasificación RUG-III.Los sistemas de clasificación de pacientes se utilizaron inicialmente como instrumentos para soportar los sistemas de financiación de los centros de media y larga estancia basándose en las características de paciente. Posteriormente, sus aplicaciones se han ido extendiendo hacia otros objetivos relacionados con la gestión de los centros, la evaluación de la calidad asistencial, la determinación de niveles de dotación de personal, el control del acceso a la atención y la formulación de políticas gubernamentales. En España, la única experiencia de utilización de un sistema de clasificación de pacientes es la del Programa Vida Als Anys en Cataluña, que desde 1990 utiliza una clasificación para la financiación de los centros acogidos al mismo.SummaryThe importance of long term care sector is increasingly growing. Actually, the use of patient classification systems is a useful tool for the planning and management of health services for chronic and geriatric patients.Despite being much less known, patient classification systems have had a richer and earlier development in the long term care sector than in the acute care sector. Thus, one could see the evolution from classifications based on the assessment of functional dependency to classifications progressively including variables corresponding to clinical complexity, and finally to complex systems such as RUG-III.Patient classification systems were first utilised as tools for the financing of long term centres, based on the patients' characteristics. Later, their applications have spread out to objectives related to the management of centres, assessment of quality of care, staff allocation level, control of access and national policies. In Spain, the only experience in the use of a patient classification system is the one used by the Catalan Health Care Administration which uses a classification for the financing of their centres

Strain-driven elastic and orbital-ordering effects on thickness-dependent properties of manganite thin films

We report on the structural and magnetic characterization of (110) and (001) La2/3Ca1/3MnO3 (LCMO) epitaxial thin films simultaneously grown on (110) and (001)SrTiO3 substrates, with thicknesses t varying between 8 nm and 150 nm. It is found that while the in-plane interplanar distances of the (001) films are strongly clamped to those of the substrate and the films remain strained up to well above t=100 nm, the (110) films relax much earlier. Accurate determination of the in-plane and out-of-plane interplanar distances has allowed concluding that in all cases the unit cell volume of the manganite reduces gradually when increasing thickness, approaching the bulk value. It is observed that the magnetic properties (Curie temperature and saturation magnetization) of the (110) films are significantly improved compared to those of (001) films. These observations, combined with 55Mn-nuclear magnetic resonance data and X-ray photoemission spectroscopy, signal that the depression of the magnetic properties of the more strained (001)LCMO films is not caused by an elastic deformation of the perovskite lattice but rather due to the electronic and chemical phase separation caused by the substrate-induced strain. On the contrary, the thickness dependence of the magnetic properties of the less strained (110)LCMO films are simply described by the elastic deformation of the manganite lattice. We will argue that the different behavior of (001) and (110)LCMO films is a consequence of the dissimilar electronic structure of these interfaces.Comment: 16 pages, 15 figure

Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in Spain.

Before 1990, outbreaks of multidrug-resistanttuberculosis (MDRTB) were uncommon (1); sincethen, more than 10 outbreaks have been reported,all in hospitals and prisons in the eastern UnitedStates (2-7). Persons traditionally considered atrisk for MDRTB (foreign-born TB patients andthose inadequately treated for TB) have not beenassociated with these outbreaks. Instead, the pres-ence of patients with active TB near immunocom-promised patients in HIV-dedicated wards has ledto MDRTB-infected HIV patients whose TB casesoften go unrecognized. The patients receive inade-quate treatment in facilities without effective pro-cedures for isolating acid-fast bacilli; thesecircumstances favor nosocomial transmission.Health officials in other geographic areas whereHIV and TB are major public health threats havebeen alerted to this emerging problem, and sur-veillance systems have been designed (8).Drs. Herrera, Peiró, Castell, and Godoy have received ascholarship from the Fondo de Investigación Sanitaria delInstituto de Salud Carlos III during their 2-year epidemiologictraining period in the Field Epidemiology Training Program(Programa de Epidemiología Aplicada de Campo)

Epitaxial growth in dislocation-free strained alloy films: Morphological and compositional instabilities

The mechanisms of stability or instability in the strained alloy film growth are of intense current interest to both theorists and experimentalists. We consider dislocation-free, coherent, growing alloy films which could exhibit a morphological instability without nucleation. We investigate such strained films by developing a nonequilibrium, continuum model and by performing a linear stability analysis. The couplings of film-substrate misfit strain, compositional stress, deposition rate, and growth temperature determine the stability of film morphology as well as the surface spinodal decomposition. We consider some realistic factors of epitaxial growth, in particular the composition dependence of elastic moduli and the coupling between top surface and underlying bulk of the film. The interplay of these factors leads to new stability results. In addition to the stability diagrams both above and below the coherent spinodal temperature, we also calculate the kinetic critical thickness for the onset of instability as well as its scaling behavior with respect to misfit strain and deposition rate. We apply our results to some real growth systems and discuss the implications related to some recent experimental observations.Comment: 26 pages, 13 eps figure

