La opinión de los usuarios como oportunidad de mejora en atención primaria

ObjetivosDeterminar los aspectos del centro de atención primaria (CAP) que desagradan más a los clientes/usuarios, investigar sus determinantes y aplicar la intervención o intervenciones correspondientes.DiseñoEvaluación orientada hacia los resultados. Detección de los motivos de insatisfacción a través de un estudio observacional transversal a partir de una encuesta autocumplimentada en 200 individuos seleccionados mediante muestreo aleatorio por conglomerados. Constitución de un grupo de mejora continua para investigar los factores determinantes de los problemas detectados y sus posibles soluciones.EmplazamientoCAP Rambla, Sant Feliu de Llobregat, del Instituto Catalán de la Salud.Participantes y contextoUsuarios/clientes de la sala de espera del CAP. Grupo de mejora: profesionales del Equipo de Atención Primaria Sant Feliu y del Servicio de Atención Primaria Baix Llobregat Nord.IntervencionesReorganización de las agendas de los médicos de cabecera y disminución de las tareas burocráticas en las consultas.Mediciones principalesVariables sociodemográficas de los encuestados y motivos de insatisfacción de éstos. Se procedió a analizar los determinantes del problema. La variable principal fue la demora de la cita previa.ResultadosEntre los motivos de insatisfacción expresados por los usuarios, el más frecuente fue el tiempo de demora, con un 16% (intervalo de confianza [IC] del 95%, 10,9-21,1). Esta queja se refería tanto a la espera para obtener un visita como al tiempo en la sala de espera. Como determinantes de la demora se identificaron el número elevado de pacientes, la duplicación de visitas, las visitas burocráticas, el número elevado de visitas urgentes y la cita previa insuficiente.ConclusionesLa opinión de los usuarios nos ayuda a conocer en qué medida los servicios públicos de salud están cumpliendo sus expectativas. La mejora de los procesos es un paso fundamental para la mejora continua, pero debe ir acompañada de recursos adecuados a las necesidades de la población.ObjectivesTo determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions.DesignResults evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed.LocationRambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute.Participants and contextUsers/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service.InterventionsReorganization of the family doctors’ agendas and reduction of bureaucratic tasks in the physicians’ offices.Principal measurementsRespondents sociodemographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment.ResultsAmong reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits.ConclusionsPatient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs

Evaluation of potential of high Si high C steel nanostructured bainite for wear and fatigue applications

The present study is concerned with the potential of high carbon, high silicon steel grades isothermally transformed to bainite at low temperature (<300 C). The first part gives an overview of the design principles, allowing very high strength and ductility to be achieved while minimising transformation duration. Wear and fatigue properties are then investigated for over 10 variants of such materials, manufactured in the laboratory or industrially. The results are discussed against published data. Tensile strengths above 2 GPa are routinely achieved, with, in one case, an exceptional and unprecedented total elongation of over 20%. Bainite plate thickness and retained austenite content are shown to be important factors in controlling the yield strength, though additional, non-negligible parameters remain to be quantified. Rolling-sliding wear performances are found to be exceptional, with as little as 1% of the specific wear rate of conventional 100Cr6 isothermally transformed to bainite. It is suggested that this results from the decomposition of retained austenite in the worn layer, which considerably increases hardness and presumably introduces compressive residual stresses. Fatigue performance was slightly improved over 100Cr6 for one of the two industrially produced materials but significantly lower otherwise. Factors controlling fatigue resistance require further investigations. © 2013 Institute of Materials, Minerals and Mining Published by Maney on behalf of the Institute.Peer Reviewe

Analysis and comparison of monofocal, extended depth of focus and trifocal intraocular lens profiles

