Expectativas previas y satisfacción del usuario en un programa de tratamiento de mantenimiento con metadona

Los indicadores de satisfacción miden el grado de conformidad con la atención recibida y se construyen en base a las apreciaciones subjetivas de los pacientes. Los factores que influyen en la percepción de los tratamientos con metadona son: la utilización del fármaco, las listas de espera y la influencia sobre aspectos laborales. Se plantea este estudio con los objetivos de conocer las expectativas de los pacientes, previas al inicio de un programa de tratamiento con metadona y estudiar el grado de satisfacción con el mismo. Se elaboró una entrevista estructurada de preguntas abiertas a cerca de la información y expectativas previas al tratamiento. También se elaboró un cuestionario relativo a la accesibilidad, a las características del programa y a la intervención del equipo. La satisfacción con el programa (88,35%) y con el equipo terapéutico (92,02%) fueron muy altas, no así con la accesibilidad al tratamiento (73.4%). Los desplazamientos a la unidad interferían negativamente en las obligaciones de casi la mitad de los pacientes. Se proponen mejoras orientadas a facilitar la accesibilidad al fármaco

Theorizing the principles of sustainable production in the context of circular economy and industry 4.0

The concept of Sustainable Production is evolving with changes triggered by the emergence of new economic and industrial models such as Circular Economy and Industry 4.0. However, most studies that currently link these concepts are based on the principles of Sustainable Production defined 20 years ago. Therefore, the primary aim of this study is to redefine the principles that should govern Sustainable Production operations in the tran- sition towards a Circular Economy and smart industry models. To this end, an initial proposal of 11 principles was shared with 11 world-class experts (academics and practitioners) and a consensus proposal was sought through a Delphi Panel. Ten principles emerged from this study, which were evaluated by experts according to criteria of significance, parsimony, semantic consistency and empirical adequacy. Additionally, to study the rela- tionships between the ten principles, the Interpretative Structural Model (ISM) technique was applied. The ISM technique identified which principles are independent of or dependent on each other and established relation- ships between the principles. The findings suggest that Principle 5 (“Prioritize employees' well-being”), Principle 6 (“Enhance management commitment to sustainability”), Principle 9 (“Measure and optimize sustainable pro- cesses”) and Principle 10 (“Boost the use of sustainable technologies”) help to establish an ideal context to enhance the development of the rest of the principles that characterize Sustainable Production. The presentation of the ten principles opens new possibilities for researchers while helping managers to better understand sustainability in terms of production and, therefore contribute to achieving SDG 12

Theorizing the principles of sustainable production in the context of Circular Economy and Industry 4.0

The concept of Sustainable Production is evolving with changes triggered by the emergence of new economic and industrial models such as Circular Economy and Industry 4.0. However, most studies that currently link these concepts are based on the principles of Sustainable Production defined 20 years ago. Therefore, the primary aim of this study is to redefine the principles that should govern Sustainable Production operations in the tran-sition towards a Circular Economy and smart industry models. To this end, an initial proposal of 11 principles was shared with 11 world-class experts (academics and practitioners) and a consensus proposal was sought through a Delphi Panel. Ten principles emerged from this study, which were evaluated by experts according to criteria of significance, parsimony, semantic consistency and empirical adequacy. Additionally, to study the rela-tionships between the ten principles, the Interpretative Structural Model (ISM) technique was applied. The ISM technique identified which principles are independent of or dependent on each other and established relation-ships between the principles. The findings suggest that Principle 5 ("Prioritize employees' well-being"), Principle 6 ("Enhance management commitment to sustainability"), Principle 9 ("Measure and optimize sustainable pro-cesses") and Principle 10 ("Boost the use of sustainable technologies") help to establish an ideal context to enhance the development of the rest of the principles that characterize Sustainable Production. The presentation of the ten principles opens new possibilities for researchers while helping managers to better understand sustainability in terms of production and, therefore contribute to achieving SDG 12

A new mindset for circular economy strategies: case studies of circularity in the use of water

