Proyecto de Nutrición 7ª Grado

Reconociendo las conexiones entre la salud y el rendimiento académico, así como la importancia de las prácticas escolares basadas en evidencia, el colegio SEK Ciudalcampo se asoció con Stephen Heppell, UCJC y Catergest en un proyecto de interés mutuo: establecer hábitos alimenticios saludables que tengan un efecto positivo en el aprendizaje. Un grupo de estudiantes apasionadas por el proyecto lanzó el Brain Food Group y trabajó en varias iniciativas para correr la voz sobre la alimentación saludable, específicamente al agregar 20 "alimentos para el cerebro" a nuestras dietas. Este libro de recetas fue desarrollado por ellas para que pudieran promover hábitos alimenticios saludables. ¡Esperamos que disfrutes el libro! Bajo el liderazgo del Dr. Juan Carlos Segovia de la UCJC y el Proyecto NARA, el Grupo de “Brain Food” elaboró 20 “Alimentos Cerebrales” con evidencia científica de poseer un efecto positivo en el cerebro y el aprendizaje. Basándose en la revisión de la literatura, que se puede encontrar en el apéndice, los siguientes alimentos fueron acuñados como "Alimentos para el cerebro"Fundación Felipe Segovi

Brain Food Recipes

Much is said about nutrition, and for a relatively short time we have been talking about the importance of nutrition on the brain and, therefore, on cognitive performance. A correct diet in sports performance is a priority, but will it guarantee success in competitions? Obviously not, but a wrong diet, almost certainly, will lead us to a sporting and health disaster. The same premise applies to cognitive performance. Will eating properly guarantee academic results? No, but it will facilitate better neuronal connections, more fluid information, and better oxygenation of the brain, which in the end will allow us to obtain better cognitive results. And these behaviours should be avoided in conditions where students are confined for long periods of study during exams, due to illness or any other academic activity. This is why the importance of sociodemographic factors in the dietary preferences of children at an early age is vital. We could even go further by echoing the findings of some studies that suggest that poor food choices, rich in saturated fat, salt and sugar, in preschool age are associated with reduced verbal and cognitive ability scores. Sometimes opinions emerge as to whether breakfast is appropriate or not, in which case the balance strongly shifts more toward “ adequate” breakfast. We wanted to go a bit further by analysing the different ingredients that influence the various brain functions and/or connections, for their integration into students’ daily diets. But to integrate this model it is not enough to tell the students what is right and what is not, but in this case, we have intended that they are the ones who discover them; and use them to develop different recipes so that the message reaches the rest of their classmates better. We hope that this initiative will continue over time, passing the baton to the next generations.Brain food ProjectIntertational School SEKCatergestFundación Felipe Segovi

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Guía de práctica clínica para el tratamiento del mieloma múltiple: guía para profesionales de la salud

113 p.La guía está dirigida al personal clínico asistencial especializado que brinda tratamiento a los pacientes con diagnóstico de MM activo, en el contexto del Sistema General de Seguridad Social en Salud (SGSSS) colombiano. Incluye a los siguientes profesionales potenciales: médicos especialistas en hematología, oncología y hemato-oncología. Dado que se abordan algunos datos del contexto de la enfermedad, la guía puede ser de utilidad para otros profesionales tales como: médicos internistas, radioterapeutas, enfermeras oncólogas y profesionales en formación. También está dirigida a los centros asistenciales que brindan cuidado a los pacientes con diagnóstico de MM activo y a quienes toman decisiones administrativas, tanto en el medio hospitalario como en las aseguradoras, pagadores del gasto en la salud y en la generación de políticas de salud. Finalmente, las recomendaciones pueden ser de interés para pacientes con MM activo, sus familiares y cuidadores.Incluye glosario y lista de siglas y acrónimo

Guía de práctica clínica para el tratamiento del mieloma múltiple

296 p.El mieloma múltiple (MM) es una patología caracterizada por una infiltración maligna de las células plasmáticas de la médula ósea, y se encuentra asociada con un incremento en el nivel de proteína monoclonal, tanto en sangre como en orina. Este crecimiento incontrolado, genera consecuencias, incluyendo destrucción ósea, falla de médula ósea, supresión de la producción de inmunoglobulina e insuficiencia renal. Se considera que es la enfermedad maligna ósea primaria más común. Según datos del Instituto Nacional de Cáncer de los Estados Unidos, la incidencia de esta patología, ajustada por edad, en población americana entre los años 2003 y 2007 fue de 7 casos por 100.000 hombres y de 4,6 casos por 100.000 mujeres y se sabe que la mediana de edad de presentación de la enfermedad es a los 66 años . Según las estimaciones hechas por GLOBOCAN 2012, la tasa de incidencia mundial, estandarizada por edad en hombres es de 1,7 casos por 100.000 personas año y en las mujeres de 1,2 casos por 100.000 personas año.Incluye glosario y lista de siglas y acrónimo