To test the feasibility of using profilometers to extract information about IOL surfaces design. A standard monofocal IOL (Tecnis 1), a monofocal IOL that provided some depth of focus (Eyhance), an extended depth of focus IOL based on refractive optics (Mini Well) and a trifocal IOL based on diffractive optics were used in this study (Tecnis Synergy). The surface topography of the IOLs was measured by using a multimode optical profilometer. Posterior surface of Tecnis 1 IOL was spherical and the anterior surface aspherical. In the Eyhance IOL, posterior surface was spherical and anterior surface did not fit to any of our reference surfaces, indicating a higher order aspheric surface design. In the Mini Well Ready IOL, a best-fit sphere surface was obtained for the second surface and a high order aspherical surface design was deduced for the first surface. The anterior surface of the Synergy IOL was aspherical and the base curve of the diffractive structure fitted very well to a spherical surface. To consider an aspheric surface as possible best-fit surface provided more information than if only best-fit spherical surface was considered. The high order aspheric surface designs employed in the IOLs studied presented differences, regarding best-fit asphere surface, higher than 1 micron. These differences were correlated with the generation of spherical aberration complex profiles (with Zernike terms higher than 4th order) and with the production of distinct amounts of depth of focus. This method was also useful to deduce the base curve of diffractive surfaces.This work was supported by the “Generalitat Valenciana” of Spain (project AICO/2021/130)

La importancia del diseño de una página web de un departamento

En este proyecto pretendemos mejorar la visibilidad de la página web del departamento de Óptica, Farmacología y Anatomía a partir de la creación de un nuevo diseño de la misma. Trataremos por tanto de diseñar una estrategia de promoción de toda la actividad que esté relacionada con el departamento y del personal que lo conforma. Diversos aspectos deberán ser analizados y definidos para la puesta en marcha del proyecto. Primero de todo es importante determinar cuál es la información que debe aparecer en la página web y de qué manera. Para ello se debe establecer un mecanismo de toma de decisiones que decida la política de la página web. Los resultados de este nuevo diseño y estrategia serán analizados a partir de las estadísticas que ofrece la propia página web institucional. Estableceremos comparativas entre las visitas realizadas antes y después de crear el nuevo diseño y también analizaremos la actividad generada entorno a la página web. Por último, trataremos de establecer cuáles serían los recursos mínimos que se deberían destinar los departamentos para mantener una página web actualizada y atractiva de manera viable y duradera en el tiempo

Understanding the Real Effect of the High-Order Aberrations after Myopic Femto-Lasik

In this work we try to understand the real effect of increase in aberrations after Femto-LASIK surgery on the patient’s final visual quality, specifically when the visual acuity measurement is considered. A clinical study with 37 eyes of 20 patients that underwent myopic Femto-LASIK surgery and different personalized eye model simulations were carried out. In clinical study, correlations between pre- and postoperative parameters with visual acuity were analysed. Eye simulations (based on real data) provided simulations of vision quality before and after surgery. Our main results showed a significant increase in aberrations was obtained after surgery; however, no differences were found between the preoperative corrected distance visual acuity (CDVA) and the postoperative uncorrected distance visual acuity (UDVA). This absence of differences in visual quality could be explained by performing different simulations on three eyes that would cover most of the possible clinical situations. Simulations were implemented considering a pupil size of 2.5 mm and the personalized data of each patient. Results showed that final visual acuity (VA) change are determined by the final high-order aberrations (HOAS) and their increase after surgery but measured under photopic conditions. In conclusion, customized analysis of higher-order aberrations in scotopic pupils better predicts patient visual acuity after Lasik surgery.This work was supported by the “Generalitat Valenciana” of Spain (project AICO/2021/130)

The nuclear and extended mid-infrared emission of Seyfert galaxies

We present subarcsecond resolution mid-infrared (MIR) images obtained with 8-10 m-class ground-based telescopes of a complete volume-limited (DL<40 Mpc) sample of 24 Seyfert galaxies selected from the Swift/BAT nine month catalog. We use those MIR images to study the nuclear and circumnuclear emission of the galaxies. Using different methods to classify the MIR morphologies on scales of ~400 pc, we find that the majority of the galaxies (75-83%) are extended or possibly extended and 17-25% are point-like. This extended emission is compact and it has low surface brightness compared with the nuclear emission, and it represents, on average, ~30% of the total MIR emission of the galaxies in the sample. We find that the galaxies whose circumnuclear MIR emission is dominated by star formation show more extended emission (650+-700 pc) than AGN-dominated systems (300+-100 pc). In general, the galaxies with point-like MIR morphologies are face-on or moderately inclined (b/a~0.4-1.0), and we do not find significant differences between the morphologies of Sy1 and Sy2. We used the nuclear and circumnuclear fluxes to investigate their correlation with different AGN and SF activity indicators. We find that the nuclear MIR emission (the inner ~70 pc) is strongly correlated with the X-ray emission (the harder the X-rays the better the correlation) and with the [O IV] lambda 25.89 micron emission line, indicating that it is AGN-dominated. We find the same results, although with more scatter, for the circumnuclear emission, which indicates that the AGN dominates the MIR emission in the inner ~400 pc of the galaxies, with some contribution from star formation.Comment: 27 pages, 12 figures, accepted by MNRA