In a circular economy (CE) environment, it is important to make good and efficient use of resources and consider that the waste generated in production processes can be a valuable resource. However, the tools and methodologies conventionally used to analyze and evaluate production systems are based on techniques focused on linear production management models, where the primary purpose is to reduce the treatment and management of waste as much as possible and where productive and environmental efficiency are not evaluated simultaneously. Changing the paradigm from a linear to a circular economy requires that a new strategy for production systems be defined, one that makes production processes simultaneously circular and efficient (in terms of quality and productivity). In this context, a holistic vision is needed when implementing CE strategies. Therefore, the main aim of this paper is to provide evidence, through two real case studies in the use of water, that the management of this resource without considering systemic thinking may not be the most circular solution. Main results showed that improvements based on the traditional approach of reducing resource use cannot provide the best results if they are supported only by current process consumption without considering the circularity of resources

El papel de los estudios bioarqueológicos en las interpretaciones sobre las comunidades neolíticas del noreste peninsular

Resumen del trabajo presentado al VI Congreso del Neolítico en la Península Ibérica: "Los cambios económicos y sus implicaciones sociales durante el Neolítico de la Península Ibérica", celebrado en Granada del 22 al 26 de junio de 2016.-- et al.El marco del proyecto I+D: “Aproximación a las primeras comunidades neolíticas del NE peninsular a través de sus prácticas funerarias” (2011-2015), y su continuidad para los próximos cuatro años al haber sido renovado, tiene por objetivo conocer cada día más y mejor las comunidades de agricultores y pastores que entre finales del V e inicios del IV milenio cal BC ocuparon y enterraron a sus muertos en el noreste de la Península Ibérica. El contexto de estudio es excepcional, puesto que aquellas comunidades inhumaron sistemáticamente a sus congéneres en tumbas habitualmente individuales y ocasionalmente junto a otro individuo. En esta presentación no sólo queremos mostrar los nuevos análisis y metodologías que estamos aplicando al estudio de los restos humanos, sino también el modelo de trabajo que hemos seguido. A este respecto, tres aspectos son fundamentales: 1) las dataciones absolutas son el eje que vertebra los posteriores análisis; 2) la colaboración con los distintos investigadores/as y laboratorios debe ser estrecha (no es cuestión de solicitar los resultados de un análisis a un laboratorio sino trabajar con las personas que manipulan las muestras y conocen los pros y contras de cada una de las técnicas empleadas) y 3) los estudios y análisis a realizar confluyen para responder a las hipótesis planteadas. A este respecto, en el proyecto hemos tenido la fortuna de poder colaborar con numerosos investigadores/as cuya especialidad versa alrededor de los restos funerarios y que firman la presente comunicación: análisis isotópicos, Adn, tafonomía funeraria, estudios de stress muscular y análisis de morfología dental.Peer Reviewe

Measurement of the cross-section and charge asymmetry of WW bosons produced in proton-proton collisions at s=8\sqrt{s}=8 TeV with the ATLAS detector

This paper presents measurements of the $W^+ \rightarrow \mu^+\nu$ and $W^- \rightarrow \mu^-\nu$ cross-sections and the associated charge asymmetry as a function of the absolute pseudorapidity of the decay muon. The data were collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with the ATLAS experiment at the LHC and correspond to a total integrated luminosity of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the 1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured with an uncertainty between 0.002 and 0.003. The results are compared with predictions based on next-to-next-to-leading-order calculations with various parton distribution functions and have the sensitivity to discriminate between them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables, submitted to EPJC. All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13

Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry

Background: Venous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities. Objective: To determine the admission pDd cut-off value associated with in-hospital VTE in patients with COVID-19. Methods: Multicenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19. Results: Among 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation <93% (45.4% vs. 33.1%; p = 0.0003), higher at admission pDd (median [IQR]: 1.4 [0.6–5.5] vs. 0.6 [0.4–1.2] µg/ml; p < 0.0001) and platelet count (median [IQR]: 208 [158–289] vs. 189 [148–245] platelets × 109/L; p = 0.0013). A pDd cut-off of 1.1 µg/ml showed specificity 72%, sensitivity 49%, positive predictive value (PPV) 4%, and negative predictive value (NPV) 99% for in-hospital VTE. A cut-off value of 4.7 µg/ml showed specificity of 95%, sensitivity of 27%, PPV of 9%, and NPV of 98%. Overall mortality was proportional to pDd value, with the lowest incidence for each pDd category depending on anticoagulation intensity: 26.3% for those with pDd >1.0 µg/ml treated with prophylactic dose (p < 0.0001), 28.8% for pDd for patients with pDd >2.0 µg/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 µg/ml and full anticoagulation (p = 0.0183). Conclusions: In hospitalized patients with COVID-19, a pDd value greater than 3.0 µg/ml can be considered to screen VTE and to consider full-dose anticoagulation. © 2021, Society of General Internal Medicine

