Evolución de la relación entre atención primaria y especializada 1992-2001: estudio Delphi

ObjetivoValorar la tendencia en la relación de atención primaria (AP) y especializada (hospital) en 2 momentos diferentes de la reforma sanitaria, al inicio (1992) y tras una fase de consolidación (2001).DiseñoEstudio cualitativo basado en la técnica Delphi modificada.EmplazamientoComunidad Valenciana.ParticipantesSe seleccionó a un total de 196 profesionales de la Comunidad Valenciana (103 coordinadores de AP, 43 directores médicos hospitalarios y de AP, y 50 jefes de servicio de medicina interna/urgencias).ResultadosSe enviaron 196 cuestionarios, con una tasa de respuesta del 38%. Desde AP los problemas se mantienen, con un empeoramiento en la desmotivación del personal sanitario (+1,34), la falta de visión integral del paciente (+1,10) y la masificación asistencial (+1,06), y un mejoría en la presencia de especialistas de ambulatorio no integrados (–1,32). Desde el ámbito hospitalario empeora la falta de visión integral del paciente (+0,51), pero destaca la mejoría generalizada de los problemas, sobre todo la falta de comunicación y diálogo (–1,14). Las soluciones que aumentan su demanda desde AP son una historia clínica única informatizada (+1,50), la elaboración de protocolos comunes (+0,86) y las rotaciones periódicas de los médicos de AP (MAP) por servicios hospitalarios (+0,85), con una disminución de las derivaciones burocráticas a AP (–0,60) y la necesidad de especialistas en AP como consultores (–0,36). Desde el ámbito hospitalario, todas las soluciones disminuyen su valoración y entre ellas destaca facilitar el acceso de MAP para el seguimiento de los pacientes ingresados (–2,44) y la realización de guardias hospitalarias por MAP (–2,30).ConclusionesLos problemas y las soluciones siguen siendo los mismos que en 1992, pero en AP se observa una tendencia a empeorar y en el ámbito hospitalario se detecta una visión más positiva.AimTo evaluate the trends in the inter-professional relationship between primary health care (PHC) and secondary care (hospital) at 2 different moments of the health reform, at its start in 1992 and after a phase of consolidation (2001).DesignObservational study based on modified Delphi technique.SettingValencia Community, Spain.ParticipantsOne hundred and ninety six professionals from Valencia Community were selected (103 PH centre administrators, 43 hospital and PC medical directors, and 50 heads of internal medicine or emergency services).ResultsOne hundred and ninety six questionnaires were sent out, with a response rate of 38%. In PHC problems remained the same, but the following got worse: “lack of motivation” (+1.34), “lack of overall vision of patients” (+1.10), and “overuse of medical services” (+1.06). The existence of non-integrated out-patient specialists got better (–1.32). In hospitals, “lack of overall vision of patients” got worse (+0.51), but in general problems got better, especially in “lack of communication and dialogue” (–1.14). PC increased its demand for “a single computerized clinical record” (+1.50), drawing up of common protocols (+0.86), and periodic rotations of PC doctors through hospitals (+0.85), but bureaucratic referrals to PC (–0.60) and the need for specialists in PC as consultants (-0.36) diminished. In hospitals all solutions showed lower scores, particularly access of PC doctors to monitoring of admitted patients (–2.44) and PC doctors doing hospital cover (–2.30).ConclusionsProblems and solutions from PHC and hospitals remain the same, but there is a trend to the worse in PHC, whereas in hospitals the trend is more positive

The Ultimatum Game in Complex Networks

We address the problem of how cooperative (altruistic-like) behavior arises in natural and social systems by analyzing an ultimatum game in complex networks. Specifically, three types of players are considered: (a) empathetic, whose aspiration level and offer are equal, (b) pragmatic, who do not distinguish between the different roles and aim to obtain the same benefit, and (c) agents whose aspiration level and offer are independent. We analyze the asymptotic behavior of pure populations on different topologies using two kinds of strategic update rules. Natural selection, which relies on replicator dynamics, and Social Penalty, inspired in the Bak-Sneppen dynamics, in which players are subjected to a social selection rule penalizing not only the less fitted individuals, but also their first neighbors. We discuss the emergence of fairness in the different settings and network topologies.Comment: version publishe

The invisible enemy : Understanding bird-window strikes through citizen science in a focal city

Bird-window collisions have been estimated to be among the most important sources of bird death. Despite increasing knowledge in Latin America, our understanding of this phenomenon is still incipient, with research performed in Mexico limited to a handful of studies. Here, we present the results of a citizen science effort focused on bird-window collisions at seven buildings in the university campus of the National School of Higher Studies (ENES) of the National Autonomous University of Mexico, located in the city of Leon (central Mexico). Our main goal was to describe seasonal patterns of bird-window collisions and their relationship with building traits (i.e., building height, window area) through citizen science monitoring strategies. Our results showed that collisions were higher in two of the seven studied buildings, with two bird species recording almost half of the total collisions: Clay-colored Sparrow (Spizella pallida) and Indigo Bunting (Passerina cyanea). Seasonally, April was the only month to differ from the rest of the studied months, showing significantly higher rate of bird-window collision. Regarding building traits, only building height was related to the number of recorded bird-window collisions. In sum, our study provides findings from an understudied area, showing the value of citizen science approaches to generate knowledge on a deadly phenomenon. Notably, besides the potential drawbacks and importance of generating this kind of information, our project raised awareness on the topic across the entire campus community, from the students and academics to the administration, highlighting the potential for social impact with these kinds of projects.Peer reviewe