Comparison of the optical quality vision between real post-LASIK myopic laser surgery and the simulated implantation of a phakic IOL in low myopia

A phakic intraocular lens (PIOL) of − 4.5 D was characterized from its wavefront aberration profile. A preclinical study was conducted using pre- and post-surgery data from four patients that had undergone myopic laser refractive surgery. All these patients would have needed a PIOL of − 4.5 D. Pre-surgery data were used to simulate the effect of a PIOL implantation. Post myopic refractive surgery data were used to calculate the post-LASIK eye model. Modulation transfer function (MTF), point spread function (PSF) and simulation of optotypes vision were obtained and compared. The PIOL did not worsen the optical quality of the eyes evaluated. High order Aberrations were always higher in the post-LASIK eye model. Optics quality trended to be better in PIOL implantation than post-LASIK surgery as pupil size increased.This work was supported by the “Generalitat Valenciana” of Spain (project AICO/2021/130)

The action of obestatin in skeletal muscle repair: stem cell expansion, muscle growth, and microenvironment remodeling

The development of therapeutic strategies for skeletal muscle diseases, such as physical injuries and myopathies, depends on the knowledge of regulatory signals that control the myogenic process. The obestatin/GPR39 system operates as an autocrine signal in the regulation of skeletal myogenesis. Using a mouse model of skeletal muscle regeneration after injury and several cellular strategies, we explored the potential use of obestatin as a therapeutic agent for the treatment of trauma-induced muscle injuries. Our results evidenced that the overexpression of the preproghrelin, and thus obestatin, and GPR39 in skeletal muscle increased regeneration after muscle injury. More importantly, the intramuscular injection of obestatin significantly enhanced muscle regeneration by simulating satellite stem cell expansion as well as myofiber hypertrophy through a kinase hierarchy. Added to the myogenic action, the obestatin administration resulted in an increased expression of VEGF/VEGFR2 and the consequent microvascularization, with no effect on collagen deposition in skeletal muscle. Furthermore, the potential inhibition of myostatin during obestatin treatment might contribute to its myogenic action improving muscle growth and regeneration. Taken together, our data demonstrate successful improvement of muscle regeneration, indicating obestatin is a potential therapeutic agent for skeletal muscle injury and would benefit other myopathies related to muscle regeneration

Knowledge representation tool for cognitiveprocesses modeling

In the last decades, neuropsychological theories tend to consider cognitive functions as a result of the whole brainwork and not as individual local areas of its cortex. Studies based on neuroimaging techniques have increased in the last years, promoting an exponential growth of the body of knowledge about relations between cognitive functions and brain structures [1]. However, so fast evolution make complicated to integrate them in verifiable theories and, even more, translated in to cognitive rehabilitation. The aim of this research work is to develop a cognitive process-modeling tool. The purpose of this system is, in the first term, to represent multidimensional data, from structural and functional connectivity, neuroimaging, data from lesion studies and derived data from clinical intervention [2][3]. This will allow to identify consolidated knowledge, hypothesis, experimental designs, new data from ongoing studies and emerging results from clinical interventions. In the second term, we pursuit to use Artificial Intelligence to assist in decision making allowing to advance towards evidence based and personalized treatments in cognitive rehabilitation. This work presents the knowledge base design of the knowledge representation tool. It is compound of two different taxonomies (structure and function) and a set of tags linking both taxonomies at different levels of structural and functional organization. The remainder of the abstract is organized as follows: Section 2 presents the web application used for gathering necessary information for generating the knowledge base, Section 3 describes knowledge base structure and finally Section 4 expounds reached conclusions