Percutaneous mitral valve repair : Outcome improvement with operator experience and a second-generation device

Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT sys-tem. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time

Burden of paediatric Rotavirus Gastroenteritis (RVGE) and potential benefits of a universal Rotavirus vaccination programme with a pentavalent vaccine in Spain

<p>Abstract</p> <p>Background</p> <p>Rotavirus is the most common cause of gastroenteritis in young children worldwide. The aim of the study was to assess the health outcomes and the economic impact of a universal rotavirus vaccination programme with RotaTeq, the pentavalent rotavirus vaccine, versus no vaccination programme in Spain.</p> <p>Methods</p> <p>A birth cohort was followed up to the age of 5 using a cohort model. Epidemiological parameters were taken from the REVEAL study (a prospective epidemiological study conducted in Spain, 2004-2005) and from the literature. Direct and indirect costs were assessed from the national healthcare payer and societal perspectives by combining health care resource utilisation collected in REVEAL study and unit costs from official sources. RotaTeq per protocol efficacy data was taken from a large worldwide rotavirus clinical trial (70,000 children). Health outcomes included home care cases, General Practioner (GP)/Paediatrician, emergency department visits, hospitalisations and nosocomial infections.</p> <p>Results</p> <p>The model estimates that the introduction of a universal rotavirus vaccination programme with RotaTeq (90% coverage rate) would reduce the rotavirus gastroenteritis (RVGE) burden by 75% in Spain; 53,692 home care cases, 35,187 GP/Paediatrician visits, 34,287 emergency department visits, 10,987 hospitalisations and 2,053 nosocomial infections would be avoided. The introduction of RotaTeq would avoid about 76% of RVGE-related costs from both perspectives: €22 million from the national health system perspective and €38 million from the societal perspective.</p> <p>Conclusions</p> <p>A rotavirus vaccination programme with RotaTeq would reduce significantly the important medical and economic burden of RVGE in Spain.</p

Rotavirus symptomatic infection among unvaccinated and vaccinated children in Valencia, Spain

BACKGROUND: Human group A rotavirus is the leading cause of severe acute gastroenteritis in young children worldwide. Immunization programs have reduced the disease burden in many countries. Vaccination coverage in the Autonomous Region of Valencia, Spain, is around 40%, as the rotavirus vaccine is not funded by the National Health System. Despite this low-medium vaccine coverage, rotavirus vaccination has substantially reduced hospitalizations due to rotavirus infection and hospital-related costs. However, there are very few studies evaluating symptomatic rotavirus infections not requiring hospitalization in vaccinated children. The objective of this study was to investigate symptomatic rotavirus infections among vaccinated children in the health area served by the Hospital Clínico Universitario of Valencia, Spain, from 2013 to 2015. METHODS: A total of 133 children younger than 5 years of age with rotavirus infection were studied. Demographic and epidemiological data were collected and informed consent from their caretakers obtained. Rotavirus infection was detected by immunological methods and G/P rotavirus genotypes were determined by RT-PCR, following standard procedures from the EuroRotaNet network. RESULTS: Forty infants (30.1%; 95% CI: 22.3-37.9) out of 133 were diagnosed with symptomatic rotavirus infection despite having been previously vaccinated, either with RotaTeq (85%) or with Rotarix (15%). Children fully vaccinated against rotavirus (24.8%), partially vaccinated (5.3%) and unvaccinated (69.9%) were found. The infecting genotypes showed high G-type diversity, although no significant differences were found between the G/P genotypes infecting vaccinated and unvaccinated children during the same time period. G9P[8], G12P[8] and G1P[8] were the most prevalent genotypes. Severity of gastroenteritis symptoms required 28 (66.6%) vaccinated and 67 (73.6%) unvaccinated children to be attended at the Emergency Room. CONCLUSION: Rotavirus vaccine efficacy in reducing the incidence of severe rotavirus infection has been well documented, but symptomatic rotavirus infection can sometimes occur in vaccinees