Guía de práctica clínica para el tratamiento del mieloma múltiple: guía para profesionales de la salud

113 p.La guía está dirigida al personal clínico asistencial especializado que brinda tratamiento a los pacientes con diagnóstico de MM activo, en el contexto del Sistema General de Seguridad Social en Salud (SGSSS) colombiano. Incluye a los siguientes profesionales potenciales: médicos especialistas en hematología, oncología y hemato-oncología. Dado que se abordan algunos datos del contexto de la enfermedad, la guía puede ser de utilidad para otros profesionales tales como: médicos internistas, radioterapeutas, enfermeras oncólogas y profesionales en formación. También está dirigida a los centros asistenciales que brindan cuidado a los pacientes con diagnóstico de MM activo y a quienes toman decisiones administrativas, tanto en el medio hospitalario como en las aseguradoras, pagadores del gasto en la salud y en la generación de políticas de salud. Finalmente, las recomendaciones pueden ser de interés para pacientes con MM activo, sus familiares y cuidadores.Incluye glosario y lista de siglas y acrónimo

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Caractérisation électrique et physico-chimique des procédés de grille métallique pour modulation du travail de sortie et réduction de la variabilité locale du Vth des technologies FDSOI 14 nm

Cette thèse porte sur l’élaboration et la caractérisation électrique et physico-chimique des grilles métalliques des dispositifs FDSOI MOSFET 14 nm à base d’oxyde high-K fabriqués chez STMicroelectronics. Ces grilles métalliques sont composées de couches de TiN, lanthane et aluminium, déposées par pulvérisation cathodique RF. Des structures de test et un schéma d’intégration simplifié permettant l’analyse capacitive ont été mis en place pour caractériser la modulation du travail de sortie effectif des grilles métalliques en TiN avec l’incorporation d'additifs tels que le lanthane ou l’aluminium. Ces additifs ont été incorporés suivant une approche de grille sacrificielle. Par ailleurs, une méthodologie inédite basée sur la fluorescence X a été proposée et validée pour la caractérisation précise en ligne de la diffusion des additifs. Cette méthodologie permet de prouver que la dose effective de l’espèce incorporée après recuit de diffusion peut être modélisée en fonction de l’épaisseur du TiN piédestal dans la grille sacrificielle ainsi que de la température de recuit. De plus, la variation de l’épaisseur de l’oxyde interfaciel sur une seule plaquette (oxyde biseau) autorise l’identification de l’origine physique de la modulation du travail de sortie effectif, qui s’explique par un dipôle qui évolue avec la dose effective de l’espèce incorporée. En conséquence, un modèle de la diffusion des dopants de grille dans l’oxyde high-K et de leur impact sur le travail de sortie effectif des grilles métalliques a été proposé afin de moduler avec précision la tension de seuil (VTH) des dispositifs FDSOI 14 nm. En outre, l’impact de l’oxyde high-K à la fois sur la diffusion des additifs et sur la modulation du travail de sortie effectif a été mis en évidence. Enfin, un procédé innovant de dépôt métallique, permettant la modification de la microstructure du TiN, a été développé afin d’améliorer davantage la variabilité locale du VTH des dispositifs FDSOI.This Ph.D. thesis is focused on the fabrication and electrical and physicochemical characterization of metal gates in 14 nm high-K based FDSOI MOSFET devices, manufactured at STMicroelectronics. These metal gates are composed of TiN, lanthanum and aluminum layers, deposited by RF sputtering. Test structures and a simplified integration scheme allowing C-V measurements, have been implemented in order to characterize the modulation of the effective work function of TiN metal gates with the incorporation of dopants such as lanthanum or aluminum. These additives are incorporated in a sacrificial gate-first approach. Furthermore, a new methodology based on X-ray fluorescence was proposed and validated for accurate in-line characterization of the diffusion of dopants. This methodology enables to prove that the effective dose of the species incorporated into dielectrics after diffusion annealing may be modeled as a function of the thickness of the pedestal TiN in the sacrificial gate and the annealing temperature. Moreover, the variation of the thickness of the interfacial oxide along the wafer (bevel oxide) authorizes the identification of the origin of the modulation of the effective work function, which is explained by a dipole that evolves with the effective dose of the incorporated dopant. Accordingly, a model of the diffusion of dopants into the gate dielectrics and their impact on the effective work function of metal gates has been proposed to precisely modulate the threshold voltage (VTH) of the 14 nm FDSOI devices. In addition, the influence of the high-K oxide on both the diffusion of dopants and the modulation of the effective work function was highlighted. Lastly, an innovative process for metal deposition, allowing the modification of the microstructure of TiN, was developed in order to further improve the local VTH variability in FDSOI devices