Using radio astronomical receivers for molecular spectroscopic characterization in astrochemical laboratory simulations: A proof of concept

We present a proof of concept on the coupling of radio astronomical receivers and spectrometers with chemical reactorsand the performances of the resulting setup for spectroscopy and chemical simulations in laboratory astrophysics. Several experiments including cold plasma generation and UV photochemistry were performed in a 40\,cm long gas cell placed in the beam path of the Aries 40\,m radio telescope receivers operating in the 41-49 GHz frequency range interfaced with fast Fourier transform spectrometers providing 2 GHz bandwidth and 38 kHz resolution. The impedance matching of the cell windows has been studied using different materials. The choice of the material and its thickness was critical to obtain a sensitivity identical to that of standard radio astronomical observations. Spectroscopic signals arising from very low partial pressures of CH3OH, CH3CH2OH, HCOOH, OCS,CS, SO2 (<1E-03 mbar) were detected in a few seconds. Fast data acquisition was achieved allowing for kinetic measurements in fragmentation experiments using electron impact or UV irradiation. Time evolution of chemical reactions involving OCS, O2 and CS2 was also observed demonstrating that reactive species, such as CS, can be maintained with high abundance in the gas phase during these experiments.Comment: Accepted for publication in Astronomy and Astrophysics in September 21, 2017. 16 pages, 18 figure

Mechanical properties of freely suspended atomically thin dielectric layers of mica

We have studied the elastic deformation of freely suspended atomically thin sheets of muscovite mica, a widely used electrical insulator in its bulk form. Using an atomic force microscope, we carried out bending test experiments to determine the Young's modulus and the initial pre-tension of mica nanosheets with thicknesses ranging from 14 layers down to just one bilayer. We found that their Young's modulus is high (190 GPa), in agreement with the bulk value, which indicates that the exfoliation procedure employed to fabricate these nanolayers does not introduce a noticeable amount of defects. Additionally, ultrathin mica shows low pre-strain and can withstand reversible deformations up to tens of nanometers without breaking. The low pre-tension and high Young's modulus and breaking force found in these ultrathin mica layers demonstrates their prospective use as a complement for graphene in applications requiring flexible insulating materials or as reinforcement in nanocomposites.Comment: 9 pages, 5 figures, selected as cover of Nano Research, Volume 5, Number 8 (2012

Somatostatin subtype-2 receptor-targeted metal-based anticancer complexes

Conjugates of a dicarba analogue of octreotide, a potent somatostatin agonist whose receptors are overexpressed on tumor cells, with [PtCl 2(dap)] (dap = 1-(carboxylic acid)-1,2-diaminoethane) (3), [(η 6-bip)Os(4-CO 2-pico)Cl] (bip = biphenyl, pico = picolinate) (4), [(η 6-p-cym)RuCl(dap)] + (p-cym = p-cymene) (5), and [(η 6-p-cym)RuCl(imidazole-CO 2H)(PPh 3)] + (6), were synthesized by using a solid-phase approach. Conjugates 3-5 readily underwent hydrolysis and DNA binding, whereas conjugate 6 was inert to ligand substitution. NMR spectroscopy and molecular dynamics calculations showed that conjugate formation does not perturb the overall peptide structure. Only 6 exhibited antiproliferative activity in human tumor cells (IC 50 = 63 ± 2 μ in MCF-7 cells and IC 50 = 26 ± 3 μ in DU-145 cells) with active participation of somatostatin receptors in cellular uptake. Similar cytotoxic activity was found in a normal cell line (IC 50 = 45 ± 2.6 μ in CHO cells), which can be attributed to a similar level of expression of somatostatin subtype-2 receptor. These studies provide new insights into the effect of receptor-binding peptide conjugation on the activity of metal-based anticancer drugs, and demonstrate the potential of such hybrid compounds to target tumor cells specifically. © 2012 American Chemical Society