Status of the TREX-DM experiment at the Canfranc Underground Laboratory

The TREX-DM experiment is conceived to look for low mass WIMPs by means of a gas time projection chamber equipped with novel micromegas readout planes at the Canfranc Underground Laboratory. The detector can hold 20 l of pressurized gas up to 10 bar, which corresponds to 0.30 kg of Ar, or alternatively, 0.16 kg of Ne. The micromegas will be read with a self-triggered acquisition, allowing for effective thresholds below 0.4 keV (electron equivalent). The preliminary background model, following a complete material screening program, points to levels of the order of 1-10 counts keV-1 kg-1 d-1 in the region of interest, making TREX-DM competitive. The status of the commissioning, description of the background model and the corresponding WIMP sensitivity will be presented here

Ordered gan/ingan nanorods arrays grown by molecular beam epitaxy for phosphor-free white light emission

The basics of the self-assembled growth of GaN nanorods on Si(111) are reviewed. Morphology differences and optical properties are compared to those of GaN layers grown directly on Si(111). The effects of the growth temperature on the In incorporation in self-assembled InGaN nanorods grown on Si(111) is described. In addition, the inclusion of InGaN quantum disk structures into selfassembled GaN nanorods show clear confinement effects as a function of the quantum disk thickness. In order to overcome the properties dispersion and the intrinsic inhomogeneous nature of the self-assembled growth, the selective area growth of GaN nanorods on both, c-plane and a-plane GaN on sapphire templates, is addressed, with special emphasis on optical quality and morphology differences. The analysis of the optical emission from a single InGaN quantum disk is shown for both polar and non-polar nanorod orientation

Evaluation of the use of desalinated seawater with different boron concentrations for citrus irrigation. Preliminary results.

En las principales zonas citrícolas, donde predomina el clima semiárido, la disponibilidad de agua para el riego representa el principal factor limitante de la producción y rentabilidad del cultivo. En este contexto, el agua marina desalada (AMD) se posiciona como un recurso hídrico estratégico que puede contribuir a la sostenibilidad de la agricultura de regadío. Sin embargo, desde el punto de vista de su uso para riego, el AMD, a pesar de su baja salinidad (EC25≈0.5 dS m‐1), presenta diversos problemas agronómicos asociados a desequilibrios, ya que ciertos elementos presentan concentraciones muy reducidas mientras que elementos como el boro (B3+) se mantienen en concentraciones relativamente elevadas ([B3+]≈ 1,5 mg L‐1–RD 3/2023) que podrían producir daños por toxicidad en cultivos sensibles como los cítricos. El objetivo principal del estudio fue la evaluación de los efectos fisiológicos y agronómicos a corto plazo del riego con AMD con diferente concentración de B3+ en una plantación joven de naranjo ‘Navelina N7’ (Citrus sinensis L. Osbeck) durante un ciclo de cultivo (2021‐2022). Para el riego se han utilizado dos fuentes de agua: Agua convencional procedente de pozo (Pozo, [B3+] = 0,1 mg∙L‐1), apta para el riego de cítricos y AMD con 2 niveles de B3+ diferentes: AMD1 ([B+3] = 0,5 mg∙L‐1) y AMD2 ([B+3] = 1 mg∙L‐1). Los tres tratamientos de riego; Pozo, AMD1 y AMD2 fueron regados con el mismo volumen de agua (100% ETc). Se analizaron parámetros del estado hídrico de la planta, la acumulación de B3+ en el suelo y hojas y el desarrollo vegetativo. Los primeros resultados mostraron que el riego con AMD supuso un aumento de la concentración de B3+ en el suelo, principalmente en la zona radicular. Esta acumulación de boro en el suelo fue mayor en árboles regados con la concentración de B3+ más elevada (AMD2). A nivel de planta, el contenido de B3+ foliar solo aumentó en plantas del tratamiento AMD2. En términos fisiológicos, la baja CE del AMD (CE = 0,7 dS m‐1) no generó alteraciones en el estado hídrico del cultivo, mostrando un desarrollo vegetativo similar a los árboles regados con agua de pozo (CE = 1,3 dS m‐1). En base a estos resultados, el riego continuado con AMD no generó alteraciones fisiológicas significativas a corto plazo. Por lo tanto, los resultados obtenidos respaldan la viabilidad del riego con AMD en el corto plazo. Sin embargo, los resultados obtenidos en este ensayo son preliminares, y el estudio deberá extenderse durante un periodo más prolongado para evaluar los efectos de la utilización de AMD en cítricos a largo plazo