Caractérisation électrique et physico-chimique des procédés de grille métallique pour modulation du travail de sortie et réduction de la variabilité locale du Vth des technologies FDSOI 14 nm

This Ph.D. thesis is focused on the fabrication and electrical and physicochemical characterization of metal gates in 14 nm high-K based FDSOI MOSFET devices, manufactured at STMicroelectronics. These metal gates are composed of TiN, lanthanum and aluminum layers, deposited by RF sputtering. Test structures and a simplified integration scheme allowing C-V measurements, have been implemented in order to characterize the modulation of the effective work function of TiN metal gates with the incorporation of dopants such as lanthanum or aluminum. These additives are incorporated in a sacrificial gate-first approach. Furthermore, a new methodology based on X-ray fluorescence was proposed and validated for accurate in-line characterization of the diffusion of dopants. This methodology enables to prove that the effective dose of the species incorporated into dielectrics after diffusion annealing may be modeled as a function of the thickness of the pedestal TiN in the sacrificial gate and the annealing temperature. Moreover, the variation of the thickness of the interfacial oxide along the wafer (bevel oxide) authorizes the identification of the origin of the modulation of the effective work function, which is explained by a dipole that evolves with the effective dose of the incorporated dopant. Accordingly, a model of the diffusion of dopants into the gate dielectrics and their impact on the effective work function of metal gates has been proposed to precisely modulate the threshold voltage (VTH) of the 14 nm FDSOI devices. In addition, the influence of the high-K oxide on both the diffusion of dopants and the modulation of the effective work function was highlighted. Lastly, an innovative process for metal deposition, allowing the modification of the microstructure of TiN, was developed in order to further improve the local VTH variability in FDSOI devices.Cette thèse porte sur l’élaboration et la caractérisation électrique et physico-chimique des grilles métalliques des dispositifs FDSOI MOSFET 14 nm à base d’oxyde high-K fabriqués chez STMicroelectronics. Ces grilles métalliques sont composées de couches de TiN, lanthane et aluminium, déposées par pulvérisation cathodique RF. Des structures de test et un schéma d’intégration simplifié permettant l’analyse capacitive ont été mis en place pour caractériser la modulation du travail de sortie effectif des grilles métalliques en TiN avec l’incorporation d'additifs tels que le lanthane ou l’aluminium. Ces additifs ont été incorporés suivant une approche de grille sacrificielle. Par ailleurs, une méthodologie inédite basée sur la fluorescence X a été proposée et validée pour la caractérisation précise en ligne de la diffusion des additifs. Cette méthodologie permet de prouver que la dose effective de l’espèce incorporée après recuit de diffusion peut être modélisée en fonction de l’épaisseur du TiN piédestal dans la grille sacrificielle ainsi que de la température de recuit. De plus, la variation de l’épaisseur de l’oxyde interfaciel sur une seule plaquette (oxyde biseau) autorise l’identification de l’origine physique de la modulation du travail de sortie effectif, qui s’explique par un dipôle qui évolue avec la dose effective de l’espèce incorporée. En conséquence, un modèle de la diffusion des dopants de grille dans l’oxyde high-K et de leur impact sur le travail de sortie effectif des grilles métalliques a été proposé afin de moduler avec précision la tension de seuil (VTH) des dispositifs FDSOI 14 nm. En outre, l’impact de l’oxyde high-K à la fois sur la diffusion des additifs et sur la modulation du travail de sortie effectif a été mis en évidence. Enfin, un procédé innovant de dépôt métallique, permettant la modification de la microstructure du TiN, a été développé afin d’améliorer davantage la variabilité locale du VTH des dispositifs FDSOI