The Code Stroke: medical evaluation by a pre-hospital attention service

In 1996, the NINDS (National Institute of Neurological Disorders and Treatment of Acute Stroke) published targets for the management of patients with acute cerebrovascular events, setting a time of 3 h or less for administration of thrombolytics, creating the Code Stroke. Objective: Evaluate the time between onset of symptoms and arrival at the emergency department of a hospital as prognostic factors in patients with cerebrovascular events attended by the prehospital emergency medical service in the metropolitan area of Monterrey, Nuevo Leon. Materials and methods: Calls received in the ED (EMME) between January and December 2012 were included in a retrospective cross-sectional study, with symptoms showing within the first 8 h or with an unknown onset. The Mann---Whitney test and Fisher’s exact test were used. Results: Thirty-six patients were included in the study. In 21, the final diagnosis was cerebral infarction, 5 patients were treated with thrombolysis (23.8%). They were divided into two groups: group 1 died or were left with severe neurological sequelae (n = 9) and Group 2 survived without sequelae or mild neurological sequelae (n = 12). The door hospital arrival time was 67 (29---116) min (Group 1) versus 54 (24---86) min (Group 2) (p = 0.110). The neurological status at the start of the event affected prognosis and mortality (p = 0.018). Conclusions: There are few studies analyzing the time between the inception of the symptomatology and the arrival to the emergency room. In our study 23.8% of this series were thrombolyzed, which puts us in the range of international statistics, compared to the series published by Geffner-Sclarsky et al. The population of this study is small so it is not able to show statistical differences, but the few studies that evaluate the Code Stroke in Mexico open the doors to future work with a larger population in Latin American society

Monitoring the incidence of Xylella fastidiosa infection in olive orchards using ground-based evaluations, airborne imaging spectroscopy and Sentinel-2 time series through 3-D radiative transfer modelling

Outbreaks of Xylella fastidiosa (Xf) in Europe generate considerable economic and environmental damage, and this plant pest continues to spread. Detecting and monitoring the spatio-temporal dynamics of the disease symptoms caused by Xf at a large scale is key to curtailing its expansion and mitigating its impacts. Here, we combined 3-D radiative transfer modelling (3D-RTM), which accounts for the seasonal background variations, with passive optical satellite data to assess the spatio-temporal dynamics of Xf infections in olive orchards. We developed a 3D-RTM approach to predict Xf infection incidence in olive orchards, integrating airborne hyperspectral imagery and freely available Sentinel-2 satellite data with radiative transfer modelling and field observations. Sentinel-2A time series data collected over a two-year period were used to assess the temporal trends in Xf-infected olive orchards in the Apulia region of southern Italy. Hyperspectral images spanning the same two-year period were used for validation, along with field surveys; their high resolution also enabled the extraction of soil spectrum variations required by the 3D-RTM to account for canopy background effect. Temporal changes were validated with more than 3000 trees from 16 orchards covering a range of disease severity (DS) and disease incidence (DI) levels. Among the wide range of structural and physiological vegetation indices evaluated from Sentinel-2 imagery, the temporal variation of the Atmospherically Resistant Vegetation Index (ARVI) and Optimized Soil-Adjusted Vegetation Index (OSAVI) showed superior performance for DS and DI estimation (r2VALUES>0.7, p < 0.001). When seasonal understory changes were accounted for using modelling methods, the error of DI prediction was reduced 3-fold. Thus, we conclude that the retrieval of DI through model inversion and Sentinel-2 imagery can form the basis for operational vegetation damage monitoring worldwide. Our study highlight the value of interpreting temporal variations in model retrievals to detect anomalies in vegetation health.Data collection was partially supported by the European Union's Horizon 2020 research and innovation programme through grant agreements POnTE (635646) and XF-ACTORS (727987). A. Hornero was supported by research fellowship DTC GEO 29 “Detection of global photosynthesis and forest health from space” from the Science Doctoral Training Centre (Swansea University, UK). The authors would also like to thank QuantaLab-IAS-CSIC (Spain) for laboratory assistance and the support provided during the airborne campaigns and image processing. B. Landa, C. Camino, M. Montes-Borrego, M. Morelli, M. Saponari and L. Susca are acknowledged for their support during the field campaigns, as well as IPSP-CNR and Dipartimento di Scienze del Suolo (Università di Bari, Italy) as host institutions

Nutritional screening and prevalence of hospital malnutrition risk. University Hospital of the UANL, Monterrey

Introduction: Hospital malnutrition risk has prevalence values of 20%-50%, and it is a major health problem in the health institutions worldwide. Objective: To assess the accomplishment of nutritional screening and the prevalence of hospital malnutrition risk in a University Hospital. Materials and methods: A retrospective analysis was carried out with nutritional screening, using primary data from six clinical areas obtained in the period between July 2012 and December 2013. According to previous results in Mexican health institutions and considering a mean malnutrition risk prevalence of 50%, it was calculated that a sample size of 3200 subjects was required for the assessment of valid risk values. Patients with values ≥3 on the Nutritional Risk Screening (NRS, 2002) were classiied as carriers of nutritional risk. Results: A total of 5611 patients (38% of all patients admitted) were studied. The rate of screening declined from 55% in 2012 to 31% in 2013. During the whole period, 3034 patients were classiied with risk of malnutrition (54% prevalence). Conclusions: The prevalence of hospital malnutrition risk was high. The accomplishment of the nutritional screening was deicient, and declined between 2012 and 2013. The lack of nutritional screening does not meet the vital care requirements of hospitalized patients and prevents the timely treatment of those at malnutrition risk

Global regime shift dynamics of catastrophic sea urchin overgrazing

A pronounced, widespread and persistent regime shift among marine ecosystems is observable on temperate rocky reefs as a result of sea urchin overgrazing. Here, we empirically define regime-shift dynamics for this grazing system which transitions between productive macroalgal beds and impoverished urchin barrens. Catastrophic in nature, urchin overgrazing in a well-studied Australian system demonstrates a discontinuous regime shift, which is of particular management concern as recovery of desirable macroalgal beds requires reducing grazers to well below the initial threshold of overgrazing. Generality of this regime-shift dynamic is explored across 13 rocky reef systems (spanning 11 different regions from both hemispheres) by compiling available survey data (totalling 10 901 quadrats surveyed in situ) plus experimental regime-shift responses (observed during a total of 57 in situ manipulations). The emergent and globally coherent pattern shows urchin grazing to cause a discontinuous ‘catastrophic’ regime shift, with hysteresis effect of approximately one order of magnitude in urchin biomass between critical thresholds of overgrazing and recovery. Different life-history traits appear to create asymmetry in the pace of overgrazing versus recovery. Once shifted, strong feedback mechanisms provide resilience for each alternative state thus defining the catastrophic nature of this regime shift. Importantly, human-derived stressors can act to erode resilience of desirable macroalgal beds while strengthening resilience of urchin barrens, thus exacerbating the risk, spatial extent and irreversibility of an unwanted regime shift for marine ecosystems.Peer reviewe

Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial)

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.This study was awarded a Health Research Fund (Fondo de Investigaciones Sanitarias/FIS) grant, dossier No. PI12/01161 of the Carlos III Institute of Health and the Ministry of Sciences, Innovation and Universities.S