The QUIJOTE experiment: project overview and first results

QUIJOTE (Q-U-I JOint TEnerife) is a new polarimeter aimed to characterize the polarization of the Cosmic Microwave Background and other Galactic and extragalactic signals at medium and large angular scales in the frequency range 10-40 GHz. The multi-frequency (10-20~GHz) instrument, mounted on the first QUIJOTE telescope, saw first light on November 2012 from the Teide Observatory (2400~m a.s.l). During 2014 the second telescope has been installed at this observatory. A second instrument at 30~GHz will be ready for commissioning at this telescope during summer 2015, and a third additional instrument at 40~GHz is now being developed. These instruments will have nominal sensitivities to detect the B-mode polarization due to the primordial gravitational-wave component if the tensor-to-scalar ratio is larger than r=0.05.Comment: To appear in "Highlights of Spanish Astrophysics VIII", Proceedings of the XI Scientific Meeting of the Spanish Astronomical Society, Teruel, Spain (2014

Evaluation of a candidate breast cancer associated SNP in ERCC4 as a risk modifier in BRCA1 and BRCA2 mutation carriers. Results from the Consortium of Investigators of Modifiers of BRCA1/BRCA2 (CIMBA)

Background: In this study we aimed to evaluate the role of a SNP in intron 1 of the ERCC4 gene (rs744154), previously reported to be associated with a reduced risk of breast cancer in the general population, as a breast cancer risk modifier in BRCA1 and BRCA2 mutation carriers. Methods: We have genotyped rs744154 in 9408 BRCA1 and 5632 BRCA2 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA) and assessed its association with breast cancer risk using a retrospective weighted cohort approach. Results: We found no evidence of association with breast cancer risk for BRCA1 (per-allele HR: 0.98, 95% CI: 0.93–1.04, P=0.5) or BRCA2 (per-allele HR: 0.97, 95% CI: 0.89–1.06, P=0.5) mutation carriers. Conclusion: This SNP is not a significant modifier of breast cancer risk for mutation carriers, though weak associations cannot be ruled out. A Osorio1, R L Milne2, G Pita3, P Peterlongo4,5, T Heikkinen6, J Simard7, G Chenevix-Trench8, A B Spurdle8, J Beesley8, X Chen8, S Healey8, KConFab9, S L Neuhausen10, Y C Ding10, F J Couch11,12, X Wang11, N Lindor13, S Manoukian4, M Barile14, A Viel15, L Tizzoni5,16, C I Szabo17, L Foretova18, M Zikan19, K Claes20, M H Greene21, P Mai21, G Rennert22, F Lejbkowicz22, O Barnett-Griness22, I L Andrulis23,24, H Ozcelik24, N Weerasooriya23, OCGN23, A-M Gerdes25, M Thomassen25, D G Cruger26, M A Caligo27, E Friedman28,29, B Kaufman28,29, Y Laitman28, S Cohen28, T Kontorovich28, R Gershoni-Baruch30, E Dagan31,32, H Jernström33, M S Askmalm34, B Arver35, B Malmer36, SWE-BRCA37, S M Domchek38, K L Nathanson38, J Brunet39, T Ramón y Cajal40, D Yannoukakos41, U Hamann42, HEBON37, F B L Hogervorst43, S Verhoef43, EB Gómez García44,45, J T Wijnen46,47, A van den Ouweland48, EMBRACE37, D F Easton49, S Peock49, M Cook49, C T Oliver49, D Frost49, C Luccarini50, D G Evans51, F Lalloo51, R Eeles52, G Pichert53, J Cook54, S Hodgson55, P J Morrison56, F Douglas57, A K Godwin58, GEMO59,60,61, O M Sinilnikova59,60, L Barjhoux59,60, D Stoppa-Lyonnet61, V Moncoutier61, S Giraud59, C Cassini62,63, L Olivier-Faivre62,63, F Révillion64, J-P Peyrat64, D Muller65, J-P Fricker65, H T Lynch66, E M John67, S Buys68, M Daly69, J L Hopper70, M B Terry71, A Miron72, Y Yassin72, D Goldgar73, Breast Cancer Family Registry37, C F Singer74, D Gschwantler-Kaulich74, G Pfeiler74, A-C Spiess74, Thomas v O Hansen75, O T Johannsson76, T Kirchhoff77, K Offit77, K Kosarin77, M Piedmonte78, G C Rodriguez79, K Wakeley80, J F Boggess81, J Basil82, P E Schwartz83, S V Blank84, A E Toland85, M Montagna86, C Casella87, E N Imyanitov88, A Allavena89, R K Schmutzler90, B Versmold90, C Engel91, A Meindl92, N Ditsch93, N Arnold94, D Niederacher95, H Deißler96, B Fiebig97, R Varon-Mateeva98, D Schaefer99, U G Froster100, T Caldes101, M de la Hoya101, L McGuffog49, A C Antoniou49, H Nevanlinna6, P Radice4,5 and J Benítez1,3 on behalf of CIMB

Measurement of the Depth of Maximum of Extensive Air Showers above 10^18 eV

We describe the measurement of the depth of maximum, Xmax, of the longitudinal development of air showers induced by cosmic rays. Almost four thousand events above 10^18 eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106 +35/-21) g/cm^2/decade below 10^(18.24 +/- 0.05) eV and (24 +/- 3) g/cm^2/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm^2. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.Comment: Accepted for publication by PR