Conocimientos y actitudes de usuarios, médicos y enfermeras sobre las instrucciones previas en el Área Asistencial Este de la Comunidad de Madrid

En una primera parte se realiza un análisis histórico de las instrucciones previas, desde su aparición en Estados Unidos, a finales de la década de los sesenta, hasta su regulación en Europa y España a partir del Convenio de Oviedo. El estudio continua con una revisión teórica sobre la fundamentación ética y jurídica de las instrucciones previas. A pesar del tiempo transcurrido desde su implantación las instrucciones previas presentan un bajo índice de otorgamientos tanto en España y como la Comunidad de Madrid. La hipótesis del estudio es que el déficit de otorgamientos puede ser debido al bajo conocimiento de los usuarios sobre esta cuestión que, a su vez, se corresponde con un conocimiento también bajo de los profesionales sanitarios. Los objetivos del estudio son identificar y analizar los conocimientos y actitudes de los usuarios, médicos y enfermeras sobre las de instrucciones previas. Para la consecución de los objetivos planteados se diseña un estudio descriptivo transversal. El ámbito del estudio incluye centros de Atención Primaria y Especializada del Área Asistencial Este de la Comunidad de Madrid. Para la recogida de los datos se utilizaron dos cuestionarios validados, uno para usuarios y otro para profesionales sanitarios. En el análisis de los resultados en una escala Likert de 1 a 10, el conocimiento sobre las instrucciones previas de los usuarios alcanza una mediana de 4 (RI 2 a 6) y en los médicos y enfermeras de 5 (RI 3 a7). Sólo un 1,6 % de los usuarios habían otorgado instrucciones previas, pero más de la mitad manifiestan una alta probabilidad de hacerlo en el futuro. Estos resultados son similares a los presentados por otros autores de estudios realizados en distintas áreas sanitarias de España. Se puede concluir que existe una relación entre el deficiente conocimiento de los usuarios y el de los profesionales sanitarios. No obstante, a pesar este bajo índice de otorgamientos la actitud de los usuarios y profesionales sanitarios hacia las instrucciones previas es positiva. Sería recomendable una mayor formación en los profesionales sanitarios sobre la toma de decisiones al final de la vida. También seria aconsejable proporcionar una mayor información sobre las instrucciones previas a los usuarios

Fear Detection in Multimodal affective computing: Physiological Signals versus Catecholamine Concentration

Affective computing through physiological signals monitoring is currently a hot topic in the scientific literature, but also in the industry. Many wearable devices are being developed for health or wellness tracking during daily life or sports activity. Likewise, other applications are being proposed for the early detection of risk situations involving sexual or violent aggressions, with the identification of panic or fear emotions. The use of other sources of information, such as video or audio signals will make multimodal affective computing a more powerful tool for emotion classification, improving the detection capability. There are other biological elements that have not been explored yet and that could provide additional information to better disentangle negative emotions, such as fear or panic. Catecholamines are hormones produced by the adrenal glands, two small glands located above the kidneys. These hormones are released in the body in response to physical or emotional stress. The main catecholamines, namely adrenaline, noradrenaline and dopamine have been analysed, as well as four physiological variables: skin temperature, electrodermal activity, blood volume pulse (to calculate heart rate activity. i.e., beats per minute) and respiration rate. This work presents a comparison of the results provided by the analysis of physiological signals in reference to catecholamine, from an experimental task with 21 female volunteers receiving audiovisual stimuli through an immersive environment in virtual reality. Artificial intelligence algorithms for fear classification with physiological variables and plasma catecholamine concentration levels have been proposed and tested. The best results have been obtained with the features extracted from the physiological variables. Adding catecholamine’s maximum variation during the five minutes after the video clip visualization, as well as adding the five measurements (1-min interval) of these levels, are not providing better performance in the classifiers.This research has been supported by the Madrid Governement (Comunidad de Madrid, Spain) under the ARTEMISA-UC3M-CM research project (reference 2020/00048/001), the EMPATIACM research project (reference Y2018/TCS-5046) and the Multiannual Agreement with UC3M in the line of Excellence of University Professors (EPUC3M26), and in the context of the V PRICIT (Regional Programme of Research and Technological Innovation)

Relación genética, formación de biopelículas, movilidad y virulencia de Escherichia coli aislada de mastitis bovina

Escherichia coli es una de las bacterias ambientales que frecuentemente se ha visto implicada en infecciones de la glándula mamaria bovina. Aunque se desconocen los factores de virulencia específicos involucrados en dicho proceso, se ha observado que las bacterias formadoras de biopelículas se asocian con infecciones persistentes. De igual forma se ha planteado que las bacterias móviles pueden ser más patógenas. El propósito del presente trabajo fue analizar la relación genética, capacidad de formación de biopelículas y movilidad de E. coli aislada de casos de mastitis bovina, así como la virulencia in vivo de aislados representativos. De acuerdo a los datos obtenidos en este trabajo el 67.7% de las bacterias pertenece al grupo filogenético A, el 17.6% al grupo B1 y el 14.7% al D. El estudio de la relación genética mediante (GTG)5 reveló que solo dos bacterias son idénticas genéticamente, el resto de las bacterias se organizaron en siete grupos distintos con 70% de similitud. Por otro lado, el 76.5% de las bacterias estudiadas fue capaz de formar biopelículas de forma fuerte, moderada o débil. Además, los genes csgA y fimA se detectaron en el 52.9% de las bacterias formadoras de biopelículas. Por su parte, el análisis de movilidad arrojó que el 70.6% fue móvil. Mientras que, el análisis de patogenicidad en larvas de Galleria mellonella reveló que aquellas bacterias formadoras de películas y móviles fueron capaces de matar un mayor número de larvas a las 24 h que las no formadoras. Los datos presentados en este trabajo indican que las E. coli causantes de mastitis bovina son muy diversas y pertenecen principalmente al grupo filogenético A y que las formadoras de biopelículas y móviles son más patógenas.Escherichia coli es una de las bacterias ambientales que frecuentemente se ha visto implicada en infecciones de la glándula mamaria bovina. Aunque se desconocen los factores de virulencia específicos involucrados en dicho proceso, se ha observado que las bacterias formadoras de biopelículas se asocian con infecciones persistentes. De igual forma se ha planteado que las bacterias móviles pueden ser más patógenas. El propósito del presente trabajo fue analizar la relación genética, capacidad de formación de biopelículas y movilidad de E. coli aislada de casos de mastitis bovina, así como la virulencia in vivo de aislados representativos. De acuerdo a los datos obtenidos en este trabajo el 67.7% de las bacterias pertenece al grupo filogenético A, el 17.6% al grupo B1 y el 14.7% al D. El estudio de la relación genética mediante (GTG)5 reveló que solo dos bacterias son idénticas genéticamente, el resto de las bacterias se organizaron en siete grupos distintos con 70% de similitud. Por otro lado, el 76.5% de las bacterias estudiadas fue capaz de formar biopelículas de forma fuerte, moderada o débil. Además, los genes csgA y fimA se detectaron en el 52.9% de las bacterias formadoras de biopelículas. Por su parte, el análisis de movilidad arrojó que el 70.6% fue móvil. Mientras que, el análisis de patogenicidad en larvas de Galleria mellonella reveló que aquellas bacterias formadoras de películas y móviles fueron capaces de matar un mayor número de larvas a las 24 h que las no formadoras. Los datos presentados en este trabajo indican que las E. coli causantes de mastitis bovina son muy diversas y pertenecen principalmente al grupo filogenético A y que las formadoras de biopelículas y móviles son más patógenas

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Physics with the KLOE-2 experiment at the upgraded DAϕ\phiNE

Investigation at a $\phi$--factory can shed light on several debated issues in particle physics. We discuss: i) recent theoretical development and experimental progress in kaon physics relevant for the Standard Model tests in the flavor sector, ii) the sensitivity we can reach in probing CPT and Quantum Mechanics from time evolution of entangled kaon states, iii) the interest for improving on the present measurements of non-leptonic and radiative decays of kaons and eta/eta$^\prime$ mesons, iv) the contribution to understand the nature of light scalar mesons, and v) the opportunity to search for narrow di-lepton resonances suggested by recent models proposing a hidden dark-matter sector. We also report on the $e^+ e^-$ physics in the continuum with the measurements of (multi)hadronic cross sections and the study of gamma gamma processes.Comment: 60 pages, 41 figures; added affiliation for one of the authors; added reference to section

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data